Anatomy-Heart Sounds

• AV-mitral and tricuspid-prevent backflow into atria during systole-thick and irregular
• Semilunar valves-aortic and pulmonary-prevent backflow into ventricules during diastole
• Aortic valve-free standing leflets, 2 aortic sinuses
• Sinuses of Valsalva,no attachments
• Open and close passively
• Pathology-Stenosis and/or regurgitation (insufficiency, incompetence)
• all 4 valves in same plane connected by fibrous tissue

AV valves open-elastic recoil; blood coming back

• Semilunar valves open-ejection
• blood sent out of body or comes back to heart

anchor valve leflets

• 1st-"Lub"-closure of mitral and tricuspid valves-start of systole, louder, longer, and lower frequency because valves larger in size
• 2nd-"Dub"-closure of semilunar valves-two componenets, aortic (A2) and pulmonary (2), physiologic splitting of 2nd HS during inspiration with delayed pulmonary closer-higher pressure and smaller diameter-pulmonary takes longer to close due to increased VR

• Aortic: right 2nd intercostal space
• Mitral: left fifth intercostal space (nipple line)
• Pulmonary: left 2nd intercostal space
• Tricuspid: beginning of left 5th intercostal space

Result from disturbances of normal blood flow patterns through heart and great vessels

• forward flow through a narrowed orifice
• retrograde flow through an incompetent valve-leaky valve
• blood flow past valvular or great vessel irregularities (plaue or clot), flase passages or enlarged chambers
• sound carried in direction of blood flow

• Stenosis (insufficiency)-flow in normal direction-plaque etc. narrow down space
• Regurgitation (incompetence)-flow in opposite direction-leaky

Less significant, most common:aortic and pulmonary stenosis

Almost always due to significant lesions; incompetent semilunar or AV stenosis-blood going back into chambers

pressure difference throughout cardiac cycle, patent ductus arteriosus-higher pressure in aorta than pulmonary

• Systolic murmur at apex extending to left axilla
• moderate to severe will lead to LV enlargement, LA dilation, pulmonary congestion, and RV hypertrophy and dilatation
• both lub-murmur-dub and lub-dub-murmur
• diastole and systole

• Presystolic murmur at apex
• Acceleration of blood flow by atrial contraction
• Diastolic murmur
• "rub-dub"

• Systolic murmur over valve to right 2nd intercostal space
• Lub-murmur-Dub

• Diastolic murmur in left 3rd-4th intercostal space
• Lub-Dub-murmur

Can't completely seal off valve-leaky

blood coming out in jet stream manner

• Left 2nd intercostal space
• Murmur heard throughout cycle, both systole and diastole
• Described as a tunnel murmur, train driving through tunnel
• continuous-aorta always higher than pulmonary
• newborns-should close within days or weeks