23 Heart Sounds
![](https://photos.thisispiggy.com/file/wikiFiles/ykwq1lv.jpg)
- S1: closure of MV, LV > LA
- S2: closure of AV, LV < aortic pressure
![](https://photos.thisispiggy.com/file/wikiFiles/v7jSILb.jpg)
- S1: QRS, depolarization of ventricles, contract, close mitral and tricuspid valves
- S2: aortic closes first
Splitting
Physiologic
![](https://photos.thisispiggy.com/file/wikiFiles/ZFEbnqI.jpg)
- inspiration: increased venous return to RV, longer for RV to pump blood, delays PV closure
Persistent
![](https://photos.thisispiggy.com/file/wikiFiles/gLQoSn7.jpg)
- exhalation: some separation of aortic and pulmonic components of S2, increases with inspiration, doesn't go away in exhalation
- RBBB: delayed contraction of RV, even during exhalation, PV closure late
- PHTN: dilated RV, delayed closure of PV even during exhalation
- anything delays contraction of RV: electrical (RBBB) or structural (dilated)
![](https://photos.thisispiggy.com/file/wikiFiles/mjEMxnD.jpg)
Fixed
![](https://photos.thisispiggy.com/file/wikiFiles/KQ2M6Wx.jpg)
- ASD: blood from left to right, always have increased venous return to right, even during exhalation
- doesn't change in size during exhalation/inspiration, different from persistent
- child with shortness of breath and fixed split S2 = ASD
![](https://photos.thisispiggy.com/file/wikiFiles/mjEMxnD.jpg)
Paradoxical
![](https://photos.thisispiggy.com/file/wikiFiles/DvWORtP.jpg)
- split during exhalation and single during inhalation
- exhalation: AV closure delayed
- inhalation: venous return delays PV closure, single heart sound
![](https://photos.thisispiggy.com/file/wikiFiles/zM3248X.jpg)
- pacemaker: signal to RV first, delayed left closure
- HCM: blockage to flow from thickened septum
![](https://photos.thisispiggy.com/file/wikiFiles/mjEMxnD.jpg)
Pathologic
P2
![](https://photos.thisispiggy.com/file/wikiFiles/3lbue18.jpg)
S3
![](https://photos.thisispiggy.com/file/wikiFiles/2iqwfT4.jpg)
- quick moving blood hits wall
![](https://photos.thisispiggy.com/file/wikiFiles/Acyscr9.jpg)
![](https://photos.thisispiggy.com/file/wikiFiles/a37LEYO.jpg)
- pt lie on left side on exam table
- Kentucky
![](https://photos.thisispiggy.com/file/wikiFiles/xs9nwf7.jpg)
- between s2 and s1 is diastole
![](https://photos.thisispiggy.com/file/wikiFiles/E5H6qt0.jpg)
- slams blood hitting stiff wall and making a loud noise, requires atrial kick, can't occur in afib
- Tennessee
![](https://photos.thisispiggy.com/file/wikiFiles/Acyscr9.jpg)
![](https://photos.thisispiggy.com/file/wikiFiles/xs9nwf7.jpg)
- between s2 and s1 is diastole
Clicks
![](https://photos.thisispiggy.com/file/wikiFiles/OJNhbSe.jpg)
- sound like click and in systole
![](https://photos.thisispiggy.com/file/wikiFiles/TElQoTK.jpg)
- normal: leveled plane
- MVP: leaflets bellow up into LA, leaflets damaged and stretched, cause click when leaflets snap up into LA like a parachute, small amount of mitral regurge after click
![](https://photos.thisispiggy.com/file/wikiFiles/NQHODIj.jpg)
- click and holosystolic: sounds like mitral regurge with S3
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