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Deteriorating Patient
Deteriorating Patient

Cardiac Auscultation

February 15th, 2021


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. 


  • 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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