396:(heart strings). When the papillary muscles contract, the chordae tendineae become tense and thereby prevent the backflow of blood into the lower pressure environment of the atria. The chordae tendineae act a bit like the strings on a parachute, and allow the leaflets of the valve to balloon up into the atria slightly, but not so much as to evert the cusp edges and allow backflow of blood. It is the pressure created from ventricular contraction that closes the valve, not the papillary muscles themselves. The contraction of the ventricle begins just prior to AV valves closing and prior to the opening of the semilunar valves. The sudden tensing of the chordae tendineae and the squeezing of the ventricles against closed semilunar valves, send blood rushing back toward the atria, and the parachute-like valves catch the rush of blood in their leaflets causing the valve to snap shut. The S1 sound results from reverberation within the blood associated with the sudden block of flow reversal by the valves. The delay of T1 even more than normally causes the split S1 which is heard in a
615:
557:
sounds). A left-sided S3 is best heard in the left lateral decubitus position and at the apex of the heart, which is normally located in the 5th left intercostal space at the midclavicular line. A right-sided S3 is best heard at the lower left sternal border. The way to distinguish between left and right-sided S3 is to observe whether it increases in intensity with inhalation or exhalation. A right-sided S3 will increase on inhalation, while a left-sided S3 will increase on exhalation.
913:
722:
675:
629:
34:
103:
959:
pressure has an opposite effect on the left side of the heart, making it harder for the blood to exit into circulation. Therefore, left-sided murmurs generally decrease in intensity during inhalation. Increasing venous blood return to the right side of the heart by raising a patient's legs to a 45-degree while lying supine produces similar effect which occurs during inhalation. Inhalation can also produce a non-pathological
484:, also known as physiological split, normally occurs during inhalation because the decrease in intrathoracic pressure increases the time needed for pulmonary pressure to exceed that of the right ventricular pressure. A widely split S2 can be associated with several different cardiovascular conditions, and the split is sometimes wide and variable whereas, sometimes wide and fixed. The wide and variable split occurs in
553:(CHF). S3 is thought to be caused by the oscillation of blood back and forth between the walls of the ventricles initiated by blood rushing in from the atria. The reason the third heart sound does not occur until the middle third of diastole is probably that during the early part of diastole, the ventricles are not filled sufficiently to create enough tension for reverberation.
599:" gallop where S4 represents the "Ten-" syllable. It is best heard at the cardiac apex with the patient in the left lateral decubitus position and holding their breath. The combined presence of S3 and S4 is a quadruple gallop, also known as the "Hello-Goodbye" gallop. At rapid heart rates, S3 and S4 may merge to produce a summation gallop, sometimes referred to as S7.
1014:, the sac surrounding the heart. This is a characteristic scratching, creaking, high-pitched sound emanating from the rubbing of both layers of inflamed pericardium. It is the loudest in systole, but can often be heard at the beginning and at the end of diastole. It is very dependent on body position and breathing, and changes from hour to hour.
290:
556:
It may also be a result of tensing of the chordae tendineae during rapid filling and expansion of the ventricle. In other words, an S3 heart sound indicates increased volume of blood within the ventricle. An S3 heart sound is best heard with the bell-side of the stethoscope (used for lower frequency
793:
Regurgitation through the aortic valve, if marked, is sometimes audible to a practiced ear with high quality, especially electronically amplified, stethoscope. Generally, this is a very rarely heard murmur, even though aortic valve regurgitation is not so rare. Aortic regurgitation, though obvious
548:
It occurs at the beginning of diastole after S2 and is lower in pitch than S1 or S2 as it is not of valvular origin. The third heart sound is benign in youth, some trained athletes, and sometimes in pregnancy but if it re-emerges later in life it may signal cardiac problems, such as a failing left
958:
decreases intrathoracic pressure which allows more venous blood to return to the right heart (pulling blood into the right side of the heart via a vacuum-like effect). Therefore, right-sided heart murmurs generally increase in intensity with inhalation. The decreased (more negative) intrathoracic
767:
are produced as a result of turbulent flow of blood strong enough to produce audible noise. They are usually heard as a whooshing sound. The term murmur only refers to a sound believed to originate within blood flow through or near the heart; rapid blood velocity is necessary to produce a murmur.
1022:
The aortic area, pulmonic area, tricuspid area and mitral area are areas on the surface of the chest where the heart is auscultated. Heart sounds result from reverberation within the blood associated with the sudden block of flow reversal by the valves closing. Because of this, auscultation to
984:
There are a number of interventions that can be performed that alter the intensity and characteristics of abnormal heart sounds. These interventions can differentiate the different heart sounds to more effectively obtain a diagnosis of the cardiac anomaly that causes the heart sound.
1131:
recorder. The same connection can be used to listen to the previously recorded auscultation through the stethoscope headphones, allowing for a more detailed study of murmurs and other heart sounds, for general research as well as evaluation of a particular patient's condition.
1346:
778:
through the mitral valve is by far the most commonly heard murmur, producing a pansystolic/holosystolic murmur which is sometimes fairly loud to a practiced ear, even though the volume of regurgitant blood flow may be quite small. Yet, though obvious using
900:
and other techniques, heart status can be recognized and quantified much more accurately than formerly possible with only a stethoscope, examination, and experience. Another advantage to the use of the echocardiogram is that the devices can be handheld.
891:
conditions can cause heart murmurs, the murmurs can change markedly with the severity of the cardiac disease. An astute physician can sometimes diagnose cardiac conditions with some accuracy based largely on the murmur, related
1338:
930:
2550:
700:
Heart sounds of a 16-year-old girl diagnosed with mitral valve prolapse and mitral regurgitation. Auscultating her heart, a systolic murmur and click are heard. Recorded with the stethoscope over the mitral
789:
of the aortic valve is typically the next most common heart murmur, a systolic ejection murmur. This is more common in older adults or in those individuals having a two-leaflet, not a three-leaflet, aortic
801:
Stenosis of the mitral valve, if severe, also rarely produces an audible, low frequency soft rumbling murmur, best recognized by a practiced ear using high quality, especially electronically amplified,
463:. Aortic blood flow quickly reverses back toward the left ventricle, catching the pocket-like cusps of the aortic valve, and is stopped by aortic valve closure. Similarly, as the pressure in the
740:
2026:
931:
51:
646:
392:. When the ventricles begin to contract, so do the papillary muscles in each ventricle. The papillary muscles are attached to the cusps or leaflets of the tricuspid and mitral valves via
805:
Other audible murmurs are associated with abnormal openings between the left ventricle and right heart or from the aortic or pulmonary arteries back into a lower pressure heart chamber.
692:
2543:
73:
1422:
747:
Heart sounds of a healthy young woman with a functional, physiological or "innocent" murmur. Recorded after exercise with the stethoscope placed over the pulmonic valve area.
579:
when audible in an adult is called a presystolic gallop or atrial gallop. This gallop is produced by the sound of blood being forced into a stiff or hypertrophic ventricle.
739:
2536:
922:
52:
2019:
647:
59:
Heart sounds of a 16 year old girl immediately after running, with a heart rate of 186 BPM. The S1 heart sound is intensified due to the increased cardiac output.
560:
S3 can be a normal finding in young patients but is generally pathologic over the age of 40. The most common cause of pathologic S3 is congestive heart failure.
277:), which allows backflow of blood when the incompetent valve closes with only partial effectiveness. Different murmurs are audible in different parts of the
693:
273:
restricting the opening of a heart valve, resulting in turbulence as blood flows through it. Abnormal murmurs may also occur with valvular insufficiency (
2012:
1320:
74:
1645:
595:. The sound occurs just after atrial contraction at the end of diastole and immediately before S1, producing a rhythm sometimes referred to as the "
1415:
896:, and experience with the relative frequency of different heart conditions. However, with the advent of better quality and wider availability of
837:
Very faint, heard only after listener has "tuned in"; may not be heard in all positions. Only heard if the patient "bears down" or performs the
261:
based on the pressure dominance. Turbulence may occur inside or outside the heart; if it occurs outside the heart then the turbulence is called
1023:
determine function of a valve is usually not performed at the position of the valve, but at the position to where the sound waves reverberate.
731:
3221:
2472:
253:
between the chambers and the pressure dominant chamber will outflow the blood to non-dominant chamber in diseased condition which leads to
500:. Pulmonary S2 (P2) will be accentuated (loud P2) in pulmonary hypertension and pulmonary embolism. S2 becomes softer in aortic stenosis.
43:
2490:
2413:
1408:
638:
2401:
2312:
932:
249:
are generated by turbulent flow of blood and a murmur to be heard as turbulent flow must require pressure difference of at least 30
587:
It is a sign of a pathologic state, usually a failing or hypertrophic left ventricle, as in systemic hypertension, severe valvular
1123:
Using electronic stethoscopes, it is possible to record heart sounds via direct output to an external recording device, such as a
614:
2485:
2434:
2294:
3216:
2060:
684:
1558:
1151:
65:
1935:
741:
2973:
1690:
1668:
3137:
1930:
53:
3178:
1675:
775:
648:
592:
274:
1068:
2281:
1756:
996:– Heart clicks are short, high-pitched sounds that can be appreciated with modern non-invasive imaging techniques.
493:
2945:
694:
2408:
2396:
2097:
2092:
1960:
1917:
1907:
1783:
1763:
1727:
1650:
1610:
1431:
485:
397:
75:
2701:
2388:
1778:
1768:
1658:
999:
970:, the opposite haemodynamic changes occur: left-sided murmurs generally increase in intensity with exhalation.
550:
1317:
768:
Most heart problems do not produce any murmur and most valve problems also do not produce an audible murmur.
167:
and the resultant flow of blood through it. Specifically, the sounds reflect the turbulence created when the
2801:
2663:
2480:
2263:
1965:
1897:
1842:
1743:
1663:
1547:
1525:
1505:
3026:
2864:
2658:
2517:
2452:
1902:
1892:
1806:
1552:
1510:
1146:
654:
Ventricular septal defect murmur in 14 year old Rachel
Morrison's heart, heard from the mitral valve area.
1362:"A survey into paramedic accuracy in identifying the correct anatomic locations for cardiac auscultation"
3131:
2641:
2528:
2324:
2173:
1751:
1169:
310:
250:
218:, respectively. In addition to these normal sounds, a variety of other sounds may be present including
269:. Murmurs may be physiological (benign) or pathological (abnormal). Abnormal murmurs can be caused by
3157:
3064:
2968:
2873:
2686:
2668:
2368:
2307:
2158:
2140:
2087:
2035:
1500:
1483:
893:
497:
478:
sound results from reverberation within the blood associated with the sudden block of flow reversal.
783:
visualization, probably about 20% of cases of mitral regurgitation do not produce an audible murmur.
531:
is rarely heard, and is also called a protodiastolic gallop, ventricular gallop, or informally the "
3211:
3184:
3013:
2901:
2886:
2825:
2680:
2504:
2289:
2234:
2102:
1847:
1685:
1680:
1515:
1488:
1394:
603:
258:
254:
2896:
3172:
3105:
3083:
3077:
2848:
2692:
2675:
2624:
2563:
2559:
2462:
2444:
2337:
2271:
2070:
1955:
1820:
1573:
569:
539:
reference to the rhythm and stress of S1 followed by S2 and S3 together (S1=Ken; S2=tuck; S3=y).
489:
389:
334:
237:
223:
3167:
2891:
771:
Murmurs can be heard in many situations in adults without major congenital heart abnormalities:
2964:
2838:
2833:
2756:
2651:
2646:
2619:
2512:
2216:
2065:
1591:
1563:
1543:
1241:
1156:
1124:
1040:
838:
521:
393:
314:
306:
293:
Diagram showing relations of opened heart to front of thoracic wall. Ant. Anterior segment of
230:
3069:
3040:
2881:
2796:
2768:
2761:
2746:
2589:
2358:
2206:
2191:
1940:
1535:
1373:
1231:
1221:
897:
817:(Defined based on use of an acoustic, not a high-fidelity amplified electronic stethoscope)
795:
780:
468:
440:
322:
302:
606:
and in other rhythms in which atrial contraction does not precede ventricular contraction.
102:
3058:
3002:
2995:
2363:
2224:
2055:
2047:
2039:
1790:
1520:
1400:
1324:
1292:
1085:
1081:
1054:
1050:
618:
588:
464:
448:
381:
330:
294:
153:
142:
3125:
3097:
2978:
2940:
2906:
2004:
2936:
2931:
2854:
2806:
2342:
2229:
2201:
2115:
1950:
1875:
1867:
1461:
1448:
1269:
1236:
1103:
456:
318:
138:
3205:
3162:
3118:
3091:
2716:
2629:
2579:
2107:
1568:
1478:
1471:
1456:
1361:
1209:
509:
278:
227:
219:
3007:
2926:
2784:
2636:
2601:
2241:
2163:
1982:
1972:
1945:
1834:
1825:
1622:
1596:
1099:
1029:
1007:
1003:
979:
764:
536:
444:
385:
377:
326:
246:
172:
149:
127:
1377:
929:
738:
691:
645:
72:
50:
2955:
2917:
2843:
2741:
2736:
2706:
2429:
2378:
2183:
1987:
1977:
1705:
1700:
1695:
1606:
1011:
993:
938:
Heart sounds of a 16-year-old girl with mitral regurgitation holding her breath.
873:
Very loud, with thrill. May be heard when stethoscope is partly off the chest.
215:
211:
176:
168:
131:
82:
881:
Very loud, with thrill. May be heard with stethoscope entirely off the chest.
2813:
2571:
2332:
2251:
2246:
2196:
2080:
1925:
1710:
1600:
1583:
1466:
1226:
967:
955:
947:
756:
710:
663:
94:
2789:
2168:
2125:
1857:
1628:
1495:
602:
Atrial contraction must be present for production of an S4. It is absent in
1339:"Heart doctors are listening for clues to the future of their stethoscopes"
1245:
186:
In healthy adults, there are two normal heart sounds, often described as a
17:
1270:"Techniques – Heart Sounds & Murmurs Exam – Physical Diagnosis Skills"
3112:
2614:
2457:
1885:
1616:
1163:
960:
849:
Quiet, but heard immediately after placing the stethoscope on the chest.
786:
481:
452:
270:
1159:, a metre in poetry that follows a similar rhythm to the human heartbeat
2075:
1880:
179:
to listen for these unique and distinct sounds that provide important
3049:
3019:
2584:
2120:
1720:
1715:
865:
Loud, with palpable thrill (a tremor or vibration felt on palpation)
451:) at the end of ventricular systole and the beginning of ventricular
119:
107:
81:
Normal heart sounds of a 16 year old female at rest, as heard with a
289:
2728:
2711:
2373:
1852:
1439:
1141:
1033:
888:
613:
460:
298:
262:
180:
164:
123:
115:
3149:
2150:
111:
2532:
2008:
1404:
376:
slightly. It is caused by the closure of the atrioventricular
1128:
419:, forms the "dub" of "lub-dub" and is composed of components A
360:, forms the "lub" of "lub-dub" and is composed of components M
341:
Normal heart sounds are associated with heart valves closing:
911:
720:
673:
627:
388:(bicuspid), at the beginning of ventricular contraction, or
32:
798:
visualization, usually does not produce an audible murmur.
194:
that occur in sequence with each heartbeat. These are the
137:
First heart sound: caused by atrioventricular valves –
512:
and are heard in both normal and abnormal situations.
459:
empties, its pressure falls below the pressure in the
545:
If new, indicates heart failure or volume overload.
3148:
3048:
3039:
2987:
2954:
2915:
2872:
2863:
2824:
2777:
2727:
2600:
2570:
2503:
2471:
2443:
2422:
2387:
2351:
2323:
2280:
2262:
2215:
2182:
2148:
2139:
2046:
1916:
1866:
1833:
1819:
1799:
1736:
1638:
1582:
1534:
1447:
1438:
439:can be heard. It is caused by the closure of the
1264:
1262:
435:especially during inspiration where a split of S
148:Second heart sound caused by semilunar valves –
1166:– hearing a heartbeat sound in one or both ears
1002:– The pericardial friction rub can be heard in
496:. The wide and fixed splitting of S2 occurs in
1276:. University of Washington School of Medicine.
2544:
2020:
1416:
8:
183:data regarding the condition of the heart.
3045:
2869:
2551:
2537:
2529:
2145:
2027:
2013:
2005:
1830:
1444:
1423:
1409:
1401:
1287:
1285:
1283:
1208:Leng, S; Tan, R; Chai, R; Wang, C (2015).
1235:
1225:
1025:
808:
288:
281:, depending on the cause of the murmur.
163:are the noises generated by the beating
134:are labeled with "M", "T", "A", and "P".
101:
1432:Physiology of the cardiovascular system
1181:
963:which will be heard upon auscultation.
1203:
1201:
1199:
1197:
1195:
1193:
1191:
1189:
1187:
1185:
945:
754:
708:
661:
621:from normal and abnormal heart sounds.
92:
1091:left fourth, fifth intercostal spaces
427:(pulmonary valve closure). Normally A
368:(tricuspid valve closure). Normally M
126:(red outline). The locations of best
7:
1297:The Lecturio Medical Concept Library
27:Noise generated by the beating heart
2414:Upper limb neurological examination
508:The rarer extra heart sounds form
471:, the pulmonary valve closes. The
210:), produced by the closing of the
93:Problems playing these files? See
25:
974:Interventions that change murmurs
1349:from the original on 2016-01-09.
1327:Medline Plus Medical Dictionary.
946:Problems playing this file? See
927:
755:Problems playing this file? See
736:
709:Problems playing this file? See
689:
662:Problems playing this file? See
643:
467:falls below the pressure in the
70:
48:
2435:Ballard Maturational Assessment
2295:Peripheral vascular examination
1337:Bernstein, Lenny (2016-01-02),
110:, showing surface relations of
2061:History of the present illness
923:Heartbeat while holding breath
583:"ta-lub-dub" or "a-stiff-wall"
543:"lub-dub-ta" or "slosh-ing-in"
1:
2402:Mini–mental state examination
2313:Ankle–brachial pressure index
1559:Aortic valve area calculation
1395:Heart Sounds – Heart Murmurs.
1378:10.29045/14784726.2017.2.2.13
1214:BioMedical Engineering OnLine
1152:Benign pediatric heart murmur
1060:left second intercostal space
492:, pulmonary hypertension and
1210:"The electronic stethoscope"
1109:left fifth intercostal space
1073:Left third intercostal space
685:Mitral valve prolapse murmur
423:(aortic valve closure) and P
364:(mitral valve closure) and T
3222:Symptoms and signs: Cardiac
3179:superior vena cava syndrome
1676:Effective refractory period
1555:) / End-diastolic dimension
1397:practicalclinicalskills.com
1045:upper right sternal border
593:hypertrophic cardiomyopathy
3238:
1094:lower left sternal border
1063:upper left sternal border
977:
494:ventricular septal defects
3092:radial artery sufficiency
2409:Cranial nerve examination
1961:Tubuloglomerular feedback
1908:Critical closing pressure
1728:Hexaxial reference system
1651:Cardiac electrophysiology
1366:British Paramedic Journal
1227:10.1186/s12938-015-0056-y
887:Though several different
486:Right bundle branch block
398:right bundle branch block
2702:Pericardial friction rub
1936:Renin–angiotensin system
1112:left midclavicular line
551:congestive heart failure
549:ventricle as in dilated
175:, an examiner may use a
44:Emily's racing heartbeat
3138:Nicoladoni–Branham sign
2802:Jugular venous pressure
2664:Pulmonary insufficiency
2481:Athletic heart syndrome
1966:Cerebral autoregulation
1931:Kinin–kallikrein system
1898:Jugular venous pressure
1548:End-diastolic dimension
1526:Pressure volume diagram
732:Functional heart murmur
212:atrioventricular valves
3027:Gallavardin phenomenon
2865:Cardiovascular disease
2518:Differential diagnosis
2453:Well-woman examination
1903:Portal venous pressure
1893:Mean arterial pressure
1807:Ventricular remodeling
1553:End-systolic dimension
1511:Cardiac function curve
1293:"Aortic Regurgitation"
1147:Precordial examination
1119:Recording heart sounds
916:
725:
678:
632:
622:
338:
171:snap shut. In cardiac
157:
37:
3217:Audible medical signs
3132:arteriovenous fistula
2946:Bracht–Wachter bodies
1544:Fractional shortening
1360:Mallinson, T (2017).
1170:Souffle (heart sound)
989:Other abnormal sounds
915:
813:Gradations of Murmurs
724:
677:
631:
617:
311:common carotid artery
292:
105:
36:
2969:Pericardial effusion
2874:Aortic insufficiency
2687:Mitral insufficiency
2669:Graham Steell murmur
2486:Sudden cardiac death
2369:Shoulder examination
2308:Abdominojugular test
2141:Physical examination
2088:Past medical history
1484:End-diastolic volume
1274:depts.washington.edu
1076:left sternal border
905:Effects of breathing
894:physical examination
498:atrial septal defect
285:Primary heart sounds
2902:Austin Flint murmur
2681:Carey Coombs murmur
2505:Assessment and plan
2290:Cardiac examination
2235:Swinging light test
2103:Psychiatric history
2036:Medical examination
1848:Vascular resistance
1686:Electrocardiography
1681:Pacemaker potential
1611:Conduction velocity
1516:Venous return curve
1489:End-systolic volume
604:atrial fibrillation
259:Right-to-left shunt
255:Left-to-right shunt
224:adventitious sounds
3173:Trendelenburg test
3106:pseudohypertension
3084:Right heart strain
3078:pulmonary embolism
2693:Presystolic murmur
2564:circulatory system
2560:Signs and symptoms
2463:Breast examination
2338:Rectal examination
2272:Respiratory sounds
2071:Nursing assessment
1956:Myogenic mechanism
1574:Left atrial volume
1506:Frank–Starling law
1323:2011-05-27 at the
917:
726:
679:
633:
623:
570:fourth heart sound
564:Fourth heart sound
504:Extra heart sounds
490:pulmonary stenosis
410:second heart sound
404:Second heart sound
339:
335:Ventricular septum
204:second heart sound
158:
154:Pulmonary/Pulmonic
38:
3199:
3198:
3195:
3194:
3158:Friedreich's sign
3065:Cardarelli's sign
3035:
3034:
2965:Cardiac tamponade
2757:Pulsus bisferiens
2647:Functional murmur
2526:
2525:
2513:Medical diagnosis
2499:
2498:
2374:Elbow examination
2002:
2001:
1998:
1997:
1815:
1814:
1655:Action potential
1646:Conduction system
1592:Cardiac pacemaker
1564:Ejection fraction
1157:Iambic pentameter
1116:
1115:
1041:intercostal space
933:
885:
884:
857:Moderately loud.
839:Valsalva maneuver
742:
695:
649:
522:third heart sound
516:Third heart sound
394:chordae tendineae
351:first heart sound
345:First heart sound
315:subclavian artery
307:Innominate artery
196:first heart sound
76:
66:Emily’s heartbeat
54:
16:(Redirected from
3229:
3185:Pemberton's sign
3046:
3041:Vascular disease
2887:De Musset's sign
2882:Collapsing pulse
2870:
2769:Pulsus alternans
2762:Pulsus bigeminus
2747:Pulsus paradoxus
2562:relating to the
2553:
2546:
2539:
2530:
2359:Knee examination
2207:Respiratory rate
2146:
2029:
2022:
2015:
2006:
1941:Vasoconstrictors
1918:Regulation of BP
1831:
1764:pulmonary artery
1737:Chamber pressure
1445:
1425:
1418:
1411:
1402:
1382:
1381:
1357:
1351:
1350:
1334:
1328:
1315:
1309:
1308:
1306:
1304:
1289:
1278:
1277:
1266:
1257:
1256:
1254:
1252:
1239:
1229:
1205:
1026:
935:
934:
914:
898:echocardiography
809:
796:echocardiography
781:echocardiography
744:
743:
723:
697:
696:
676:
651:
650:
630:
469:pulmonary artery
441:semilunar valves
323:Pulmonary artery
303:papillary muscle
301:. A.P. Anterior
216:semilunar valves
78:
77:
56:
55:
35:
21:
3237:
3236:
3232:
3231:
3230:
3228:
3227:
3226:
3202:
3201:
3200:
3191:
3168:Kussmaul's sign
3144:
3059:aortic aneurysm
3031:
3003:Anitschkow cell
2996:rheumatic fever
2983:
2950:
2911:
2892:Duroziez's sign
2859:
2820:
2773:
2723:
2596:
2566:
2557:
2527:
2522:
2495:
2467:
2439:
2418:
2383:
2364:Hip examination
2352:Musculoskeletal
2347:
2319:
2276:
2258:
2225:Eye examination
2211:
2178:
2135:
2056:Chief complaint
2048:Medical history
2042:
2033:
2003:
1994:
1912:
1862:
1824:
1821:Vascular system
1811:
1795:
1732:
1634:
1619:(Contractility)
1578:
1530:
1521:Wiggers diagram
1434:
1429:
1391:
1386:
1385:
1359:
1358:
1354:
1343:Washington Post
1336:
1335:
1331:
1325:Wayback Machine
1316:
1312:
1302:
1300:
1291:
1290:
1281:
1268:
1267:
1260:
1250:
1248:
1207:
1206:
1183:
1178:
1138:
1121:
1086:right ventricle
1082:Tricuspid valve
1055:pulmonary trunk
1051:Pulmonary valve
1020:
1018:Surface anatomy
991:
982:
976:
953:
952:
944:
942:
941:
940:
939:
936:
928:
925:
918:
912:
907:
762:
761:
753:
751:
750:
749:
748:
745:
737:
734:
727:
721:
716:
715:
707:
705:
704:
703:
702:
698:
690:
687:
680:
674:
669:
668:
660:
658:
657:
656:
655:
652:
644:
641:
634:
628:
619:Phonocardiogram
612:
589:aortic stenosis
577:
566:
535:" gallop as an
529:
518:
506:
482:Splitting of S2
476:
465:right ventricle
449:pulmonary valve
438:
434:
430:
426:
422:
417:
406:
375:
371:
367:
363:
358:
347:
331:Right ventricle
295:tricuspid valve
287:
267:vascular murmur
241:
234:
209:
201:
147:
146:
136:
135:
100:
99:
91:
89:
88:
87:
86:
79:
71:
68:
62:
61:
60:
57:
49:
46:
39:
33:
28:
23:
22:
15:
12:
11:
5:
3235:
3233:
3225:
3224:
3219:
3214:
3204:
3203:
3197:
3196:
3193:
3192:
3190:
3189:
3188:
3187:
3175:
3170:
3165:
3160:
3154:
3152:
3146:
3145:
3143:
3142:
3141:
3140:
3128:
3123:
3122:
3121:
3109:
3102:
3101:
3100:
3088:
3087:
3086:
3074:
3073:
3072:
3067:
3054:
3052:
3043:
3037:
3036:
3033:
3032:
3030:
3029:
3024:
3023:
3022:
3010:
3005:
3000:
2991:
2989:
2985:
2984:
2982:
2981:
2976:
2960:
2958:
2952:
2951:
2949:
2948:
2943:
2937:Janeway lesion
2934:
2922:
2920:
2913:
2912:
2910:
2909:
2904:
2899:
2894:
2889:
2884:
2878:
2876:
2867:
2861:
2860:
2858:
2857:
2855:Template:Shock
2851:
2846:
2841:
2836:
2830:
2828:
2822:
2821:
2819:
2818:
2816:
2811:
2810:
2809:
2807:Cannon A waves
2799:
2794:
2793:
2792:
2781:
2779:
2775:
2774:
2772:
2771:
2766:
2765:
2764:
2759:
2749:
2744:
2739:
2733:
2731:
2725:
2724:
2722:
2721:
2720:
2719:
2709:
2704:
2699:
2698:
2697:
2696:
2695:
2683:
2678:
2673:
2672:
2671:
2666:
2656:
2655:
2654:
2652:Still's murmur
2649:
2634:
2633:
2632:
2627:
2622:
2617:
2606:
2604:
2598:
2597:
2595:
2594:
2593:
2592:
2582:
2576:
2574:
2568:
2567:
2558:
2556:
2555:
2548:
2541:
2533:
2524:
2523:
2521:
2520:
2515:
2509:
2507:
2501:
2500:
2497:
2496:
2494:
2493:
2488:
2483:
2477:
2475:
2469:
2468:
2466:
2465:
2460:
2455:
2449:
2447:
2441:
2440:
2438:
2437:
2432:
2426:
2424:
2420:
2419:
2417:
2416:
2411:
2406:
2405:
2404:
2393:
2391:
2385:
2384:
2382:
2381:
2376:
2371:
2366:
2361:
2355:
2353:
2349:
2348:
2346:
2345:
2340:
2335:
2329:
2327:
2321:
2320:
2318:
2317:
2316:
2315:
2310:
2302:
2297:
2292:
2286:
2284:
2282:Cardiovascular
2278:
2277:
2275:
2274:
2268:
2266:
2260:
2259:
2257:
2256:
2255:
2254:
2249:
2239:
2238:
2237:
2232:
2230:Ophthalmoscopy
2221:
2219:
2213:
2212:
2210:
2209:
2204:
2202:Blood pressure
2199:
2194:
2188:
2186:
2180:
2179:
2177:
2176:
2171:
2166:
2161:
2155:
2153:
2143:
2137:
2136:
2134:
2133:
2132:
2131:
2128:
2123:
2118:
2110:
2108:Progress notes
2105:
2100:
2098:Social history
2095:
2093:Family history
2090:
2085:
2084:
2083:
2073:
2068:
2066:Systems review
2063:
2058:
2052:
2050:
2044:
2043:
2040:history taking
2034:
2032:
2031:
2024:
2017:
2009:
2000:
1999:
1996:
1995:
1993:
1992:
1991:
1990:
1985:
1980:
1970:
1969:
1968:
1963:
1958:
1951:Autoregulation
1948:
1943:
1938:
1933:
1928:
1922:
1920:
1914:
1913:
1911:
1910:
1905:
1900:
1895:
1890:
1889:
1888:
1883:
1876:Pulse pressure
1872:
1870:
1868:Blood pressure
1864:
1863:
1861:
1860:
1855:
1850:
1845:
1839:
1837:
1828:
1817:
1816:
1813:
1812:
1810:
1809:
1803:
1801:
1797:
1796:
1794:
1793:
1788:
1787:
1786:
1781:
1773:
1772:
1771:
1761:
1760:
1759:
1754:
1746:
1744:Central venous
1740:
1738:
1734:
1733:
1731:
1730:
1725:
1724:
1723:
1718:
1713:
1708:
1703:
1698:
1693:
1683:
1678:
1673:
1672:
1671:
1666:
1661:
1653:
1648:
1642:
1640:
1636:
1635:
1633:
1632:
1626:
1625:(Excitability)
1620:
1614:
1604:
1594:
1588:
1586:
1580:
1579:
1577:
1576:
1571:
1566:
1561:
1556:
1550:
1540:
1538:
1532:
1531:
1529:
1528:
1523:
1518:
1513:
1508:
1503:
1498:
1493:
1492:
1491:
1486:
1476:
1475:
1474:
1469:
1462:Cardiac output
1459:
1453:
1451:
1449:Cardiac output
1442:
1436:
1435:
1430:
1428:
1427:
1420:
1413:
1405:
1399:
1398:
1390:
1389:External links
1387:
1384:
1383:
1352:
1329:
1310:
1299:. October 2020
1279:
1258:
1180:
1179:
1177:
1174:
1173:
1172:
1167:
1160:
1154:
1149:
1144:
1137:
1134:
1120:
1117:
1114:
1113:
1110:
1107:
1104:left ventricle
1096:
1095:
1092:
1089:
1078:
1077:
1074:
1071:
1065:
1064:
1061:
1058:
1047:
1046:
1043:
1037:
1019:
1016:
990:
987:
978:Main article:
975:
972:
943:
937:
926:
921:
920:
919:
910:
909:
908:
906:
903:
883:
882:
879:
875:
874:
871:
867:
866:
863:
859:
858:
855:
851:
850:
847:
843:
842:
835:
831:
830:
825:
819:
818:
815:
807:
806:
803:
799:
791:
784:
752:
746:
735:
730:
729:
728:
719:
718:
717:
706:
699:
688:
683:
682:
681:
672:
671:
670:
659:
653:
642:
637:
636:
635:
626:
625:
624:
611:
608:
575:
565:
562:
527:
517:
514:
510:gallop rhythms
505:
502:
474:
457:left ventricle
436:
432:
428:
424:
420:
415:
405:
402:
373:
369:
365:
361:
356:
346:
343:
319:Left ventricle
309:. L.C.C. Left
286:
283:
239:
232:
228:gallop rhythms
207:
199:
90:
80:
69:
64:
63:
58:
47:
42:
41:
40:
31:
30:
29:
26:
24:
14:
13:
10:
9:
6:
4:
3:
2:
3234:
3223:
3220:
3218:
3215:
3213:
3210:
3209:
3207:
3186:
3183:
3182:
3181:
3180:
3176:
3174:
3171:
3169:
3166:
3164:
3163:Caput medusae
3161:
3159:
3156:
3155:
3153:
3151:
3147:
3139:
3136:
3135:
3134:
3133:
3129:
3127:
3124:
3120:
3119:Lines of Zahn
3117:
3116:
3115:
3114:
3110:
3108:
3107:
3103:
3099:
3096:
3095:
3094:
3093:
3089:
3085:
3082:
3081:
3080:
3079:
3075:
3071:
3070:Oliver's sign
3068:
3066:
3063:
3062:
3061:
3060:
3056:
3055:
3053:
3051:
3047:
3044:
3042:
3038:
3028:
3025:
3021:
3018:
3017:
3016:
3015:
3011:
3009:
3006:
3004:
3001:
2999:
2997:
2993:
2992:
2990:
2986:
2980:
2977:
2975:
2972:
2970:
2966:
2962:
2961:
2959:
2957:
2953:
2947:
2944:
2942:
2938:
2935:
2933:
2930:
2928:
2924:
2923:
2921:
2919:
2914:
2908:
2905:
2903:
2900:
2898:
2897:MĂĽller's sign
2895:
2893:
2890:
2888:
2885:
2883:
2880:
2879:
2877:
2875:
2871:
2868:
2866:
2862:
2856:
2852:
2850:
2847:
2845:
2842:
2840:
2837:
2835:
2832:
2831:
2829:
2827:
2823:
2817:
2815:
2812:
2808:
2805:
2804:
2803:
2800:
2798:
2797:CĹ“ur en sabot
2795:
2791:
2788:
2787:
2786:
2783:
2782:
2780:
2776:
2770:
2767:
2763:
2760:
2758:
2755:
2754:
2753:
2750:
2748:
2745:
2743:
2740:
2738:
2735:
2734:
2732:
2730:
2726:
2718:
2715:
2714:
2713:
2710:
2708:
2705:
2703:
2700:
2694:
2691:
2690:
2689:
2688:
2684:
2682:
2679:
2677:
2674:
2670:
2667:
2665:
2662:
2661:
2660:
2657:
2653:
2650:
2648:
2645:
2644:
2643:
2640:
2639:
2638:
2635:
2631:
2630:Gallop rhythm
2628:
2626:
2623:
2621:
2618:
2616:
2613:
2612:
2611:
2608:
2607:
2605:
2603:
2599:
2591:
2590:Levine's sign
2588:
2587:
2586:
2583:
2581:
2580:Referred pain
2578:
2577:
2575:
2573:
2569:
2565:
2561:
2554:
2549:
2547:
2542:
2540:
2535:
2534:
2531:
2519:
2516:
2514:
2511:
2510:
2508:
2506:
2502:
2492:
2489:
2487:
2484:
2482:
2479:
2478:
2476:
2474:
2470:
2464:
2461:
2459:
2456:
2454:
2451:
2450:
2448:
2446:
2445:Gynecological
2442:
2436:
2433:
2431:
2428:
2427:
2425:
2421:
2415:
2412:
2410:
2407:
2403:
2400:
2399:
2398:
2397:Mental status
2395:
2394:
2392:
2390:
2386:
2380:
2377:
2375:
2372:
2370:
2367:
2365:
2362:
2360:
2357:
2356:
2354:
2350:
2344:
2341:
2339:
2336:
2334:
2331:
2330:
2328:
2326:
2322:
2314:
2311:
2309:
2306:
2305:
2303:
2301:
2298:
2296:
2293:
2291:
2288:
2287:
2285:
2283:
2279:
2273:
2270:
2269:
2267:
2265:
2261:
2253:
2250:
2248:
2245:
2244:
2243:
2240:
2236:
2233:
2231:
2228:
2227:
2226:
2223:
2222:
2220:
2218:
2214:
2208:
2205:
2203:
2200:
2198:
2195:
2193:
2190:
2189:
2187:
2185:
2181:
2175:
2172:
2170:
2167:
2165:
2162:
2160:
2157:
2156:
2154:
2152:
2147:
2144:
2142:
2138:
2129:
2127:
2124:
2122:
2119:
2117:
2114:
2113:
2111:
2109:
2106:
2104:
2101:
2099:
2096:
2094:
2091:
2089:
2086:
2082:
2079:
2078:
2077:
2074:
2072:
2069:
2067:
2064:
2062:
2059:
2057:
2054:
2053:
2051:
2049:
2045:
2041:
2037:
2030:
2025:
2023:
2018:
2016:
2011:
2010:
2007:
1989:
1986:
1984:
1981:
1979:
1976:
1975:
1974:
1971:
1967:
1964:
1962:
1959:
1957:
1954:
1953:
1952:
1949:
1947:
1944:
1942:
1939:
1937:
1934:
1932:
1929:
1927:
1924:
1923:
1921:
1919:
1915:
1909:
1906:
1904:
1901:
1899:
1896:
1894:
1891:
1887:
1884:
1882:
1879:
1878:
1877:
1874:
1873:
1871:
1869:
1865:
1859:
1856:
1854:
1851:
1849:
1846:
1844:
1841:
1840:
1838:
1836:
1832:
1829:
1827:
1822:
1818:
1808:
1805:
1804:
1802:
1798:
1792:
1789:
1785:
1782:
1780:
1777:
1776:
1774:
1770:
1767:
1766:
1765:
1762:
1758:
1755:
1753:
1750:
1749:
1747:
1745:
1742:
1741:
1739:
1735:
1729:
1726:
1722:
1719:
1717:
1714:
1712:
1709:
1707:
1704:
1702:
1699:
1697:
1694:
1692:
1689:
1688:
1687:
1684:
1682:
1679:
1677:
1674:
1670:
1667:
1665:
1662:
1660:
1657:
1656:
1654:
1652:
1649:
1647:
1644:
1643:
1641:
1637:
1630:
1627:
1624:
1621:
1618:
1615:
1612:
1608:
1605:
1602:
1598:
1595:
1593:
1590:
1589:
1587:
1585:
1581:
1575:
1572:
1570:
1569:Cardiac index
1567:
1565:
1562:
1560:
1557:
1554:
1551:
1549:
1545:
1542:
1541:
1539:
1537:
1533:
1527:
1524:
1522:
1519:
1517:
1514:
1512:
1509:
1507:
1504:
1502:
1499:
1497:
1494:
1490:
1487:
1485:
1482:
1481:
1480:
1479:Stroke volume
1477:
1473:
1472:Stroke volume
1470:
1468:
1465:
1464:
1463:
1460:
1458:
1457:Cardiac cycle
1455:
1454:
1452:
1450:
1446:
1443:
1441:
1437:
1433:
1426:
1421:
1419:
1414:
1412:
1407:
1406:
1403:
1396:
1393:
1392:
1388:
1379:
1375:
1371:
1367:
1363:
1356:
1353:
1348:
1344:
1340:
1333:
1330:
1326:
1322:
1319:
1314:
1311:
1298:
1294:
1288:
1286:
1284:
1280:
1275:
1271:
1265:
1263:
1259:
1247:
1243:
1238:
1233:
1228:
1223:
1219:
1215:
1211:
1204:
1202:
1200:
1198:
1196:
1194:
1192:
1190:
1188:
1186:
1182:
1175:
1171:
1168:
1165:
1161:
1158:
1155:
1153:
1150:
1148:
1145:
1143:
1140:
1139:
1135:
1133:
1130:
1126:
1118:
1111:
1108:
1105:
1101:
1098:
1097:
1093:
1090:
1087:
1083:
1080:
1079:
1075:
1072:
1070:
1067:
1066:
1062:
1059:
1056:
1052:
1049:
1048:
1044:
1042:
1039:right second
1038:
1035:
1031:
1028:
1027:
1024:
1017:
1015:
1013:
1009:
1005:
1001:
997:
995:
988:
986:
981:
973:
971:
969:
964:
962:
957:
951:
949:
924:
904:
902:
899:
895:
890:
880:
877:
876:
872:
869:
868:
864:
861:
860:
856:
853:
852:
848:
845:
844:
840:
836:
833:
832:
829:
826:
824:
821:
820:
816:
814:
811:
810:
804:
800:
797:
792:
788:
785:
782:
777:
776:Regurgitation
774:
773:
772:
769:
766:
765:Heart murmurs
760:
758:
733:
714:
712:
686:
667:
665:
640:
620:
616:
609:
607:
605:
600:
598:
594:
590:
585:
584:
580:
578:
571:
563:
561:
558:
554:
552:
546:
544:
540:
538:
534:
530:
523:
515:
513:
511:
503:
501:
499:
495:
491:
487:
483:
479:
477:
470:
466:
462:
458:
454:
450:
446:
442:
418:
411:
403:
401:
399:
395:
391:
387:
383:
379:
359:
352:
344:
342:
336:
332:
328:
324:
320:
316:
312:
308:
304:
300:
296:
291:
284:
282:
280:
279:cardiac cycle
276:
275:regurgitation
272:
268:
264:
260:
256:
252:
248:
247:Heart murmurs
244:
242:
235:
229:
225:
221:
220:heart murmurs
217:
213:
205:
197:
193:
189:
184:
182:
178:
174:
170:
166:
162:
155:
151:
144:
140:
133:
129:
125:
121:
117:
113:
109:
104:
98:
96:
84:
67:
45:
19:
3177:
3130:
3126:Adson's sign
3111:
3104:
3098:Allen's test
3090:
3076:
3057:
3012:
3008:Aschoff body
2994:
2979:Ewart's sign
2974:Beck's triad
2963:
2941:Osler's node
2927:endocarditis
2925:
2907:Mayne's sign
2853:See further
2849:Distributive
2785:Palpitations
2751:
2685:
2637:Heart murmur
2610:Heart sounds
2609:
2602:Auscultation
2389:Neurological
2343:Bowel sounds
2300:Heart sounds
2299:
2164:Auscultation
1983:Carotid body
1946:Vasodilators
1826:hemodynamics
1631:(Relaxation)
1623:Bathmotropic
1597:Chronotropic
1372:(2): 13–17.
1369:
1365:
1355:
1342:
1332:
1313:
1301:. Retrieved
1296:
1273:
1249:. Retrieved
1217:
1213:
1122:
1100:Mitral valve
1030:Aortic valve
1021:
1008:inflammation
1004:pericarditis
998:
992:
983:
980:Heart murmur
965:
954:
886:
827:
822:
812:
802:stethoscope.
770:
763:
639:Heart murmur
601:
596:
586:
582:
581:
573:
567:
559:
555:
547:
542:
541:
537:onomatopoeic
532:
525:
519:
507:
480:
472:
445:aortic valve
413:
409:
407:
354:
350:
348:
340:
327:Right atrium
313:. L.S. Left
266:
245:
203:
195:
191:
187:
185:
173:auscultation
169:heart valves
161:Heart sounds
160:
159:
128:auscultation
122:(blue), and
2956:Pericardium
2932:Roth's spot
2918:endocardium
2844:Hypovolemic
2839:Obstructive
2834:Cardiogenic
2742:Bradycardia
2737:Tachycardia
2707:Heart click
2430:Apgar score
2379:GALS screen
2264:Respiratory
2192:Temperature
2184:Vital signs
2081:Medications
1988:Glomus cell
1978:Aortic body
1973:Paraganglia
1784:ventricular
1757:ventricular
1706:QT interval
1701:QRS complex
1696:PR interval
1669:ventricular
1607:Dromotropic
1069:Erb's point
1012:pericardium
828:Description
177:stethoscope
132:heart valve
83:stethoscope
18:Heart sound
3212:Cardiology
3206:Categories
2814:Hyperaemia
2676:Continuous
2572:Chest pain
2333:Liver span
2197:Heart rate
2174:Percussion
2159:Inspection
2112:Mnemonics
1926:Baroreflex
1843:Compliance
1835:Blood flow
1711:ST segment
1639:Conduction
1629:Lusitropic
1601:Heart rate
1584:Heart rate
1536:Ultrasound
1467:Heart rate
1176:References
1162:Pulsatile
968:exhalation
956:Inhalation
948:media help
757:media help
711:media help
664:media help
431:precedes P
372:precedes T
118:(purple),
95:media help
2790:Apex beat
2659:Diastolic
2325:Abdominal
2169:Palpation
2076:Allergies
1886:Diastolic
1858:Perfusion
1617:Inotropic
1496:Afterload
1318:"thrill".
1220:(1): 66.
597:Tennessee
455:. As the
382:tricuspid
143:Tricuspid
130:for each
106:Front of
3113:thrombus
3050:Arterial
2642:Systolic
2615:Split S2
2458:Pap test
2423:Neonatal
2149:General/
2130:COASTMAP
1881:Systolic
1659:cardiac
1347:archived
1321:Archived
1246:26159433
1164:tinnitus
1136:See also
961:split S2
878:Grade 6
870:Grade 5
862:Grade 4
854:Grade 3
846:Grade 2
834:Grade 1
787:Stenosis
533:Kentucky
453:diastole
271:stenosis
251:mm of Hg
181:auditory
152:(A) and
141:(M) and
2752:doubled
2717:carotid
2242:Hearing
1501:Preload
1303:30 June
1251:30 June
1237:4496820
1010:of the
889:cardiac
610:Murmurs
390:systole
380:, i.e.
333:. V.S.
329:. R.V.
325:. R.A.
321:. P.A.
317:. L.V.
297:. A O.
3150:Venous
3020:J wave
2916:Other
2585:Angina
2473:Sports
2304:Other
2121:OPQRST
2116:SAMPLE
1791:Aortic
1779:atrial
1752:atrial
1748:Right
1721:U wave
1716:T wave
1691:P wave
1664:atrial
1244:
1234:
1125:laptop
994:Clicks
794:using
790:valve.
701:valve.
591:, and
386:mitral
378:valves
305:. In.
226:, and
202:) and
190:and a
150:Aortic
139:Mitral
120:pleura
108:thorax
2988:Other
2826:Shock
2778:Other
2729:Pulse
2712:Bruit
2491:RED-S
2252:Rinne
2247:Weber
2217:HEENT
1853:Pulse
1800:Other
1775:Left
1769:wedge
1440:Heart
1142:Pulse
1034:aorta
1006:, an
966:With
823:Grade
572:, or
524:, or
461:aorta
443:(the
412:, or
353:, or
299:Aorta
263:bruit
165:heart
145:(T).
124:heart
116:lungs
112:bones
2151:IPPA
2126:SOAP
2038:and
1305:2021
1253:2021
1242:PMID
1102:(to
1084:(to
1053:(to
1032:(to
1000:Rubs
568:The
520:The
447:and
408:The
384:and
349:The
236:and
214:and
156:(P).
3014:EKG
1546:= (
1374:doi
1232:PMC
1222:doi
1129:MP3
1127:or
265:or
257:or
192:dub
188:lub
3208::
2625:S4
2620:S3
1368:.
1364:.
1345:,
1341:,
1295:.
1282:^
1272:.
1261:^
1240:.
1230:.
1218:14
1216:.
1212:.
1184:^
841:.
488:,
400:.
243:.
222:,
206:(S
198:(S
114:,
2998::
2971::
2967:/
2939:/
2929::
2552:e
2545:t
2538:v
2028:e
2021:t
2014:v
1823:/
1613:)
1609:(
1603:)
1599:(
1424:e
1417:t
1410:v
1380:.
1376::
1370:2
1307:.
1255:.
1224::
1106:)
1088:)
1057:)
1036:)
950:.
759:.
713:.
666:.
576:4
574:S
528:3
526:S
475:2
473:S
437:2
433:2
429:2
425:2
421:2
416:2
414:S
374:1
370:1
366:1
362:1
357:1
355:S
337:.
240:4
238:S
233:3
231:S
208:2
200:1
97:.
85:.
20:)
Text is available under the Creative Commons Attribution-ShareAlike License. Additional terms may apply.
