read more of the common secundum variety) or complete right bundle branch block Bundle Branch Block and Fascicular Block Bundle branch block is partial or complete interruption of impulse conduction in a bundle branch fascicular block is similar interruption in a hemifascicle of the left bundle. Delayed pulmonic valve closure may result from increased blood flow through the right ventricle (eg, in atrial septal defect Atrial Septal Defect (ASD) An atrial septal defect (ASD) is an opening in the interatrial septum, causing a left-to-right shunt and volume overload of the right atrium and right ventricle. Aortic valve closure is late in left bundle branch block or aortic stenosis pulmonic valve closure is early in some forms of preexcitation phenomena. Aortic valve closure (A2) normally precedes pulmonic valve closure (P2) unless the former is late or the latter is early. S2 occurs at the beginning of diastole, due to aortic and pulmonic valve closure. read more or tricuspid valve prolapse, typically occurring in mid to late systole, are thought to result from abnormal tension on redundant and elongated chordae tendineae or valve leaflets. The most common cause is idiopathic myxomatous degeneration. Clicks in mitral valve prolapse Mitral Valve Prolapse (MVP) Mitral valve prolapse (MVP) is a billowing of mitral valve leaflets into the left atrium during systole. In pulmonary hypertension, pulmonary vessels may become constricted. It has many secondary causes some cases are idiopathic. Similar clicks occur in severe pulmonary hypertension Pulmonary Hypertension Pulmonary hypertension is increased pressure in the pulmonary circulation. These clicks occur early in systole (very near S1) and are not affected by hemodynamic changes. read more are thought to result from abnormal ventricular wall tension. S1 is often soft or absent in first-degree atrioventricular block as the atrioventricular valve leaflets (mitral and tricuspid) drift to a nearly closed position prior to ventricular systole.Ĭlicks in congenital aortic stenosis or pulmonic stenosis Pulmonic Stenosis Pulmonic stenosis (PS) is narrowing of the pulmonary outflow tract causing obstruction of blood flow from the right ventricle to the pulmonary artery during systole. read more due to valve leaflet sclerosis and rigidity but is often distinctly heard in mitral regurgitation due to myxomatous degeneration of the mitral apparatus or due to ventricular myocardial abnormality (eg, papillary muscle dysfunction, ventricular dilation). It may be soft or absent in mitral regurgitation Mitral Regurgitation Mitral regurgitation (MR) is incompetency of the mitral valve causing flow from the left ventricle (LV) into the left atrium during ventricular systole. S1 is loud in mitral stenosis Mitral Stenosis Mitral stenosis is narrowing of the mitral orifice that impedes blood flow from the left atrium to the left ventricle.
S1 occurs just after the beginning of systole and is predominantly due to mitral closure but may also include tricuspid closure components. Subsequent examination findings should be interpreted in the context of available imaging results (including echocardiogram and cardiac MRI) to diagnose and monitor valvular abnormalities. With such diagrams, findings from each examination could be compared. read more of the precordium was drawn in the patient’s chart each time the patient’s cardiovascular system was examined (see figure Diagram of physical findings Diagram of physical findings in a patient with aortic stenosis and mitral regurgitation ). Historically, a diagram of the major auscultatory and palpatory findings Palpation Complete examination of all systems is essential to detect peripheral and systemic effects of cardiac disorders and evidence of noncardiac disorders that might affect the heart.
Intensity, pitch, duration, and timing of the sounds and the intervals between them are analyzed, often providing an accurate diagnosis. The clinician focuses attention sequentially on each phase of the cardiac cycle, noting each heart sound and murmur.