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During each cardiac cycle, 4 heart sounds are produced. These can be recorded in phonocardiogram. By auscultation we can hear/ auscultate, 1st & 2nd heart sounds & sometimes 3rd as well. But 4th is Atrial heart sound, which is never auscultated normally. 1st & 2nd heart sounds are called as CLASSICAL HEART SOUNDS (as they are usually auscultated in normal subjects).
4 Auscultatory areas
Pulmonary Area: Left 2nd intercostal space, close to sternal border. Aortic Area: Right 2nd intercostal space, close to sternal border. Mitral Area: left 5th intercostal space in the midclavicular line, 9 cm away from the sternal border. Tricuspid Area: 4th left intercostal space close to sternal border.
Cause of splitting: During inspiration venous return increases more blood returns to right atrium right ventricle more ejection delayed closure of pulmonary valve. Reverse occurs in expiration.
Also called ATRIAL HEART SOUND. Cause: Vibrations of ventricular wall, due to impact of blood pumped from the atrium into ventricle during Atrial Systole.
Diseases: In CCF, 4th Heart Sound is auscultated.
MURMURS:
These are abnormal heart sounds. Produced when:
1. Valvular stenosis.
2. Valvular incompetence.
3. Hyperdynamic circulation:
Hyperthyroidism, severe anemia (hemic murmurs)
MURMURS
Systolic murmurs:
Aortic stenosis Mitral regurgitation
Diastolic murmurs:
Aortic regurgitation Mitral stenosis