Cardiovascular disorders, 302.2
II. Auscultatory areas of the precordium—characterized by location at which valvular activity may usually be heard best
A. Aortic—Second right intercostal space (ICS) at the right sternal border (S2 heart sound louder than S1)
B. Pulmonic—Second left ICS at the left sternal border (S2 louder than S1)
C. Erb’s point—Third ICS at the left sternal border
D. Tricuspid—Left lower sternal border at the fifth ICS (closure of AV valves)
E. Mitral—Fifth ICS midclavicular line (S1 louder than S2)
III. S1 Heart sound
A. Denotes closure of the mitral and tricuspid (AV) valves
B. Occurs almost simultaneously with apical and carotid impulses
C. Coincides with the R wave on ECG
D. More easily heard than S2 at the apex
V. Split S2 heart sound
A. Normal event heard at end inspiration in some patients
B. Located in the pulmonic auscultatory area
C. If the patient holds his or her breath, the sounds will disappear.
D. Occurs approximately every fourth heartbeat
VI. S3 Heart sound
A. Referred to as a ventricular gallop
B. Caused by resistance to ventricular filling
C. Occurs immediately after S2 (early diastole) at the left lower sternal border (apex)
D. Occurs with such conditions as fluid overload, congestive heart failure, and cardiomyopathy
E. Normal sound associated with pregnancy (i.e., hyperdynamic state of increased volume)
F. Sounds like the word “Ken-tuc-ky”
VII. S4 Heart sound
A. Referred to as an atrial or presystolic gallop
B. Caused by increased ventricular diastolic pressure
C. Occurs immediately before S1 (late diastole)
D. Most clearly heard at the left lower sternal border (apex)
E. Occurs with such conditions as myocardial infarction, hypertension, and ventricular hypertrophy
F. Sounds like the word “Ten-nes-see”
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