Precordium Sounds Ventricular Gallop (S3) 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) 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) 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) 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 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 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.