Practical

physiology (CVS)

Dr. Ramadan Mohamed Ahmed

Associate. Prof. in physiology
Heart Sounds
Stethoscope
 THE STETHOSCOPE
 A special instrument used to study sounds normally heard over certain organs or
abnormally produced in the body. Stethoscope is formed of three parts:

1- The ear pieces: which should be well-fitted to the external auditory meatus. The
fit is very important to prevent reduction of loudness of sound.

2-The rubber tubes: They should be thick-walled, about 50 cm long.

 No fissures should be allowed as they may lead to leakage of sound.

3-The end piece: there are 2 standard shapes, the bell and the diaphragm.
 The bell is best used for detection of low pitched sounds and murmurs.

 The diaphragm: is used best for hearing high-pitched sounds and murmurs.
 Heart sounds
First heart sound Second heart sound

Characters: - Low pitched High pitched

Site of best a- Mitral area. a- Aortic area
hearing: b- Tricuspid area b- Pulmonary area
cause Closure of A-V valves Closure of semilunar valves.

Relation to Begin of systole Begin of diastole

cardiac
cycle
Auscultatory areas
 Auscultatory areas
a- Mitral area:
at the 5th intercostals space, in midclavicular line,
b- Tricuspid area:
heard at lower end of the sternum
c- Aortic component:
at the second Rt costo -sternal junction
d- Pulmonary component:
heard at the second left intercostal space parasternally
•

Auscultation Areas
N.B. Both the 1st & 2nd heart sounds are heard over these areas, but the first
sound is best heard over the mitral and tricuspid area, while the second sound
is best heard over the pulmonary and aortic area.
Splitting of heart sounds
The two components of the second heart sound nearly
overlap like the first. But during inspiration the interval
between the aortic and pulmonary valve closure is
frequently long enough for the second sound to be
heard as two sounds: duplicated.
Heart Murmurs
Definition: abnormal noisy sounds heard over the heart, if the blood flow is turbulent.
This occurs if the valve is narrow (stenosis) or incompetent (regurgitation.

Systolic Diastolic

1- Incompetence or AV valves. Semilunar valves.

regurgitation of:

2- Stenosis Semilunar valves.. AV valves

(narrowing) of:
Auscultatory areas