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The two major sounds heard in the normal heart sound like “lub dub”. The “ lub” is the first heart sound, commonly termed S1, and is caused by turbulence caused by the closure of mitral and tricuspid valves at the start of systole.

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The two major sounds heard in the normal heart sound like “lub dub”. The “ lub” is the first heart sound, commonly termed S1, and is caused by turbulence caused by the closure of mitral and tricuspid valves at the start of systole. The fourth heart sound or S 4 is an extra heart sound that occurs during late diastole, immediately before the normal two "lub-dub" heart sounds (S 1 and S 2).It occurs just after atrial contraction and immediately before the systolic S 1 and is caused by the atria contracting forcefully in an effort to overcome an abnormally stiff or hypertrophic ventricle. Heart sounds come from the various valves of the heart including the bicuspid, mitral, tricuspid, and aortic valves.

Four sounds of heart

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Four sounds of heart

Learn more about the hardest working muscle in the body with this quick guide to the anatomy of the heart Heart blockage is a serious medical condition that can lead to death. Keep reading to learn about the signs and symptoms of heart blockage, and what to do if you are experiencing them. An echocardiogram creates images of the heart using sound waves. It can reveal a great deal of information useful to doctors in treating heart patients.
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What Are The Four Heart Sounds? Heart sounds are generated by blood flowing in and out of the heart’s chambers through the valves as they open and close.

When diastole is short or the PR interval long, third and fourth heart sounds  Systolic regurgitant murmurs are associated with mitral and tricuspid insufficiency and ventricular septal defects (Figs 1, 4 and 5). Systolic ejection murmurs  Four heart sounds can potentially be ausculted.
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A fourth sound, also occurring during diastole, is revealed by graphic methods but is usually inaudible in normal subjects; it is believed to be the result of atrial contraction and the impact of blood, expelled from the atria, against the ventricular wall.

Different heart sounds and murmurs are distinguished by four characteristics: (1) timing (i.e., systolic or diastolic), (2) intensity (i.e., loud or soft), (3) duration (i.e., long or short), and (4) pitch (i.e., low or high frequency). A fifth characteristic, the sound’s quality, is also sometimes included in descriptions of sounds (e.g., it may be described as “musical,” a “whoop,” or a “honk”).


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The base of the heart is where the aortic and pulmonic S2 sound will be loudest. The apex is where the tricuspid and mitral S1 sound is loudest upon auscultation. The apex region will also be where S3 and S4 sounds (extra heart sounds not usually noted in normal assessments) and mitral stenosis murmurs may be auscultated, if present.

At the base (the part of the heart between the apex and the sternum) In the aortic and pulmonary areas to the right and left of the sternum, respectively; Listen for normal heart sounds: The 1 st heart sound, S1 (lub), marks the beginning of systole (end of systole). There are four important areas used for listening to heart sounds. These are: Aortic area, Pulmonic area, Tricuspid area, Mitral Area (Apex). A common notation for a sound heard at an auscultatory site is to use the first initial of the site and the number 1 or 2 to describe the first or second heart sound respectively.