Part 1

Normal S1 and S2

Apex, Bell, Patient Supine Normal S1 and S2 at normal speed and at 60% normal speed, +25% pitch

What if we wanted to auscultate a normal S1/S2 but at the base positions, such as the Aortic area? Aortic, Bell, Patient Sitting Normal S1 and S2 stethoscope is at aortic position, still using the bell. Note the louder S2 compared with Normal S1/S2 at Apex

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Splitting of S2, Normal

Pulmonic, Bell, Supine Physiologic Splitting (4 cardiac cyles, looped total of 3x); 2nd beat is at peak inspiration and has best split of S2, 4th at peak expiration Same as above, but slowed to 60% and only 2 loops

Part 2

Non-Physiologic S2 Split

Use the image from Figure 11-35 to demonstrate difference in splitting Wide Splitting in this audio is caused by a Right Bundle Branch block; note that split is easily appreciated, despite respiratory variation

S3, third heart sound

Apex, Bell, Left lateral decubitus Listen to the S3 at normal speed and pitch Here is the same audio of the S3 at normal speed but pitch changed to better appreciate sound Finally this is the S3 with 60% the original speed and higher pitch

S4, fourth heart sound

Apex, Bell, Left lateral decubitus Listen to an S4 at Normal speed, left lateral decubitus, apex, bell Same audio sample of S4 but slowed to 60%

Part 3

Students, below are link to four unique heart sounds. In an effort to make things fair, the sounds are mixed up depending on the day of the week your physical diagnosis class meets.

You will be assigned one of these 4 sounds. Your responsibility is to identify the abnormality and demonstrate to the class the following:

  • Correctly identify their audio sample’s disease (also highlight if it is a systolic or diastolic murmur)
  • Playback audio and defend your answer choice
  • Demonstrate how best to auscultate this finding
    • Provide location of best auscultation, position
    • Provide areas to auscultate for radiation; if none then make note of this
    • On an audiogram, what would the shape of this murmur be
    • Any associated signs (e.g. ejection click, narrow pulse pressure, etc.)
  • If relevant, demonstrate where to auscultate for any radiation
  • Outline symptoms of the disease (can separate by acute vs chronic)
  • Outline any relevant diseases associated with your valvular disease
Monday Tuesday Wednesday Thursday
Audio 1 Audio 1 Audio 1 Audio 1
Audio 2 Audio 2 Audio 2 Audio 2
Audio 3 Audio 3 Audio 3 Audio 3
Audio 4 Audio 4 Audio 4 Audio 4

Reference Chart

By Madhero88 - Own workReference netter image, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=9663180L