CLINICAL-HEART SOUNDS ABNORMALITIES

SUMMARY

LOUD
1. Loud S1: MS, TS
2. Loud S2: AS, PS, pulmonary HTN

SOFT
3. Soft S1: failure of leaflets to coapt normally (MR), prolonged diastole (1st degree heart block), delayed systole (LBBB)
4. Soft S2: AR

ABNORMAL SPLITTING
5. Increased normal splitting of S2: delayed RV emptying (RBBB, MR, VSD, pulmonary stenosis)
6. Fixed splitting of S2: ASD
7. Reversed splitting of S2: LBBB, severe AS, aortic coarctation, large PDA

NOTE
S1 - closure of MV/TV; S2 - closure of AV/PV

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].