Overview
Listen to each of the cardiac areas for normal / pathologic heart sounds, a pericardial rub and for the presence of a murmur.
Heart Sounds
Heart Sounds
Normal
- First heart sound (S1) - indicates closure of the mitral and tricuspid valves (a loud S1 suggests MS; a soft S1 suggests MR)
- Second heart sound (S2) - indicates closure of the aortic (A2) and pulmonary (P2) valves (a loud P2 suggests pulmonary hypertension; a soft A2 suggests severe AS / AR)
Abnormal
- Third heart sound (S3) - a pathological finding associated with rapid ventricular filling (left ventricular failure, severe MR / AR, constrictive pericarditis)
- Fourth heart sound (S4) - a pathological finding associated with turbulence during atrial systole (hypertension, AS, PS, MR, HOCM, MI)
Pericardial Rub
A pericardial rub is a sign of pericarditis.
How to Assess
- Ask the patient to lean forward and hold their breath in full expiration. Listen for a superficial, scratching sound present in mid-systole, mid-diastole and late diastole.
Murmurs
Interpretation of Cardiac Murmurs
Systolic
- Early systolic - ventricular septal defect, mitral regurgitation, tricuspid regurgitation
- Ejection systolic - aortic or pulmonary stenosis
- Late systolic - mitral valve prolapse
- Pansystolic - tricuspid or mitral regurgitation
Diastolic
- Early diastolic - aortic or pulmonary regurgitation
- Mid-diastolic - mitral stenosis
- Late diastolic / presystolic - tricuspid stenosis
Continuous
- Patent ductus arteriosus, AV fistula, ruptured sinus of Valsalva aneurysm, aortopulmonary window
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