Precordium Sounds
Ventricular Gallop (S3)
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The third heart sound
This low frequency vibration occurs after S1 and S2 and seems to result from the change
in blood flow at diastole when rapid filling ends and slow filling starts
When listening to S3, the heart sounds resemble the pronunciation of Ken-tuck-Y, with
the Y representing S3. S3 has been described as testing “the auscultatory skills of the
examiner” because of its low frequency and intensity, as well as interference of the
normal sounds in the chest from the lungs and abdomen.
Best heard with the BELL of the stethoscope
Sometimes it is normally heard in those under the age of 40 and in trained athletes
Atrial Gallop (S4)
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The fourth heart sound
Low frequency sound that occurs in late diastolic filling due to atrial contraction. This
causes vibrations in the ventricular walls and happens just before S1, making it difficult
to hear.
If loud, it can indicate pathology
Resembles the pronunciation of the word TEN-nes-see, with TEN representing S4.
When it is clearly heard, it can indicate increased resistance to ventricular filling
Sometimes S4 can occur normally in people older than the age of 40, especially after
exercise
Tachycardia (rapid resting heart rate)
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Considered an arrhythmia
Resting heart rate over 100 beats per minute
Factors that can contribute to tachycardia:
o No associated heart problems------stress from illness
More serious issues can arise if tachycardia is chronic and untreated. Heart function can
be disrupted, and serious complications can occur.
Bradycardia (slow resting heart rate)
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Considered an arrhythmia
Resting heart rate less than 60 beats per minute
Seen in healthy, young athletes
Can be a sign of dysfunction in the heart’s electrical system
Pericarditis Friction Rub
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A sound generated from inflammation of the pericardial sac. As it rubs against the linings
surrounding the heart
Not really considered a heart sound
Pericarditis is an inflammatory disease of the pericardium, which causes the membranes
to become sticky, producing friction when the heart beats or the patient breathes
The sound is a scratching, grating, high frequency sound that is heard in both systole and
diastole
Heard best with the DIAPHRAGM at the lower left sternal border
Murmurs
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Produced by turbulent blood flow
Normally heard during auscultation, but they take practice to identify
Innocent (or functional) murmurs
o Non-cardiac murmurs
o Related to pregnancy, hyperthyroidism, exercise, and anemia
o Most often heard in children
o This type of murmur is normally heard with systole in the pulmonic precordial
area
Pathological murmurs
o Due to congenital or valvular defects
o Specific valvular defects can be identified by their timing (during S, systolic, S,
diastolic) and the auscultation region where they are heard.