HEART SOUNDS

They are the sounds produced by the mechanical activities of the heart during each cadiac cycle.

Causes of heart sound:1.Vibration of the leaflets of the valves during their closure. 2. Turbulent flow of blood from atrium to ventricle.

3. Movements of cardiac muscle.

Methods of study of heart sounds:3 methods are used a) By using clinical stethoscope - first & second heart sound.

b) By using microphone first, second, third heart sound .

c) By using phonocardiogram all the four heart sounds are recorded.

Auscultation areas:Mitral area ( Bicuspid area) left 5th intercostal space about half inch medial to the midclavicular line.

Tricuspid area on the xiphoid process.

 Pulmonary area on the left 2nd intercos

space close to sternum.

Aortic area over the right 2nd intercosta area close to the sternum.
FIRST HEART SOUND:-

During isometric contraction period & the earl part of ejection period. Due to the simultaneous closure of

Valvular, vascular, muscular, atrial factor are responsible for the production of 1st heart sound.
Long , soft , and low pitched.

Resemble the spoken word LUBB.

Duration : 0.1 to 0.17 sec. Frequency is about 25-45 cycles/second(hz).

coincides with the peak of R wave in the ECG. It coincides with the apex beat & commencement of carotid pulse. It precedes the onset of the c wave of the jugular pulse. Best heard in the mitral & tricuspid area.

In the phonocardiogram recorded as a single group of vibration with about 9-13 waves.

Significance are
1. indicates the onset of ventricular systole. 2. the duration & intensity indicates the condition of the myocardium. 3. a clear 1st heart sound indicates that the valves are closing properly ie , no incompetence.

SECOND HEART SOUND :Produced at the end of protodiastolic period.

due to sudden & synchronous closure of the semilunar valves. short, sharp, and high pitched.
resembles the spoken word DUBB or DUP. Duration : 0.10 0.14 sec.

Frequency is 50 cycles/ sec.

coincides with the T- wave in the ECG. Sometimes precedes or commence 0.09sec after peak of T wave.

It occurs just after the apex beat and the carotid pulse. it coincides with the notch on the ascending limb of the v wave of jugular pulse. Best heard in the pulmonary & aortic area.

In the phonocardiogram it appears as single group of vibrations with about 4- 6 waves having same amplitude. Significance are 1.indicates the end of systole and the beginning of diastole. 2. Its pitch is directly proportional to the blood pressure. 3. A clear second sound indicates that the semilunar valves are closing properly.

ie , no regurgitation. 4. The interval b/w 1st & 2nd sounds is taken as the clinical systole. The interval b/w 2nd & 1st sound is taken as the diastolic period (PAUSE) .

THIRD HEART SOUND:During first rapid filling phase. caused by the sudden rush of blood from atria to ventricles when AV valve opens.

Short and low pitched Duration : 0.07 0.1 sec.

Frequency is 1- 6 cycle /sec.

It appears b/w T- wave and P wave of ECG. it coincides with the descending limb of the v wave of the jugular pulse. In the phonocardiogram it appears as 1- 4 waves grouped together.

Significance is that it indicates ventricullar filling. FOURTH HEART SOUND:-

During atrial systole coinciding with last rapid filling phase. Caused by the contraction of atria & the consequent rush of blood into the ventricles. inaudible (short & low pitched).

Duration : 0.02- 0.04 second

Frequency 1 4 cycles/ sec. It coincides with the interval b/w the end of P- wave and the onset of Q- wave. It coincides with the rise of a wave of the jugular venous pulse. In the phonocardiogram it appears with 1-2 waves with very low amplitude. Mostly it merges with 1st heart sound.

Significance is that it indicates the end of ventricular filling.

Applied physiology:1. Reduplication of 1st heart sound Stenosis of atrioventricular valves, ASD. Soft 1st heart sound Low B.P, severe Heart failure, myocardial infarction, myxoedema. Loud 1st heart sound Mitral stenosis, Wolf-Parkinson-White syndrome, a/c RF.

2.

3.

4.Cannon sounds ventricular tachycardia, complete atioventricular block. 5.Reduplication of 2nd heart sound deep inspiration ( physiological), pulmonary stenosis, right bundle branch block, right ventricular hypertrophy (pathological), aortic stenosis, left bundle branch block, left ventricular hypertrophy.

6.Loud 2nd heart sound systemic hypertension, coarctation of aorta, pulmonary hypertension.

7.Loud 3rd heart sound aortic regurgitation, cardiac failure, cardiomyopathy with dilated ventricles.

8.Loud 4th heart sound ventricular hypertrophy, long standing hypertension, aortic stenosis. Rhythm characterized
9.Triple heart sound ( triple rhythm or GALLOP rhythm ):abnormal rhythm characterised by 3 clear heart sounds during each heart beat. Myocardial infarction, severe HTN.

QUADRUPLE HEART SOUND (quadruple gallop):abnomal rhythm of heart characterisedby 4 clear heart sounds during each heart beat. Also called rhythm. Congestive Heart failure.

Summation gallop:whenever there is tachycardia in patients with quadruple heart sound the 3rd & 4th heart sounds merge together and give rise to a single sound.