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CHAPTER 23: Hear Valves and Heart Sounds; Dynamics of Valvular and Congenital
Heart Defects
Heart Sounds
Normal Heart Sounds – occur upon closing of the valves:
Lub (first heart sound) – associated with closure of the atrio-ventricular
valves at the beginning of systole
Cause: When the semilunar valves close, they bulge backward toward
the ventricles, and their elastic stretch recoils the blood back into
the arteries, which causes a short period of reverberation of blood
back and forth between the walls of the arteries and the semilunar
valves, as well as between these valves and the ventricular walls.
The vibrations occurring in the arterial walls are then transmitted
mainly along the arteries. When the vibrations of the vessels or
ventricles come into contact with a “sounding board,” such as the
chest wall, they create sound that can be heard.
Note: Second heart sound has a higher frequency than the first heart
sound because the tautness of the semilunar valves in comparison
with the much less taut A-V valves, and the greater elastic
coefficient of the taut arterial walls that provide the principal
vibrating chambers for the second sound, in comparison with the
The normal pumping cycle of the heart is considered to start when the A-V valves
close at the onset of ventricular systole.
Third heart sound – occurs at the beginning of the middle third of diastole.
Cause: Oscillation of blood back and forth between the walls of the
ventricles initiated by inrushing blood from the atria.
Does not occur in the early part of the diastole because the
ventricles are not filled sufficiently to create even the small
amount of elastic tension necessary for reverberation
Atrial heart sound (Fourth heart sound) – occurs when the atria contract
Valvular Lesions
Rheumatic Valvular Lesions
Rheumatic fever – is an autoimmune disease in which the heart valves are likely to
be damaged or destroyed. It causes damaged in susceptible areas such as the heart
valves.
Note: Stenosis usually does not occur without the coexistence of at least some
degree of regurgitation, and vice versa.
Heart murmurs – abnormal heart sounds that occur when there are abnormalities
of the valves.