Heart Sound Abnormalities
S1
Loud
- MV or TV open long -> shuts forcefully
- MS
- increased HR
- short AV conduction
Soft
- first degree HB
- LBBB
- MR
Splitting
- RBBB
S2
Loud
- HT
- AS
- PHT
Soft
- AS
- AR
Splitting
- increased normal splitting (wider on inspiration): RBBB, PS, VSD, MR
- fixed splitting (no respiratory variation): ASD
- reversed splitting (in expiration): LBBB, AS, coarctation, PDA
S3
- = low pitched, mid-diastolic (gallop rhythm)
- children
- decreased ventricular compliance
- pregnancy
- LV failure
- MR
- AR
- VSD
- PDA
S4
- = late diastolic noise
- lost in AF
- diastolc dysfunction
- ASMR
- HTN
- MI
- angina
OTHER
- summation gallop (S3+4 superimposed): HR >120/min
- opening snap: after S2 – MS
- systolic ejection click: congenital AS and PS
- non-ejection click: MVP, ASD
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC