Physiological split of S2
Physiological split of S2
Pathological split of S2
Paradoxical split of S2
Extra sounds
Diastolic |
Systolic |
• |
|
S3 |
• |
|
Systolic click |
• |
o AH |
S4 |
|
• |
o mitral valve prolapse |
Opening snap of mitral |
|
valve in mitral stenosis |
|
S3
–Mid diastolic sound
–Rapid Filling of Left Ventricle (LV) related to LV Volume
–Low Frequency Best Heard
•At the Apex
–Can be Pathognomonic for left ventricular heart failure
•Chronic heart failure
•Myocardial infarction
•Myocarditis
S4
•Late diastolic sound
•During Atrial Phase of LV Filling
oConsequence of Ventricular Stiffness
•Low Frequency Sound best heard at the apex
•Causes
oLeft ventricular hypertrophy
•Arterial hypertension
•Aortic Stenosis
oIschemic Heart Disease
Добавочный IV тон
Summation gallop (triple rhythm)
•Occurrence of an over lapping S3 and S4
•Is due to tachycardia
•Causes
oHeart failure
oMyocardial infarction
oSevere tachycardia
Opening snap of mitral stenosis
•High Frequency
•Best heard
oLeft Lateral Decubitus Position
oApex
•After S2, before S3
•Occurs in mitral stenosis