Heart sounds courtesy of Dr Robert Lichtenberg

Case 1

I hope that you reviewed heart sounds exercise and you are comfortable with it. The emphasis for this exercise is understanding and recognizing murmurs. I will not spend much time for heart sounds. However you should be aware that in the final analysis, heart sounds are integral part for interpreting the murmurs.

Listen over and over until you become comfortable.

A.J. Chandrasekhar

List and describe the heart sounds and murmurs you are hearing. You are auscultating over the apex of heart with diaphragm.

Answer

Case 1 answer 

You are listening to:

• S1
  • Soft
• S2
• Systolic murmur
  • grade 3/6 (Of course the intensity depends on your volume set up)
  • starts with first sound and ends just with second sound.
  • there is no gap between murmur and second sound
  • uniform intensity ( plateau)
  • harsh in quality

What do we call this murmur?

What are the conditions where you may hear a similar murmur? What is the mechanism for generation of this murmur?

Answer

• Holosystolic murmur or pansystolic murmur

Mechanism

• Flow is from a chamber with high pressure to a chamber with low pressure during ventricular contraction

Can be heard in

• Mitral regurgitation (LV to LA)
• Tricuspid regurgitation (RV to RA)
• Ventricular septal defect (LV to RV)

You are listening to a patient with mitral regurgitation. What are the anticipated changes to heart sounds and why?

Answer

• S1 will be soft: due to ineffective closure of mitral orifice
• S3: increased flow during rapid filling phase

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