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Diastolic heart sounds include the 2 nd, 3 rd, and 4 th heart sounds (S 2, S 3, and S 4), as well as knocks and snaps. S 1 is a high-pitched sound caused by the closing of the mitral and tricuspid valves just after the beginning of systole.
Opening snap (OS) is a high-pitched sound that is caused by rapid opening of the mitral or tricuspid valve following the aortic valve closing sound (S2). This may indicate narrowing (stenosis) of the mitral or tricuspid valve; the closer in time the OS is to S2, the more severe the stenosis.
The purpose of auscultation of the heart is to characterize heart sounds and murmurs. (See "Examination of the precordial pulsation" and "Examination of the arterial pulse" and "Assessment of the jugular venous pressure".) This topic will review the auscultation of heart sounds.
S3, with or without S4, is usual in significant systolic left ventricular dysfunction; S4 without S3 is usual in diastolic left ventricular dysfunction. A summation gallop occurs when S3 and S4 are present in a patient with tachycardia, which shortens diastole so that the 2 sounds merge.
In healthy adults, there are two normal heart sounds, often described as a lub and a dub that occur in sequence with each heartbeat. These are the first heart sound (S 1) and second heart sound (S 2), produced by the closing of the atrioventricular valves and semilunar valves, respectively.
Before you listen to heart sounds you must know how to use your stethoscope’s chest piece properly. Diaphragm: use for listening to HIGH PITCHED sounds like S1, S2, and aortic/pulmonic murmurs. Bell: use for listening to LOW PITCHED sounds like S3, S4, and mitral stenosis murmurs.
Examples of diastolic murmurs are aortic and pulmonic valve regurgitation (AR & PR), tricuspid and mitral valve stenosis (TS & MS), S3 sounds, and S4 sounds. Diastolic heart sounds are more clinically significant because all diastolic murmurs are pathologic, except for some S3.