Harvey

Heart Sounds *Note Hypertension is not on here!

Instructions
On each slide, move mouse cursor over each heart area to play a 10-13 second clip of the respective heart sound A description of the sound is located in the right hand column To compare to the normal heart sounds, click the arrow in the lower right hand corner Test yourself at the end

Normal
Normal Mitral Regurg

Aortic Regurg

Mitral Stenosis Mitral Valve Prolapse PDA

Aortic Sclerosis

Aortic Stenosis VSD Innocent Murmur Tricuspid Regur

Normal
Aortic
S1 and S2 are present S2 is louder than S1

Pulmonic
S1 and S2 are present S2 is louder than S1 Physiological splitting of S2 on inspiration

Tricuspid
S1 and S2 are present S1 is louder than S2

Mitral
S1 and S2 are present S1 is louder than S2 S3 may be heard with a young fit patient
Normal

Aortic Regurgitation
Aortic Diminished S1 followed by ES, (ejection sound) Crescendo decrescendo murmur Medium frequency Grade 2 AND Diastolic decrescendo murmur High frequency Grade 2 Pulmonic Diastolic decrescendo murmur Grade 2 Tricuspid Diastolic decrescendo murmur Grade 3 Mitral Low frequency mid-diastolic Austin-Flint murmur=Crescendo decrescendo Grade 2

Normal

Aortic Sclerosis
Aortic
Early peaking systolic Crescendo - decrescendo murmur Medium frequency Grade 2

Pulmonic
S1 and S2 heard, S2 louder than S1, normal physiological splitting of S2 w/ inspiration, no added sounds, no murmurs

Tricuspid
Splitting of S1 due to asynchronous M&T closure

Mitral
Systolic Crescendo decrescendo murmur Medium frequency Grade 1
Normal

Aortic Stenosis
Aortic
S1 followed by ES Systolic murmur Medium frequency Crescendo decrescendo Grade 3 Systolic Crescendo decrescendo murmur Grade 2 Systolic Crescendo decrescendo murmur Grade 2 Systolic Crescendo decrescendo murmur with prominent S4 (due to atrial contraction) High frequency Grade 1

Pulmonic

Tricuspid

Mitral

Normal

Innocent Murmur
Aortic
S1 and S2 heard, S2 louder than S1, no added sounds, no murmurs

Pulmonic
S1 and S2 heard, S2 louder than S1, normal physiological splitting of S2 w/ inspiration and Systolic Crescendo - decrescendo murmur Medium frequency Grade 2

Tricuspid
Splitting of S1 due to asynchronous M&T closure

Mitral
S3 present Low frequency occurring in diastole

Normal

Mitral Regurgitation
Aortic
S1 and S2 heard, S2 louder than S1, no added sounds, no murmurs

Pulmonic
S1 and S2 heard, S2 louder than S1, normal physiological splitting of S2 w/ inspiration, no added sounds, no murmurs

Tricuspid
S1 and S2 heard, S1 louder than S2, no added sounds, no murmurs

Mitral
S1 obscured by a holosystolic murmur High frequency Grade 3 An S3 is heard introducing a mid-diastolic, crescendo decrescendo murmur Low frequency Grade 2

Normal

Mitral Stenosis
Aortic
S1 and S2 heard, S1 is increased, due to mitral stenosis S1 is increased followed by an ES and loud P2 due to pulmonary HTN Holosystolic murmur High frequency Grade 2 Followed by an S3 mid diastolic crescendo decrescendo murmur that increases upon inspiration Low frequency Grade 1 Loud S1 with OS diastolic crescendo decrescendo crescendo murmur Low frequency Grade 3

Pulmonic Tricuspid

Mitral

Normal

Mitral Valve Prolapse

Aortic
S1 and S2 heard, S2 louder than S1, no added sounds, no murmurs S1 and S2 heard, S2 louder than S1, normal physiological splitting of S2 w/ inspiration, no added sounds, no murmurs Late systolic crescendo murmur w/ Mid-systolic click Hi frequency Grade 2 Late systolic crescendo murmur w/ Mid-systolic click Hi frequency Grade 3

Pulmonic

Tricuspid

Mitral

Normal

Patent Ductus Arteriosis

Aortic
S1 and S2 heard, S2 louder than S1, no added sounds, no murmurs

Pulmonic
Continuous murmur High frequency Grade 3 S1 and S2 heard, S1 louder than S2, no added sounds, no murmurs

Tricuspid

Mitral
S3 is heard followed by Crescendo decrescendo diastolic murmur Low frequency Grade 2

Normal

Ventricular Septal Defect

Aortic S1 and S2 heard, S2 louder than S1, no added sounds, no murmurs Pulmonic
S1 and S2 heard, S2 louder than S1, normal physiological splitting of S2 w/ inspiration with an early systolic crescendo decrescendo murmur Medium frequency Grade 1 Holosystolic decrescendo murmur High frequency Grade 3 Holosystolic decrescendo murmur High frequency Grade 2

Tricuspid

Mitral

Normal

Tricuspid Regurgitation
Aortic
S1 and S2 heard, S2 louder than S1, no added sounds, no murmurs

Pulmonic
S1 and S2 heard, S2 louder than S1, normal physiological splitting of S2 w/ inspiration, no added sounds, no murmurs

Tricuspid
Holosystolic murmur Grade 3

Mitral
S1 and S2 are present S1 is louder than S2 S3 heard, no murmurs

Normal

Quiz
Move your cursor over each heart sound area Left click to reveal what should be heard in the order of aortic, pulmonic, tricuspid, mitral, then diagnosis

Innocent Murmur
Aortic
Normal

Pulmonic
Systolic murmur Crescendo - decrescendo Grade 2

Tricuspid
Normal

Mitral
S3 present

Mitral Regurgitation
Aortic
Normal

Pulmonic
Normal

Tricuspid
Normal

Mitral
Holosystolic murmur Grade 3

Aortic Regurgitation
Aortic
Long diastolic murmur Crescendo decrescendo Grade 2 Ejection sound

Pulmonic
Diastolic murmur Decrescendo Grade 2

Tricuspid
Diastolic murmur Decrescendo Grade 3

Mitral
Mid-diastolic Austin-Flint Murmur Decrescendo Grade 2

Aortic Sclerosis
Aortic
Systolic murmur Crescendo - decrescendo Grade 2

Pulmonic
Normal

Tricuspid
S1 split

Mitral
Systolic murmur Crescendo - decrescendo Grade 1

Aortic Stenosis
Aortic
Systolic murmur Crescendo decrescendo Grade 3

Pulmonic
Systolic murmur Crescendo decrescendo Grade 2

Tricuspid
Systolic murmur Crescendo decrescendo Grade 2

Mitral
Systolic murmur Crescendo decrescendo Grade 1 S4

Tricuspid Regurgitation
Aortic
Normal

Pulmonic
Normal

Tricuspid
Holosystolic murmur Grade 3

Mitral
Normal

Ventricular Septal Defect

Aortic
Normal

Pulmonic
Systolic murmur Crescendo - decrescendo Grade 1

Tricuspid
Holosystolic murmur Grade 3

Mitral
Holosystolic murmur Grade 2

Patent Ductus Arteriosis

Aortic
Normal

Pulmonic
Continuous murmur Grade 3

Tricuspid
Normal

Mitral
S3 Diastolic murmur Crescendo - decrescendo Grade 2

Normal
Aortic
S1 and S2 are present S2 is louder than S1

Pulmonic
S1 and S2 are present S2 is louder than S1 Physiological splitting of S2 on inspiration

Tricuspid
S1 and S2 are present S1 is louder than S2

Mitral
S1 and S2 are present S1 is louder than S2 S3 may be heard with a young fit patient

Mitral Stenosis
Aortic
Normal

Pulmonic
Ejection sound

Tricuspid
Diastolic murmur Crescendo decrescendo crescendo Grade 1

Mitral
Diastolic murmur Crescendo decrescendo crescendo Grade 1

Mitral Valve Prolapse

Aortic
Normal

Pulmonic
Normal

Tricuspid
Mid-systolic click Systolic murmur Crescendo Grade 2 Mid-systolic click Systolic murmur Crescendo Grade 3

Mitral