auscultation of the heart dr. r. tandon sitaram bhartia institute, new delhi
DESCRIPTION
Auscultation of The Heart Dr. R. Tandon Sitaram Bhartia Institute, New Delhi. First Sound (S1). Due to closure of MV/TV Accentuated, diminished or variable intensity Wide split – Rt. BBB. First Sound (S1). Accentuated : Loud M1 Tachycardia Short PR interval Mitral stenosis VSD, PDA. - PowerPoint PPT PresentationTRANSCRIPT
Auscultation Auscultation of of
The HeartThe Heart
Dr. R. TandonDr. R. TandonSitaram Bhartia Institute, New DelhiSitaram Bhartia Institute, New Delhi
First Sound (S1)
Due to closure of MV/TV Accentuated, diminished or variable intensity Wide split – Rt. BBB.
First Sound (S1)Accentuated : Loud M1 Tachycardia Short PR interval Mitral stenosis VSD, PDA. LVH
Loud T1 : ASD, TAPVC Tricuspid Stenosis
First Sound (S1)
Diminished :- S2 > S1 at apex. LV contractility 1° AVB AR
First Sound (S1)
Variable Intensity Comp. AVB Atrial fibrillation.
Second Sound
Normal :- Two components A2 & P2 A2 louder than P2 Insp.; split S2; A2-P2 Exp. : Single S2 A2 all over the precordium P2 - 2-3 ULSB
Second Sound
Abnormalities : A2 or P2
Intensity : Increased or decreased
Timing : Early or late
Second Sound
Splitting :- Normal. W&V - PS, PAPVC - IAS, MR, VSD W&F - ASD, TAPVC, Rt. BB, WPW(A) Single -A2 or P2 or A2 + P2 Paradox -AS, PDA, LVF, Lt. BB, WPW (B)
Third Sound (S3) End of early diast. filling. Dull, 50 to 100 msec after S2. Normal in children and young adults Abnormal above 40 yrs. Left or right sided.
Fourth Sound Abnormal if audible. Rt. / Lt. sided Rt. / Lt. atrial hypertension (high
RV/LV edp). Audible intermittently in comp. AVB. Acute MR - S4+.
Systolic Clicks (x) Loud sharp sounds Ejet. or Non-eject. Eject – Aortic, pulmonary – single. Non-eject - MV / TV prolapse - single
or multiple.
Systolic Clicks Aortic : Constant, early Heard all over the precard Bicuspid AoV. Dilated Asc, Ao
Syst. hypertension, aneurysms
Fallot’s physiology, PTA. Disapear - fibrosis, calcification.
Systolic Clicks
Pulmonary :- PS or PAH at ULSB. PS - Valvar PS
- Audible in expirat. only
- severity - closer to SI PAH - PVOD - Constant
Systolic Clicks
Non-Ejection : MVPS Single or multiple. Mid systolic but can be early - radiates
to base and neck Late murmur ±
S1 X A2 P2
Syst. m.
Opening Snap Mitral, diast. sound 40-120 msec after A2 A2-OS interval - severity Disappears in immobile valves Tricuspid OS drowned in MSm.
MurmurSystolic - Pansystolic.
Ejection systolic
Diastolic * Semilunar valves- Regurgitant m.
Early diastolic m.
* Atriovent. Valves- Functional m.- Obstructive m.
Delayed diast. (Middiast.)Late diast. (Presyst.)
Continuous
S1 X
ES. m.
A2
AR. m.
A2 P2
ES. m.
S1 X
PR m.
S1 X
ES. m.
A2 P2
PR. m.
S1x S2 S1 x
Cont. m.
S1x S2 S1
Cont. m.
AuscultationAuscultation
Clinical UtilityClinical Utility :- :- Murmurs present.Murmurs present. Murmurs absent.Murmurs absent.
AuscultationAuscultation
Clinical UtilityClinical Utility :- Murmurs absent :- Murmurs absent Myocardial diseaseMyocardial disease
- Primary – DCM, RCM, HCM- Primary – DCM, RCM, HCM
- Secondary to CAD- Secondary to CAD Pericardial diseasePericardial disease
Utility of S3, S4, S2, S1 Utility of S3, S4, S2, S1
AuscultationAuscultation
Clinical UtilityClinical Utility :- Murmurs present :- Murmurs present Cong. Ht. Dis.Cong. Ht. Dis. Rh. Ht. Dis.Rh. Ht. Dis. PMD -PMD - DCM – MR/TRDCM – MR/TR
HOCM HOCM - Outflow m.- Outflow m.-- MR. m.MR. m.
Post M.I. - MR / VSD.Post M.I. - MR / VSD.