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Heart Sounds

Quiz yourself by thinking what should be in each of the black spaces below before clicking on it to display the answer.
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Question
Answer
S1 Lubb   Mitral and tricuspid valve closing  
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S1 (Best heard)   Apex for Mitral and LLSB for tricuspid  
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S2 Dubb   Aortic and pulmonary valves closing  
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S2 (Best heard)   Right for aortic and left for pulmonic  
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Split S1   Mitral and tricuspid valves closing at different times.  
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Split S1 (Best heard)   Apex and LLSB  
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Split S1   Normal sound, but could be abnormal and indicate RBBB  
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Split S2   Aortic and pulmonary valves closing at different times  
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Split S2 (best heard)   Base Left  
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Splint S2   Normal: inspiration only Wide Split: mostly inspiration May indicate RBBB or pulmonary HTN Fixed Split: inspiration and expiration equally. SIGN of ATRIAL DEFECT Paradoxical Split: Expiration only: AORTIC STENOSIS and LBBB.  
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S3 "Kentucky"   Ventricles filling with blood  
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S3 "Kentucky"(best heard)   Apex with bell and lying on left side  
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S3 "Kentucky"   Heard immediately after S2 and does not vary with inspiration  
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Physiologic S3   Normal finding: in children and young adults with increased blood volume(prego,anemic and hyperthyroidism) Disappears when patient sit up  
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Pathological S3   Ventricular Gallop. Heard in HEART FAILURE MAINLY heard in elderly  
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S4 "Tennessee"   Atrium contracting  
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S4 "Tennessee" (best heard)   Apex with bell laying on left side  
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S4 "Tennessee"   Immediately before S1  
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Physiological S4   Can be normal in people over 40 years especially after exercise.  
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Pathological S4   Atrial Gallop. Indicates poor compliance of ventricles and seen with CAD patients  
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