Heart Sounds and Measurement of

Heart Sounds

By: Asst.Prof.Harshul Thakur

Heart Sounds
The two major audible heart sounds in a normal cardiac cycle are the first and second heart
sound, S1 and S2 (lub-dub sound)

S1 onset of the ventricular contraction

S2 closure of the semilunar valves
S3 ventricular gallop

S4 atrial gallop
Murmurs
By: Asst.Prof.Harshul Thakur

 S1 , Lub is caused by closure of the Atrioventricular-valves(Tricuspid &

Mitral), which permit flow of blood from atria into ventricles. It contains a
series of low-frequency vibrations, and is usually the longest and loudest heart
sound.
S2, dub is heard at the end of the ventricular systole, during the closure of the
semilunar valves. Typically, its frequency is higher than S1, and its duration is
shorter. It has aortic and pulmonary sub-components.
A third low-frequency sound (S3, ventricular gallop) may be heard at the
beginning of the diastole, during the rapid filling of the ventricles(rush of
blood from atria to ventricles, which cause turbulence or some vibration of the
ventricular walls).
A fourth heart sound (S4, atrial gallop) may be heard in late diastole during
atrial contraction.(squeezing the remainder of the blood to ventricles) ,not
audible but visible on the recorder.
By: Asst.Prof.Harshul Thakur

 Abnormal hearts sounds , called Murmurs are high-frequency, noise-like

sounds that are heard between the two major heart sounds during systole or
diastole.
These murmurs are generally caused either by improper opening of valves.
May be due to some backward flow of blood.
Another cause may be due to high velocity of blood flow through small openings
Small opening of septum, which separates the left and right side of heart.

By: Asst.Prof.Harshul Thakur

Relation of HEART sounds to function of the cardiovascular system

By: Asst.Prof.Harshul Thakur

LUB

DUB

Time

Measurement of Heart Sounds

In earlier days a physician listened to heart sounds by placing

his ear on the chest of the patient directly over the heart.

But now days we are using stethoscope, (in greek words,

stetho means chest and scopein means examine)

This device carries sound energy from chest of the patient to

the ear of the physician.

Phonocardiogram is an instruments for graphically recording

heart sounds.

By: Asst.Prof.Harshul Thakur

Phonocardiogram
The basic transducer for the phonocardiogram is a microphone having

the necessary frequency response, generally ranging from below 5 Hz

to above 1000Hz.

By: Asst.Prof.Harshul Thakur

 Aortic valve stenosis (AS) is a

disease of the heart valves in which

the opening of the aortic valve is
narrowed.
Mitral regurgitation is a disorder
of the heart in which the mitral
valve does not close properly when
the heart pumps out blood. It is the
abnormal leaking of blood.
Aortic regurgitation (AR), is the
leaking of the aortic valve of
the heart that causes blood to flow in
the reverse direction during
ventricular diastole, from
the aorta into the left ventricle.
Mitral Stenosis is a valvular heart
disease characterized by the
narrowing of the orifice of the mitral
valve of the heart.
Patent ductus arteriosus (PDA) is
ductus arteriosus fails to close
after birth. Resulting in irregular
transmission of blood between two of
the most important arteries close to
the heart, the aorta and the
By: Asst.Prof.Harshul
Thakur
pulmonary
artery.

By: Asst.Prof.Harshul Thakur

Echocardiograph
Echocardiogram, often referred to as a cardiac

echo.
Echocardiography uses standard two-dimensional,

three-dimensional, and Doppler ultrasound to create

images of the heart.
3D echocardiography
It is one of the most widely used diagnostic tests in

cardiology. It can provide a wealth of helpful

information, including the size and shape of the heart
(internal chamber size quantification), pumping
capacity, and the location and extent of any tissue
damage. An Echocardiogram can also give physicians
other estimates of heart function such as a calculation
of the cardiac output,ejection fraction, and diastolic
function
By: Asst.Prof.Harshul Thakur

Not only can an

echocardiogram create
ultrasound images of heart
structures, but it can also
produce accurate assessment of
the blood flowing through the
heart, using pulsed or continuous
wave Doppler ultrasound. This
allows assessment of both normal
and abnormal blood flow
through the heart.

Cardiac Output

Cardiac output (Q or or CO ) is the volume of blood being pumped by the heart,

in particular by a left or right ventricle in the time interval of one minute.

Stroke Volume (SV) = EDV ESV

End Systolic Volume (ESV)

End Diastolic Volume (EDV)
Ejection fraction (EF) is the fraction of blood in the left and right ventricles that is

pumped out with each heartbeat or cardiac cycle.

Prior to the start of Systole, the LV is filled with blood to the capacity known as End
Diastolic Volume (EDV) during the filling phase or diastole. During Systole, the LV
contracts and ejects blood until it reaches its minimum capacity known as End Systolic
Volume (ESV), it does not empty completely.
Q = Stroke Volume Heart rate
Cardiac Output (Q) = SV HR
HR can vary between 60 and 180 beats per minute, while stroke volume (SV) can vary

between 70 and 120 ml

By: Asst.Prof.Harshul Thakur

Cardiac Rate or Heart Rate

Heart rate, or heart pulse, is the speed of

the heartbeat measured by the number of heartbeats per unit

of time -typically beats per minute (bpm).
The normal resting adult human heart rate ranges from 60

100 bpm.

By: Asst.Prof.Harshul Thakur

Thankyou

By: Asst.Prof.Harshul Thakur