The First Heart Sound | Cardio Exam - MedSchool
Sign up to start your free trial of MedSchool Premium!Get Started
 
Cardio Exam
 
 
Cardio Exam
 
 
Bookmark
The first heart sound (S1) indicates closure of the mitral and tricuspid valves. S1 is normally heard best over the apex.
The Patient
Hands
Arms
Head
Neck
Chest Inspection
Chest Palpation
Chest Auscultation
Back
Abdomen
Legs
 

The First Heart Sound

 
 
Bookmark

Overview

  • The first heart sound (S1) indicates closure of the mitral and tricuspid valves.
  • S1 is normally heard best over the apex.

    • Causes of a Soft S1

    • Mitral regurgitation
    • Ventricular septal defect
    • First degree heart block
    • Left bundle branch block
    • Myocardial depression

    • Causes of a Loud S1

    • Mitral stenosis
    • Hyperdynamic circulation - exercise, infection, hyperthyroidism, pregnancy
Last updated on January 24th, 2020
 
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------
 
 

Read More...

 Barnard S. Thoracic Incisions. Surgery. 2004; 22(5): 105-107. Bergan JJ, Schmid-Schonbein GW, Smith PD, Nicolaides AN, Boisseau MR. Mechanisms of Disease: Chronic Venous Disease. The New England Journal of Medicine. 2006 Aug; 355(5): 488-498. Betul A. Hatipoglu. Cushing’s Syndrome. Journal of Surgical Oncology. 2012 Oct; 106(5): 565-571.
Butler R, Radhakrishnan R. Dementia. Clinical Evidence. 2012; 9.
 Campbell DB. Thoracic Incisions. Operative Techniques in General Surgery. 2008; 10(2): 77-86. Cheng TO. Grading Murmurs Must Always Indicate the Grading System Used. International Journal of Cardiology. 2009 Jun; 135(2): 143-145. Clark A, Cleland JG. Causes and Treatment of Oedema in Patients with Heart Failure. Nature Reviews Cardiology. 2013 Mar; 10: 156-170. Cotter L. History and Examination of the Cardiovascular System. Medicine. 38(7): 344 - 347. Daniel P Judge, Harry C Dietz, Marfan's syndrome, The Lancet, Volume 366, Issue 9501, 3-9 December 2005, Pages 1965-1976 Del Guidice P. Cutaneous Complications of Intravenous Drug Use. The British Journal of Dermatology. 2004;150(1) . Dihingia P, Pegu AK, Chaliha MS, Baruah KD, Kar S, Pramod GR, Kakati S. Takayasu’s Disease–Spectrum of Manifestations A Case Series. Official Journal of Association of Physicians of India, Assam Chapter.:31. Dornhurst AC. Pulsus Paradoxus. Intensive Care Medicine. 1986; 12: 387-388. Drasner MH, Rame JE, Stevenson LW, Dries DL. Prognostic importance of elevated jugular venous pressure and a third heart sound in patients with heart failure. N Engl J Med. 2001; 345: 574–581. Farrior III JB, Silverman ME. A consideration of the differences between a Janeway's lesion and an Osler's node in infectious endocarditis. Chest. 1976 Aug 1;70(2):239-43. Fowler NO. Adolph RJ. Fourth Sound Gallop or Split First Sound?. The American Journal of Cardiology. 1972 Sept; 30: 441-444. Fuller GN, Hargreaves MR, King DM. Scratch Test in Clinical Examination of the Liver. Lancet. 1988; 331(5878): 181. Getzen JH, Dimond EG. Saga of the Fourth Heart Sound. The American Journal of Cardiology. 1968 Nov; 22(5): 608-613. Gillam PM, Deliyannis AA, Mounsey JP. The Left Parasternal Heave. British Heart Journal. 1964; 26: 726. Gray IR. Paradoxical splitting of the second heart sound. British heart journal. 1956 Jan;18(1):21. Grey JE, Enoch S, Harding KG. ABC of Wound Healing: Venous and Arterial Ulcers. British Medical Journal. 2006 Feb; 332: 347-350. Gunson TH, Oliver GF. Osler's nodes and Janeway lesions. Australasian Journal of Dermatology. 2007 Nov;48(4):251-5. Gupta K, Dhawan A, Abel C, Talley N, Attia J. A Re-evaluation of the Scratch Test for Locating the Liver Edge. BMC gastroenterology. 2013; 13: 35.
Haber R, Khoury R, Kechichian E, Tomb R. Splinter hemorrhages of the nails: a systematic review of clinical features and associated conditions. International journal of dermatology. 2016 Dec;55(12):1304-10.
 Hass PL. Differentiation and Diagnosis of Jaundice. AACN Clinical Issues. 1999; 10(4): 433-441. Henkind SJ, Benis AM, Teichholz LE. The Paradox of Pulsus Paradoxus. American Heart Journal/ 1987; 114: 198-203. Holleman DR, Simel DL. Does the Clinical Examination Predict Airflow Limitation?. JAMA. 1995 Jan; 273(4): 313-319. Jansson L, Lavstedt S, Frithiof L, Theobald H. Relationship between oral health and mortality in cardiovascular diseases. Journal of Clinical Periodontology. 2001 Aug; 28(8): 762-768.
Jebb S. Obesity: causes and consequences. Women's Health Medicine. 2004;1:38-41.
 Kalantar J, Talley N. Unexplained weight loss. Current Therapeutics. 1998; 39: 37-43.
Keren R, Tereschuk M, Luan X. Evaluation of a Novel Method for Grading Heart Murmur Intensity. Arch Pedtr Adolesc Med. 2005. 159(4): 329-334.
 Khare N, Puri V, Venkateshwaran N. Trophic Ulcers - Practical Management Guidelines. Indian Journal of Plastic Surgery. 2012; 45(2): 340-351. Kidd HR. Examination of the Mouth. Canadian Family Physician. 1976 May; 22: 59-62. Kirby B, MacLeod K. Clinical examination of the heart. Medicine. 2006 Apr; 34(4): 123-128. Lear SA, James PT, Ko GT, Kumanyika S. Appropriateness of waist circumference and waist-to-hip ratio cutoffs for different ethnic groups. Eur J Clin Nutr. 2010;64:42-61. Leatham A. Auscultation of the heart. Lancet. 1958; 2: 702-708 757-765. Lee WH, Fisher J. Right Ventricular Diastolic Disorders.Archives of Internal Medicine. 1983 Feb; 143: 332-337. Lembo NJ, Dell’Italia LJ, Crawford MH, O’Rourke RA. Bedside Diagnosis of Systolic Murmurs. The New England Journal of Medicine. 1988; 318(24): 1572-1578. Loeys BL, Dietz HC, Braverman AC, Callewaert BL, De Backer J, Devereux RB, Hilhorst-Hofstee Y, Jondeau G, Faivre L, Milewicz DM, Pyeritz RE. The revised Ghent nosology for the Marfan syndrome. Journal of medical genetics. 2010 Jul 1;47(7):476-85. Lucy Flanders, Robert Tulloh, Cardiac problems in Down syndrome, Paediatrics and Child Health, Volume 21, Issue 1, January 2011, Pages 25-31
Malnick SDH, Knobler H. The medical complications of obesity. QJM : monthly journal of the Association of Physicians. 2006;99:565-579.
Margolies A, Wolferth CC. The opening snap (claquement d'ouverture de la mitrale) in mitral stenosis, its characteristics, mechanism of production and diagnostic importance. American Heart Journal. 1932 Apr 1;7(4):443-70.
 McLoughlin MJ, Colapinto RF, Hobbs BB. Abdominal Bruits: Clinical and Angiographic Correlation. JAMA. 1975 Jun; 232(12): 1238-1242. McLoughlin MJ, Colapinto RJ, Hobbs BB. Abdominal bruits. Clinical and angiographic correlation. JAMA. 1975 Jun 23;232(12):1238-42. McMullen SM, Ward P. Cyanosis. The American Journal of Medicine. 2013; 126(3): 210-212. Merrigan JM, Hamdan A, Lynm C, Livingston EH. Varicose Veins. JAMA. 2012; 308(24): 2638. Morgan T. Turner syndrome: diagnosis and management. American family physician. 2007 Aug 1;76(3). N Assy, G Jacob, G Spira and Y Edoute. Diagnostic approach to patients with cholestatic jaundice. WJG, 1999 June; 5(3):252-262 Nancy J Roizen, David Patterson, Down's syndrome, The Lancet, Volume 361, Issue 9365, 12 April 2003, Pages 1281-1289 O'Rahilly R, The normal cardiac apex and apex beat: A critical review of recent data. American Heart Journal. 1952 Jul; 44(1): 23-34. O’Neill TW, Smith M, Barry M, Graham IM. Diagnostic Value of the Apex Beat. Lancet. 1989 Feb; 334(8661): 499. O’Sullivan OC. On the Nature of High Arched Palate. British Medical Journal. 1934 May; 1(3826): 800. Parker F. Xanthomas and Hyperlipidaemias. Journal of the American Academy of Dermatology. 1985 Jul; 13(1): 1-30. Parmet S. Pericarditis. JAMA. 2003; 289: 1194. Pedersen SD. Metabolic complications of obesity. Best practice & research.Clinical endocrinology & metabolism. 2013;27:179. Perloff JK. Cardiac Auscultation. Disease-a-Month. 1980 Jun; 26(9): 1-47. Phillips JH, Burch GE. Selected Clues in Cardiac Auscultation. American Heart Journal. 1962 Jan; 63(1): 1-8. Pickett CA, Jackson JL, Hemann BA, Atwood JA. Carotid Artery Examination, an Important Tool in Patient Evaluation. Southern Medical Journal. 2011 Jul; 104(7): 526-532. Pozo AL, Godfrey EM, Bowles KM. Splenomegaly: Investigation, Diagnosis and Management. Blood Reviews. 2009 May; 23(3): 105-111. Shively BK. Infective Endocarditis. Current Treatment Options in Cardiovascular Medicine. 2001; 3: 25-35. Smith J. Compartment Syndrome. JAAPA. 2013 Sept; 26(9): 48-49. Sybert VP, McCauley E. Turner's Syndrome. The New England journal of medicine. 2004; 351(12): 1227-38. Teasdale G, Jennett B. Assessment of Coma and Impaired Consciousness: a practical scale. Lancet. 1974 July; 304(7872): 81-84. Timmis AJ. The Third Heart Sound. British Medical Journal. 1987. 294: 326-327. Tracy CM, Epstein AE, Darbar D, DiMarco JP, Dunbar SB, Estes M. 2012 ACCF/AHA/HRS Focused Update of the 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology. 2012; 60(14): 1297-1313. Troughton RW, Asher CR, Klein AL. Pericarditis. The Lancet. 2004; 363: 717-727. Tuy T, Peacock WF. Fluid Overload Assessment and Management in Heart Failure Patients. Semin Nephrol. 2012;32:112-120. Uzun G, Mutluoglu M. Dependent Rubor. The New England Journal of Medicine. 2011 Jun; 364(26). Woodgate P1, Jardine LA. Neonatal jaundice: phototherapy. BMJ Clin Evid. 2015 May 22;2015. pii: 0319.
Wright SM, Aronne LJ. Causes of obesity. Abdom Imaging. 2012;37:730-732.
 Yasney J. The value of optimising dentition before cardiac surgery. Journal of Cardiothoracic and Vascular Anaesthesia. 2007 Aug; 21(4): 587-591. Yernault JC, Bohadana AB. Chest Percussion. Eur Respir J. 1995; 8: 1756-1760. Zulkowski K, Ratliff CR. Managing Venous and Neuropathic Ulcers. Nursing. 2004 Aug; 24(8): 68.
Feedback