Is S1 louder than S2? Where do you hear S1 and S2 best? Where is S2 sound heard the best? What does a loud S2 indicate? What heart sound is the loudest? What causes an S3 gallop? What does S3 sound indicate? What does a gallop rhythm mean? What causes a gallop?
Is a gallop an arrhythmia? What does gallop mean? What is the best description for a summation gallop? Is S4 a gallop? What does S4 gallop indicate? How do I tell the difference between Galaxy S3 and S4? Since, the pressure is much higher in the aorta, normally A2 is louder than P2. May I know the A-V pressure gradient is atrium-ventricle pressure gradient or aortic valve pressure gradient?
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ECG Guide for Surgeons. Enlarge Normal LV vs. Dilated LV S3 Present. S3 is a low-pitched sound; this is helpful in distinguishing a S3 from a split S2, which is high pitched. A S3 heart sound should disappear when the diaphragm of the stethoscope is used and should be present while using the bell; the opposite is true for a split S2. Also, the S3 sound is heard best at the cardiac apex, whereas a split S2 is best heard at the pulmonic listening post left upper sternal border.
To best hear a S3, the patient should be in the left lateral decubitus position. If the LV is noncompliant, and atrial contraction forces blood through the atrioventricular valves, a S4 is produced by the blood striking the LV. Therefore, any condition that creates a noncompliant LV will produce a S4, while any condition that creates an overly compliant LV will produce a S3, as described above.
A S4 heart sound can be an important sign of diastolic HF or active ischemia and is rarely a normal finding. Diastolic HF frequently results from severe left ventricular hypertrophy, or LVH , resulting in impaired relaxation compliance of the LV. In this setting, a S4 is often heard. Also, if an individual is actively having myocardial ischemia, adequate adenosine triphosphate cannot be synthesized to allow for the release of myosin from actin; therefore, the myocardium is not able to relax, and a S4 will be present.
It is important to note that if a patient is experiencing atrial fibrillation, the atria are not contracting, and it is impossible to have a S4 heart sound. Like S3, the S4 sound is low pitched and best heard at the apex with the patient in the left lateral decubitus position.
Below is comparative information for S3 and S4. There are a few common extra heart sounds that the clinician may encounter. Systolic ejection click: A systolic ejection click frequently indicates a bicuspid aortic valve.
This sound is heard just after the S1 heart sound. Usually, the opening of the aortic valve is not audible; however, with a bicuspid aortic valve, the leaflets dome suddenly prior to opening and create a systolic ejection click. The click may be difficult to hear in the presence of significant AS. Mitral valve prolapse click: Mitral valve prolapse produces a mid systolic click, usually followed by a uniform, high-pitched murmur. The murmur is actually due to MR that accompanies the MVP; thus, it is heard best at the cardiac apex.
MVP responds to dynamic auscultation. After sudden standing, preload is decreased, and the click moves earlier in systole. With sudden squatting, preload increases, and the click moves later in systole. Opening snap: In the setting of MS, the increased left atrial opening pressures cause an opening snap to occur when the mitral valve leaflets suddenly tense and dome into the LV in early diastole. This high-frequency sound is best heard at the apex.
Tumor plop: A tumor plop is an early diastolic low-pitched sound just after the S2 heart sound. This is in contrast to the opening snap of rheumatic mitral valve stenosis, which is high pitched.
A tumor plop may be followed by a low-pitched diastolic murmur. If the mitral valve inflow obstruction is significant enough, physical exam findings of congestive HF will be present. Pericardial knock: A pericardial knock can be present in patients with constrictive pericarditis, as the early filling of the LV is limited from the constrictive process.
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