results from closure of the mitral and tricuspid valves
Signals beginning of systole, when the ventricles contract
results from closure of aortic and pulmonic valves.
Signals end of systole and beginning of diastole, when the ventricles relax and fill with blood from the atria.
S3 and S4
shorter sounds that may become muffled in with the normal heart sounds
will sound louder at apex—over mitral and tricuspid valves
will sound louder at base—over aortic/pulmonic area
S3 and S4
Heard with bell over mitral area with patient in left lateral recumbent position (laying on left side)
Indicates ventricular failure--considered abnormal in adults over 30
S1....s2, s3....s1....s2, s3
Sloshing in, sloshing in
S2...S4, S1....S2...S4, S1
a stiff wall, a stiff wall
Occurs in early diastole, just after S2
Occurs in late diastole, just before S1
Seen in long standing HTN and MI (and end stage heart disease)
always considered abnormal
both S3 and S4 sounds
heard only in left lateral position, with BELL
heard only when sitting up, with DIAPHRAGM
heard when mitral valve closes slightly before tricuspid valve
heard when aortic valve closes slightly before pulmonic valve
S1 and S2
heard with diaphragm
Normal adult rate 60-100 bpm (correlates with carotid pulse)
heard during inspiration, disappears during exhalation
loudest at pulmonic area
loudest at aortic and pulmonic areas
loudest at mitral and tricuspid areas
S1 and S2 are equal in loudness
Occurs with blood splashing into an overly filled ventricle, i.e. heart failure
Occurs when blood enters ventricle and hits a stiff ventricular wall (with pts who have had heart attacks and have dead scar tissue in the heart)
differences between S2 split and S3
bell vs diaphragm; lying (left side) vs sitting; S2 split comes and goes
S3 and S4
heard in left lateral position over mitral area
loudest at mitral area
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