Heart Sounds

A lecture on the recognition and physiology of both normal and abnormal heart sounds with numerous audio examples. Covered sounds include S1, S2, S3, S4, clicks, an opening snap and pericardial knock. The scientific evidence for the diagnostic utility of abnormal sounds is also discussed. For the most accurate reproduction of the heart sounds, I recommend listening with headphones instead of standard external computer speakers.

Use of the VA and Stanford name/logos is only to indicate my academic affiliation, and neither implies endorsement nor ownership of the included material.

[ZDoggMD]

ERIC!! You are KILLING it on the 'Tube man. Congratulations of edutaining the world!

[MuhammadJunaidAshraf]

This is a GREAT video. I never knew I wanted S1, split S2 and S3 in the same clip until I listened to it here. Thank you Doctor Strong.

[yvette]

Excellent video. I auscultated my heart after experiencing heart palpitations (which I attributed to stress) and identified an S2 split with inspiration and expiration. I had a friend of mine (ED physician) take a listen and he agreed. Made an appointment with my cardiologist (I was diagnosed with postural orthostatic tachycardia syndrome a while back...it's not a big deal) and told him I wanted an echo to rule out an ASD. Well, the echo confirmed my suspicion! 

[StrongMed]

If you initially struggle with the more obscure findings such as MVP click, opening snap, abnormalities of S2 splitting, don't worry - these relatively minor details will not hold you back from becoming an outstanding doctor. But if you work hard at the improving your cardiac exam over years, I think you'll find this skill to be helpful in diagnosis, as well as personally rewarding.

[VictorForysMD]

The internet is amazing. Wish we had it in the 80's

[StrongMed]

The general point you are making is very valid - we don't fully understand the physics of what generates S1 and S2 (or S3, S4 either). Whether S1 and S2 are caused by sudden approximation of the cusps, vibration of the cusps, or vibrations within the blood is debated and not known for certain. However, the distinction is prob. of minimal clinical relevance, and in the interest of clarifty for beginners, I usually simplify it and describe the sounds as just being caused by valve closure....

[Ahmadinho]

I have  never commented on a video on youtube
i signed in just to thank you, , , you just saved my life :)
i really can't thank you enogh !

[StrongMed]

LBBB causes a soft S1 through two closely related mechanisms. First, it leads to a longer delay from atrial contraction to LV contraction, mimicking the same effect as a long PR interval. Second, the force of LV contraction in early systole is diminished in LBBB as the ventricle is depolarized in a relatively uncoordinated and inefficient fashion. The consequence of both these mechanisms is a less vigorous closure of the mitral valve, and thus softer S1.

[StrongMed]

Preeti, the best way to differentiate them is by their duration. S3 and S4 are brief - simulated by tapping your finger on a wooden surface. Murmurs last longer - simulated by modestly forceful exhalation through pursed lips. If you compare the audio examples from this lecture to those in my accompanying lecture on heart murmurs, I think it will be more clear. Thanks for watching!

[digw]

Brazil's medical students says thank you for your lectures! Saving our souls in exam seasons!

[timothyadam]

Med Student at University of Witwatersraand SA.  Really useful! Thanks for the lecture!

[drharveyshahnam]

extremely comprehensive. thank you from a doctor in australia. Keep up the outstanding work.

[ujule]

WOW... excellent video, the way yuo present the theory and de audio clips is very helpful. I've just finisihed med school, and I'm currently  in a 1 year program of basic and clinical research, ( my area is neurodegenearative diseases and biomarkers in the skin), in the next months I'm goint to present the "ENARM test", in order to qualify for a medical residency, and I'm happy to get  back to the basics I spend to much time in the lab, and I've got a little bit rusty in some clinical skills.

[tammyjay]

Im a postmaster nurse practitioner student! This was an excellent presentation! I have stored in my library for frequent use! Thanks Dr. Strong :)

[StrongMed]

which has 2 subtypes - atrial and ventricular. Although "abnormal", it is not necessarily dangerous, though would require explanation if you were young and otherwise healthy. The only way to diagnose this is to get an EKG at the exact moment you are having the problem. Depending on where you live, an event monitor or something called a Ziopatch could help diagnose this, but depending on the other components of your medical history and exam, your doctor may not feel it's necessary.

[aleksandardzunic]

Dear Eric, thank you very much, for all the work you've done, so far, in spreading the knowledge in cardiology in the best possible I was able to find n the internet. As a geophysicist, who spent more than 30 years in understanding the complex interference of the reflected seismic waves, bounced from thin layers, I am witnessing, that today's reflection seismic imaging, suffers from paradigms, inherited form old acquisition technology and "way of thinking", which still exist in the 21st century .

Stethoscope, as a dominant diagnostic tool, today, should and must be abandoned, due to plenty of reasons. The main one is the subjective audio perception capabilities of an practitioner, that should lead to "quantitative" estimation of the audio signal.

By analogy of 12 lead ECG acquisition equipment, in the same time, proper audio equipment should be designed, where each of the channels should be properly and precisely corrected for the frequency and phase spectrum in order to eliminate plethora of parameters in regard to specific patient (i.e. obesity, subtle difference in acoustic parameters of the patient's tissue, etc).

Further more, in order to perform separation of superimposed signals should be analysed by frequency decomposition *in order to detected close events, both in qualitative and quantitative manner.

In other words, new, audio acquisition equipment should be designed in audio consistent way, prior to mentioned objective manner of sound event separation, as well as it's quantitative analysis.

Once again, thank you for fantastic work you've done.

Kind Regards,
Aleksandar Dzunic

[StrongMed]

udaypmishra: The conventional wisdom is that severe MR decreases LV afterload by providing a second route by which blood can exit the LV. This shortens the time it takes for LV pressure to drop below aortic pressure, which then causes A2 to occur earlier. There are several reasons why this explanation may not hold up, and in reality, we aren't really sure why this happens. Bottom line however, a wide S2 from MR is an obscure finding whose specific clinical relevance is probably minimal.

[cspvlncspvln]

Dr. Strong, I'm in nursing school right now and your video about heart sounds has been the clearest presentation of the material that I have seen so far. Thank you for that. I'm wondering if you have a similar video about auscultation of adventitious lung sounds.

[pegahzarei]

Thanks so so much Dr Eric for this informative video and for your time!

[jinsungkim]

Dear Eric! This video saved me from congenital cardiac anomalies! Thank you so much (especially for the pathophysiology of S2 split part - that explanation was crucial for me)!