Talk:Heart sounds

quotation for gradation
I think you should quote the original textbook from Samuel Levine who "invented" the scale.

http://www.sciencedirect.com/science/article/pii/S0002914908010588#tbl1

A.R. Freeman and S.A. Levine, The clinical significance of the systolic murmur: A study of 1000 consecutive “non-cardiac” cases, Ann Intern Med 6 (1933), pp. 1371–1385. --134.176.252.159 (talk) 18:56, 27 July 2011 (UTC)

Hey
Hey, very usefull article, and I'm only a high school biology student so i felt weird editing this but it said "Yet even those these" and i changed it to "Yet, even though these" becuase it was the obvious intended meaning. 24.22.106.14 01:42, 9 December 2005 (UTC) Andrew McGuiness

Abnormal heart sounds
Would be useful to include a discussion about S3 and S4 heart sounds.


 * S3 is the sound of blood rushing into the ventricles during ventricular diastole, and S4 is the turbulence created during atrial systole. Both typically need to be recorded and possibly enchanced to discern specific diseases within the heart using the S3 and S4 heart sounds.  Can anyone out there make that substantial enough to be encyclopedic?--Ryan! 04:12, 28 September 2006 (UTC)

Also, S3 is, according to Lilly's Pathophysiology of Heart Disease 4th ed., ch 2, p37, the result of tensing of the chordae tendineae during rapid filling and expansion of the ventricle. That seems much more specific (and plausible) than the explanation given about the "vibration of the ventricle and the surrounding structures." That brought to my view the entire ventricle vibrating, which is innacurate. Peetiemd 00:30, 3 October 2007 (UTC)

S3 is not the sound of rushing blood, which is descriptive of a murmur. As clearly shown in numerous recently published studies, S3 is caused by deceleration of early diastolic blood flow, resulting in a transfer of kinetic energy to the left ventricle and surrounding structures. The chordea tensing theory was discredited decades ago. S3 is a very low frequency sound, which suggests oscillation of a very large structure, certainly not chordae. The above comment stating that the entire ventricle vibrating as innacurate is misguided, likely by obsolete medical references.

S4 is not turbulence, but akin to the mechanism which produces S3, except the flow of S4 is powered by the atrial kick. —Preceding unsigned comment added by 76.17.202.79 (talk) 02:26, 22 February 2008 (UTC)

Soft versus Loud Murmurs
"soft murmurs are less likely to reflect a serious, if any, health problem; loud murmurs essentially always reflect a problem"

Can someone confirm this statement, I've always been taught otherwise. I was under the impression loudness gave no indication of the severity of the problem. 220.245.161.190 13:56, 26 July 2007 (UTC)

I will agree with you. I was taught that intensity of murmurs could not be used to differentiate severity of heart pathology. 75.187.51.238 02:11, 9 October 2007 (UTC)

Very small septal defects will cause very loud murmurs. Yet another reason why nobody should trust wikipedia for anything but fun browsing. —Preceding unsigned comment added by 92.232.46.19 (talk) 17:44, 11 June 2008 (UTC)

Notation
I think it would be helpful to have a section in here about doctors' notation, e.g. my notes say HS 1+2+0 which refers to heart sounds but am not entirely sure what this means. —Preceding unsigned comment added by 78.150.63.133 (talk) 17:08, 16 December 2007 (UTC)

S3 and S4 merge/split
Currently S3 and S4 are covered fairly extensively in two different articles, as a subsection of this heart sounds article and more extensively in gallop rhythm. They should be consolidated somehow, including these options: Being somewhat of a separatist, I vote for (1), but I wanted to open it up to some debate before jumping in. Please opine. - Draeco (talk) 05:03, 30 April 2008 (UTC)
 * 1) Split this info into separate articles for S3 (heart sound) and S4 (heart sound)
 * 2) Merge the gallop rhythm into this page
 * 3) Merge this page's subsection into gallop rhythm
 * Support. --Arcadian (talk) 16:36, 4 May 2008 (UTC)
 * Support. But currently the article on S3 just redirects to the S3 portion of heart sounds article. Mikr18 (talk) 08:57, 23 June 2008 (UTC)
 * Done - Third heart sound and Fourth heart sound articles have been created with all redirects fixed. Gallop rhythm remains as basically a cursory overview of s3, s4, and combinations thereof. Heart sounds retains an abbreviated mention of s3 and s4 with links. - Draeco (talk) 18:04, 7 July 2008 (UTC)

Auscultation points: punctum quintum
I would like to see all the auscultation points mentioned, including alternate names for them. I have had trouble finding information about the "punctum quintum", known in German as the "Erb-Punkt" (one of two meanings of this term): "Schließlich wird auch ein Auskultationspunkt über dem Herzen (dritter Interkostalraum zwei Fingerbreit links vom Brustbein) so genannt. Dort sind alle Herztöne und mögliche Herzgeräusche gemeinsam hörbar." "... an auscultation point over the heart (third intercostal space two fingers to the left of the sternum) ... all heart sounds and possible noises can be heard together there (Pschyrembel Klinisches Woerterbuch 259th edn.). Thomas.Hedden (talk) 01:33, 17 December 2008 (UTC)

I agree with the above, although I don't know if I'd take it as far as all the alternate names. My feeling is that too many wikipedia science pages get too bogged down in technical details and jargon and wind up unreadable to average users. To me, that's not what an encyclopedia is supposed to be about. Even a medical encyclopedia should be a starting point for research, and that is all. That said, it would certainly be helpful to include on this page an article about auscultating heart sounds relative to anatomy. For example, as a start, it would be interesting to know where the S1, S2 sounds can be heard loudest. The best locations to place a stethoscope in order to auscultate the various murmurs you have detailed on the page would also be informative. But, I think "upper left sternal border", "lower left sternal border", the aortic pulmonic, tricuspid and mitrial sites relative to the sternal border, intercostal spaces, apex and base of the heart (etc) would be suffice. I would be willing to write a small article on this when I have some time. I should tell you that I am almost an RN (taking the NCLEX in a few weeks), not a cardiologist. I don't know if that matters to the community. But, I think I could convey this information simplistically and that would be suffice for an encyclopedia treatment of auscultation IMO. It could also serve as a solid building block for additional information if the community judges it to be insufficient. Others let me know if it (or I) belongs here. I don't want to step on any toes. - Ev —Preceding unsigned comment added by 96.234.4.123 (talk) 05:21, 16 August 2009 (UTC)

The image and notes for the auscultation point for listening to the tricuspid valve isn't conventional (it says it's on the right). The valve is often retrosternal, but commonest point for ausultation is the left 3rd and 4th interspace closest to the sternum as the right ventricle is anterior to the left ventricle, but still is mostly on the left side. If you just do a google iages search for tricuspid valve auscultation you will see what I mean. I haven't seen another image with it on the right? If no one responds I will change the image and info in a few weeks. — Preceding unsigned comment added by Brooksie1985 (talk • contribs) 07:42, 24 September 2011 (UTC) I concur with the above comment on the conventional location for tricuspid valve auscultation, and agree that it should be changed. A good reference here is The Pathophysiology of Heart Disease, Leonard S. Lilly, 4th Edition, P. 32, Figure 2.2. Ciarán Anthony DellaFera, BSG (talk) 18:33, 10 October 2011 (UTC)

Aware Sensation
This is a bit odd but im trying to word it correctly. I have a sensory processing disorder, one that targets my sense of touch for the most part. But this extreme combinations plus a mitral valve prolapse and the resultant panic attacks has actually made it so i can feel, ongoing in my chest, the different segments of a heartbeat.

This is monumentally disturbing because if i try to describe it no one knows whati m talking about. Like, having to sleep on my right side because i feel the secondary parts as a small push up and down when on my left side, exaggerated to where it feels like it could be moving me. (It isnt.) This is true of the big artery thingies that are near your collar bone and go into arms, but thats much more rare for me to experience.

Would this be a good area to discuss things like this? Because if you don't know whats going on when it happens, it's probably going to utterly terrify you. I was thinking, something like a chart or diagram showing where the different pressures are nearest to and how they work with the other parts, maybe a .gif or something done based on average resting rate. I have no art skills, or MSpaint skills, so cant do so myself. Also can't time it myself, as paying that much attention to my heart triggers minor mitral valve twinges, which make me nervous which... well you see where this is going im sure. 74.128.56.194 (talk) 10:46, 26 May 2011 (UTC)

S1 Heart Sounds.
The discussion of S1 has me a little confused. Near the start of the paragraph it states, “ Normally M1 precedes T1slightly” yet toward the end of the paragraph it states, “ If T1 occurs slightly after M1, then the patient likely has a dysfunction of conduction of the right side of the heart such as a right bundle branch block.”

“if T1 occurs after M1” is surely the same as “M1 preceeds T1” and yet this is both normal and indicative of pathology?

Could someone wiser than me elaborate or correct?

Glidingdoc (talk) 10:15, 4 June 2012 (UTC)

"[ Edit ]" links formatting issue
For some reason, on this page the usual "[ edit ]" links that you get to the right of each section heading aren't formatting themselves normally. I don't know what's causing it, as when you edit and do a preview, the edit links no longer show up! — Preceding unsigned comment added by 5.42.129.104 (talk) 22:56, 3 March 2016 (UTC)

Heart sounds
— Preceding unsigned comment added by 2601:240:D103:C100:5C98:2363:4A4E:BAF9 (talk) 19:30, 4 August 2016 (UTC)