How Heart Sounds Can Indicate Different Types of Heart Problems

Ever wondered what the doctor is listening to when using a stethoscope? He is listening to your heart ofcourse! But more specifically, physicians listen to particular sounds as they can indicate certain diseases.

Below is a summary of the different heart sounds (what causes the heart sound and what can go wrong).

First some basic guidlines:

What is systole?

Systole is when the heart is contracting.

What is diastole?

Diastole is when the heart is relaxing.

In the typical lub-dub of a heart beat, lub is systole and dub is diastole.

Heart Sounds:

S1: start of systole; caused by the tricuspid and mitral valves closing.

S2: diastole; aortic and pulmonic valves close

S3: inrushing blood from the atria causes oscillation of the blood back and forth in the walls of the ventricles. Occurs in the middle of diastole because initially there is not enough blood in the ventricles to cause the reverberation.

Pathologic causes:

-rapid ventricular filling:

-mitral regurgitation (which means atria will be overfilled in systole and can thus send more blood to ventricles during diastole and thus cause rapid ventricular filling)

-elevated left atrial and left ventricular filling pressures (from a stiff and dilated left ventricle)

-ventricular septal defect (hole allows rapid filling from other side)

-poor left ventricular function

-post-MI (dead tissue is stiff and does not relax so filling is quick)

-dilated cardiomyopathy (thin and stiff walls)

S4: atria contracting forcefully to overcome stiff or hypertrophic ventricles. (stiff from post-MI fibrosis, hypetrophy from aortic stenosis, hypertension, overloading).

Occurs immediately before S1. Sometimes heard in healthy children and trained athletes.

If pathologic, will be best heard at apex.