heartsounds..

1. Timing Location Radiation Intensity Pitch Quality Configu Changes Ass with
ration
Innocent Systolic Pulmonic no Grade 1 Medium Vibratory Crescen Position, Split S2
(early) or 2 do/Decr phase of
escendo resps, heart
rate
Aortic Systolic Aortic Neck and Variable Medium Harsh Crescen No Left sided
stenosis (mid- left sternal do/Decr S4 or
systolic) border escendo paradoxical
S2 split if
loud may
feel thrill
dim S2
Pulmonic Systolic Pulmonic Left variable Medium Harsh Crescen Inc with S2 split if
stenosis (mid- shoulder, do/Decr deep loud may
systolic) Back or escendo inspiration feel thrill
neck Dim P2
right sided
S4
Tricuspid Systolic Tricuspid Right of varies High Blowing Plateau Increases
regurg (early) sternum but with
not into inspiration
axilla
Mitral regurg Systolic Mitral Left Axilla Variable High Blowing Plateau Inc with S3, wide S2
(early) if the heart often Transient split apical
is enlarged loud brachial thrill dim S1
artery
occlusion

2. Timing Location Radiation Intensity Pitch Quality Configu Changes Ass with
ration
Ventricular Systolic Tricuspid Right lower Often High Harsh Crescen no Wide S2
septal defect (early) sternal very do/Decr split with
border not loud escendo thrill
into axilla
Aortic regurg Diastolic Aortic Widely Variable High Blowing Decresc Inc with S3
(early) pt sit along left often endo isometric
leaning sternal faint exercise and
forward border handgrip
with
breath
exhaled
Pulmonic Diastolic Pulmonic Mid right Variable High Blowing Decresc no
regurg (early) sternal edge endo
Mitral Diastolic Mitral in no Variable Low Rumbling Decresc Inc after S2, and is
stenosis (mid) left lateral endo mild heralded by
decub exercise an “opening
position snap” Inc S1
Inc P2
Tricuspid Diastolic Tricuspid no Often Low Rumbling Decresc Inc with
stenosis (mid) faint endo inspiration,
sitting
forward and
exercise
Patent ductus Continuous pulmonic no Variable Machine Crescen no Ass with a
arteriosis like do/Decr thrill
escendo
Mitral valve Systolic mitral no Variable High Blowing Crescen no Ass with a
prolapse (late) often do mid systolic

3. Timing Location Radiation Intensity Pitch Quality Configu Changes Ass with
ration
faint click