Create an account
Normal, or physiologic splitting occurs in this heart sound
On inspiration, there is reduced pressure in the chest cavity
...the LV fills slower/less, so closes aortic valve earlier - A2
...the RV fills faster/more. so closes pulmonary valve later - P2
Factors contributing to louder heart sounds
Higher activity (exercise)
Bigger, tougher valve (e.g. mild-mod rheumatic fever)
Higher pressure in aortic / pulmonary arteries
Pathologic / Fixed causes of S2 splitting
RBBB (A2 before P2)
LBBB (P2 before A2, paradoxical splitting
Severe aortic stenosis (P2 before A2)
Cause of S3 heart sound
LV coming to a quick stop when being rapidly filled
An indication of a volume loaded heart or ventricular dysfunction (L or R)
"Sloshing in" "montreal"
Cause of S4 heart sound
Artria contracting into a non-compliant ventricle
e.g. in systemic hypertension
This is NEVER normal
"A stiff wall" "toronto"
Cause of crescendo-decrescendo systolic murmur
"diamond shape murmur"
(also get S2 split)
Systolic click occurs in
MVP, HCM, AS
MVP: louder with hand grip (increased afterload)
HCM: softer with hand grip
Effect of valsalva on AS and HCM systolic murmurs
AS: quieter (reduced preload)
HCM: louder (decreased volume / preload)
Please allow access to your computer’s microphone to use Voice Recording.
Having trouble? Click here for help.
We can’t access your microphone!
Click the icon above to update your browser permissions and try again
Reload the page to try again!Reload
Press Cmd-0 to reset your zoom
Press Ctrl-0 to reset your zoom
Please upgrade Flash or install Chrome
to use Voice Recording.
For more help, see our troubleshooting page.
Your microphone is muted
For help fixing this issue, see this FAQ.
Star this term
You can study starred terms together