Auscultation of the Heart

In Cardiac Examination Auscultation is the most important part of examination, which provides us the most of the information about Heart condition, Functioning and many more..

• The first heart sound S1 is produced by the mitral and tricuspid valve closure.
• The second heart sound S2 is produced by the closure of the aortic and pulmonary valves.
• A2 or aortic closure sound comes earlier than P₂ or pulmonary closure sound.
• During inspiration the split between A₂ and P₂ is in­creased and during expiration the split between A₂ and P₂ is decreased.
• An ejection sound may be heard after S1, in cases of pulmonary hypertension, systemic hypertension, dilatation of Pulmonary artery or aorta.
• A pericardial knock may be heard after S2 in cases of pericardial disease.

Causes of loud first sound

• MS
• Tachycardia
• Hyperdynamic circulation – fever, thyrotoxicosis, ex­ercise, AR, PDA
• Short PR interval

Causes of loud second sound (S2,)

• Loud A₂ – is found in systemic hypertension, dilata­tion of the ascending aorta as in rheumatic fever and syphilis.
• Loud P₂ – is found in pulmonary hypertension, cor­pulmonale, ASD, VSD, PDA.

Causes when split between A₂ and P2 is increased —

• ASD
• Pulmonary stenosis
• RBBB
• MR
• VSD
• Pulmonary hypertension
• Idiopathic dilatation of pulmonary artery WPW syndrome
• LV ectopics
• RV failure

Causes of single second heart sound (S2)

• Tetralogy of Fallot
• Severe PS
• AS
• LBBB
• Truncus arteriosus Tricuspid atresia

Causes of reversed (paradoxical) splitting of the second heart sound (S2)

• LBBB
• AS·
• PDA
• Hypertension
• WPW syndrome

Causes of S3 or ventricular or diastolic gallop

• LVF and LV dysfunction
• Cardiomyopathies

Causes of S4 or atrial gallop

• Aortic stenosis
• AR
• Elderly persons Hypertension
• Cardiomyopathy

Causes of pericardial knock

• Constrictive pericarditis
• Pericardial effusion

Cardiac Murmurs

Systolic murmurs at the apex may be due to :

• · Mitral regurgitation
• · Papillary muscle dysfunction
• · Cardiomyopathy
• · Aortic stenosis ejection systolic murmur

Diastolic murmurs at the apex may be due to:

• · Mitral stenosis (diastolic thrill is usually present)
• · Mitral flow murmur in MR
• · Austin Flint murmur in AR
• · Carey Coombs murmur in rheumatic carditis

Systolic murmurs in parasternal area may be due to-:–

• · Aortic stenosis – ejection systolic murmur, in­creasing on expiration, radiating to carotids
• · Tricuspid regurgitation (increasing in inspiration and best heard at the lower e ge of sternumf
• · Pulmonary hypertension – ejection systolic mur­mur
• · Ventricular septal defect (VSD) – Pansystolic murmur
• · Pulmonary stenosis (left second intercostal space) – ejection systolic murmur

Diastolic murmurs in parasternal area may be due to: –

• Aortic regurgitation
• Tricuspid stenosis
• Graham Steell murmur of pulmonary regurgita­tion
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