VOICES OF THE HEART

VOICES OF THE HEART

S1:

1. Happen time katub M/T closed

2. M1 precedes and harder than T1

3. Looks low – use bell

4. in sync with the pulsation in the apical kordis/aa. Carotid

5. S1 harden when katub wide open mitral systolic time:

- Mitral stenosis with normal sinus rhythm

- A State with a high output (anemia, hipertiroidi, etc)

- Sudden PR Interval

6. S1 weakened when katub has an opportunity to move 

towards closing before the systolic

- Degree AV block I (PR interval extends)

- Bradikardia with a long diastolic

7. S1 varies in position of the pulse to the fickle katub Pulse:

- AV block total

- Atrial fibrillation

S2:

1. Place the A/katub Po closes, high pitch – diaphragm

2. A2 precedes and harder than P2

3. Fixed splitting (bifurcated). (splitting time sounds of inspiration and ekspirasi) – found in the ASD (Atrial Septal Defects)

4. Paradoxical splitting (splitting sounds more clear ekspirasi time), 

therefore the P2 preceding the A2.

- Aortic stenosis

- LBBB (Left Bundle Branch Block)

- PDA (Patent Ductus Arteriousus)

5. Wide splitting due to the delay in right ventricular ejection or left 

ventricular ejection is too fast:

- Mitral insufficiency/regurgitation

- RBBB (Right Bundle Branch Block)

- Pulmonic stenosis

- ASD (Atrial Septal Defects), there is a fixed splitting

6. Normal is called physiologic Splitting splitting

S3:

1. Quick charging occurs at the end of the ventricles, low pitched

2. Most obviously in apical kordis

3. Physiological in children and adults

4. Pathological on young adults, indicating the presence of heart failure, myocarditis or myocardiopathy, amyloidosis

5. Rhythm that occurs due to the S3 gallop rhythm is called protodiastolik / ventrikuler

S4:

1. Occurs because the ventricle dipak distensi-sakan resulting from contraction of the atrium

2. Most definitely sound on Apex kordis

3. Physiological when obtained in children

4. Pathological if obtained in adults is usually due to pressure overload such as aortic stenosis/pulmonic

5. Rhythm that occurs due to S4 gallop rhythm called presistolik/atrial

6. S3 and S4 can be heard as one voice what-if there is a takhikardia, a rhythm that occurs is called the rhythm summasi gallop.

HEART MURMURS (NOISY)

• Due to the turbulence and the formation of bubbles in the circulatory system

• The Mechanism

-Pressure difference

-The normal Noisy – increased blood flow

• Any noisy described as follows. :

1. Phase

2. Location

3. Intensity

4. Tone

5. long time

6. Quality

Pictures

To clarify the noisy heart or pulse needed interventions or a special maneuver:

1. Respiration

2. Valsalva maneuver

3. Change positions

4. physical exercise (example: Hurricane isometric handgrip exercise, etc.)

5. change of pace/rhythm of heart rate (example: the carotid sinus massage, etc.)

6. pharmacological interventions (amyl nitrite inhalation or granting of a vasoconstrictor such as phenylephrine v. i., norepinephrine, methoxamine, mephentermine, etc.)

7. Transient arterial occlusion: by raising the tensimeter > 20 mmHg above the systolic pressure.

IN THE HEART OF THE EXAMINATION INCLUDE:

1. Anamnesis

2. physical examination

3. an electrocardiogram

4. Penerawangan/photo chest

5. Non-Invasive Examination: ekhokardiogram, nuclear cardiology, etc

6. Examination: Minimally Invasive cardiac catheterization, angiokardiografi