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..

Auscultation of the Heart heart sound

• 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.

Auscultation of the Heart heart sound positions

Auscultation of the Heart heart sound positions and timing

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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