Abnormal Heart Sounds

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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


louder at apex


louder at base

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

S2 split

fairly common


heard only in left lateral position, with BELL

S2 split

heard only when sitting up, with DIAPHRAGM

S2 split


S1 split

heard when mitral valve closes slightly before tricuspid valve

S2 split

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)

S2 split

heard during inspiration, disappears during exhalation

S2 split

loudest at pulmonic area


loudest at aortic and pulmonic areas


loudest at mitral and tricuspid areas

Erb's point

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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