Heart Sound

Where would you most likely hear abnormal bicuspid valve closure?

1st heart sound. Bicuspid is one of the AV valves and 1st heart sound is the AV valves. AV valves close at the same time.

Semilunar Valve

Prevents backflow into the ventricles. This is after the blood has been pushed out of ventricles and there is more in body than in ventricles. As the blood runs backward, it catches in the valve and causes them to close. It's actually black flow/backwash that causes the semilunar aortic and pulmonary valves to close. So, in reality, the ventricle shoots out 70ml, 10ml might run back into it before the semilunar valve closes.

Normal Heart Sounds

Result of vibration of vessels, chambers of heart when valves are closing. "Lubb Dubb" (S1 and S2) are correlated with closing of AV valves (lubb @ onset of systole) and semilunar valves (dub).

2nd Heart Sound

Dub or S2: its correlated with the closure of the semilunar valve (valves between the ventricles and the aorta/pulmonary trunk). The second heart sound of a heartbeat has a split to it. Normally, with your semilunar valves, your aortic valve closes before your pulmonary valve. So, 1st heart sound is the AV valves closing together, then the aortic closes, the pulmonary.

Extra Cardiac Sounds

Friction rub (not normally heard). Fibrinopurulent exudate in the pericardial sac. The fiber rubs against the pericardium and you get a friction rub. A whole extra sound that doesn't have anything to do with volume. It's an "extra" sound.

Explain a paradoxical split in the 2nd heart sound.

If there's a paradoxical split in the 2nd heart sound, what it probably means is the pulmonary valve is closing before the aortic valve. This most likely happens because the aortic valve is hard to close because it's stiff (e.g. stenotic). A stiff valve means it will take more backflow to make it close so the pulmonary valve will close first. This causes a weird dub sound.

4th (Atrial gallop)

Increase in ventricle resistance to atrial filling. Due to ventricle not being empty for atria to empty into ventricle. The ventricle just emptied 30ml of blood and that's all. The atria received 70ml but can't put the 70ml in the ventricle because there's not enough room. This causes pressure to be put back onto the venous system. This results in hypertrophy of the atria.

3rd (Ventricular gallop)

Increased rapid ventricular filling (blood is rushing into the ventricle); you are hearing the gushing. Normal in children to hear this because of smaller hearts, increased BP, and rapid metabolism. Not normal for adults; means pathology.

1st heart Sound

Lub or S1: correlated with the closure of the AV valves (aka (L) mitral (bicuspid) & (R) tricuspid; valves between atria and ventricles) and ventricular systole. The AV valves prevent backflow into the atria. When the pressure in the ventricles (as it's contracting) is higher than the atria, it causes the bicuspid (LA-LV) and tricuspid (RA-RV) valves to close.

Murmurs

Turbulent flow. Graded from I to VI (6 being very loud). I means you have to use your imagination to hear it. VI means take your stethoscope off and stand there and you'll hear it (they do not exit). Result of turbulence within vessels or chambers due to structural abnormalities. Valve opening and closing abnormally. If a stiff valve closes, it's often not silent due to its stiffness (there's a snap to it). If a valve doesn't close all the way so blood goes around the valves, it creates turbulence and there's a heart murmur.