hey everyone it's Sarah with register nurse rn.com and in this video I'm going to be going over heart sounds what I want to be doing is I'm going to be covering the basics of the things you need to know about listening to those heart sounds S1 S2 those extra heart sounds like s3s4 heart murmur and in the next video I'm actually going to be performing an assessment on a person and showing you by using the stethoscope how to find those anatomical positions when listening to the aortic pulmonic tricuspid and mitral Valves and walk you through how to do that now after this video be sure to go to my website registernurse rn.com and take the free quiz that will test you on this theory of listening to heart sounds because a lot of times in your health assessment classes for instance you may be asked certain questions about when do you hear S1 where do you hear it best and things like that so that can help you prepare for your exams and a card should be popping up so you can access that quiz so let's get started first let's talk about the goal what is the purpose of listening to heart sounds well the reason we listen to Heart sounds is to assess the closure of heart valves that are located in the heart where blood flows through because it tells us a lot about what's going on with the patient's heart and we're listening to four valves they're categorized into two sets and the first set are your avioventricular valves which are short for AV valves and that includes your tricuspid and mitral valves your mitral valve is also called your bicuspid valve so commit that to memory and whenever these valves close your tricuspid and your mitral that is signifying the first sound you hear the love sound which is S1 then we're looking at our semilunar valves SL valves and these are your aortic and pulmonic valves and when they close that is the S2 sound and that is the dub so it goes hand in hand whenever you're listening to the heart you hear lub dub love is S1 dub is S2 now whenever the heart is relaxing and Contracting relaxing phase is diastole the relaxing part I like to remember that because a lot of people get those too confused dye um whenever a person dies they're relaxing so that's how I remember that and the opposite of that is Sicily contraction so when the heart is Contracting and resting these valves will be opening and closing During certain times and let me walk you through this it's very important you understand how the blood flows through the heart I have another video on heart blood flow if you're Rusty on that a card should be popping up and you can access that but let me walk you through it and tell you how the valves are open and closing during diastole and systole okay first let's cover some basic anatomy of the heart and then we'll talk about the heart blood flow okay you have your Superior and inferior vena cava you have your Atrium your right atrium your tricuspid valve your right ventral cool then you have your pulmonic valve pulmonary artery then you have the pulmonary vein then you have the left atrium bicuspid valve left ventricle aortic valve and then that aorta so what happens is that you whenever blood is flown through this side is flowing through that side so what's happening on this side is happening on that side keep that in mind so what happens is that these blue arrows signify unoxidated blood and what's happening is that blood has been used by the system it needs to come back through the heart to go through the lungs to get oxygenated so it can go back and do its job so it flows in through the superior and inferior vena cava then it goes down to through your right atrium down through your tricuspid valve and into your ventricle now right now we have diastole going on dastly again what was that that was relaxation so it's nice and relaxed over here and blood is just flowing down through the tricuspid valve and how I can do that is in the Atrium the pressure is a lot higher than in The ventricle but as The ventricle becomes full it has a lot of pressure and whenever it becomes full it has a lot of pressure it closes that avioventricular Valves and whenever those close you will hear S1 and when you hear S1 that is the beginning of systole the contraction phase so systole happens which is contraction your ventricle contracts that causes a lot of pressure on your semilunar valves and they open up and allow blood to rush through up through the pulmonic artery right here and then they close because pressure Falls once that blood goes through the pressure will fall and then you will hear S2 which is signifying the closure of those semilunar valves and then it will flow through the pulmonary artery it will become oxygenated with blood through the lungs and then it will enter back through the pulmonary vein down through the left side of the heart and it'll go through the left atrium again we have we've entered back into diastole and it's relaxed because blood is nicely flowing down through the bicuspid valve right here and the pressure is building in The ventricle and whenever it builds it will cause your bicuspid valve to shut so those Avio ventricular valves will shut you will hear S1 again and then um that will be the marking of systole The ventricle will contract which will cause that increased pressure will cause those semilunar valves to open up which right here is your aortic valve and the blood will flow up through the aorta go through the body and give the body all that rich nutrients it needs and then it just starts all over and sometimes whenever you're listening to the heart listening to that S1 and S2 those closing of those valves you will sometimes hear extra heart sounds which will go in depth here in a second and you could hear a sound like S3 S4 heart murmurs and splits and I'm going to go over in great detail on how to position the patient properly how to use the proper part of your stethoscope whenever you're listening for those sounds because it takes a little bit of technique and in the next video I'll be covering that in depth as well okay so let's go over the stethoscope Basics because in order to hear these heart sounds you have to know how to use is your stethoscope okay the diaphragm of your stethoscope that is the big part of it this is um found on your chest piece and it hears high pitched sounds it is great listening throughout the chest for S1 S2 and your aortic and pulmonic murmurs where you have regurgitation so that is great for that then you can use the Bell to switch it over depending on what type of stethoscope you have this is a smaller part and this is best for low pitched sounds remember low is small remember the smallest side of the stethoscope is the bell and that likes to pick up those low pitched noises and this is perfect for assessing for S3 S4 and your mitral stenosis murmurs which we'll go over here in a second and also as you're listening with your stethoscope it's best to inch the chest piece across the chest instead of just picking up and just moving it just into it so you can continue hearing that Rhythm because the main goal is trying to distinguish S1 from S2 so inch it over don't listen over close because that interferes with sound and especially if you are new to listening to heart sounds you need to make sure that you're listening straight on the chest because you need to learn what normal sounds sound like and make sure you're decreasing your background noise because that can interfere and get a stethoscope that fits your ears and practice practice this skill takes a lot of practice okay patient positioning the key to hearing a lot of these sounds depends on patient positioning because your heart is behind you're sternum and your ribs you need to make sure you're moving the patient to get the best acoustic sound so here are some tips okay whenever you're listening you normally start out you can have the patient lay down sitting up and you are going to be listening with the diaphragm of your stethoscope for S1 and S2 and we'll go over the anatomical positions here in a second and then to listen for that S3 the S4 because after you get familiar with S1 and S2 you'll turn them over on their left side and why do you do that majority of the heart is on the left side of the body so when you lay the patient back turn them on the left side those want to shift that hard over there and you're going to listen at the Apex the Apex is the bottom it's the opposite of the heart it seems like the bass would be here in the Apex up there but it's the opposite the Apex is at the bottom and the base is at the top so you're going to listen at the apex of the heart whenever you're listening for S3 S4 and those mitral murmurs then you'll want to set the patient up lean them forward and have them exhale and what this does as if you're looking at the diagram of the chest this moves the heart forward because you're one to pay attention to the aortic and the pulmonic valves and you're listening for that regurgitation that murmur now it's really important whenever you're starting out that you understand where your landmarks are where you will place your chest piece to listen to those Valves and what each vowel what sound it reflects so this is the meat and potatoes of the lecture okay to help you remember the order of how to listen to these valves I like to remember the mnemonic all patients take medicine a for aortic P for pulmonic t for tricuspid and M4 mitral and to do that what I like to do is I like to find the clavicle then I like to go find the angle of Lewis and right below that angle because attaching to that is your second rib and what we're going to do is we'll start on the right side with our chest piece of our stethoscope and we're going to listen to the aortic valve and it is found in the second intercostal space and no it is the only Landmark area found on the right side of the chest it's right next to the sternal border and again what does the aortic valve reflect the sound of whenever it closes S2 and is found at pretty much the base of the heart then you're going to go right across so you're just going to take your stethoscope and then you're going to go right across to the other second intercostal space which is on the left side of the heart and and you're going to listen to the pulmonic valve and again these two are semilunar valves and this reflects the sound of S2 the closure of S2 and this will be your pulmonic valve then you'll find the third rib go down to the third intercostal space and this is Herb's point this is the halfway point between the base and apex of the heart then you'll Interstate the scope down to the fourth intercostal space and listen to the tricuspid valve and this reflects S1 when it closes and it is an Avio ventricular valve the AV valve then after listening to that you'll enter chest piece down to the mid covicular area which here's your clavicle you're going to go Midway through that and you're going to go to the fifth intercostal space and you're going to be listening at the mitral valve part this is also the point of maximal impulse and this is the apex of the heart so you will listen there okay whenever you start out listening for those heart sounds simply what you're going to do is you're going to either have the patient laying down you're going to have them sit or sitting up and you're going to listen with the diaphragm of your stethoscope at these landmarks starting with the aortic and working your way through the pulmonic herbs Point tricuspid and mitral and as you were listening you were listening to the Rhythm is it nice and regular is it irregular and the right then you are trying to listen for and distinguish between S1 and S2 whenever you're first starting out this can be complicated but there are some tricks you can do to help you find out Is This Love or is this dub okay first what you want to do is you will use you can use this trick S1 is louder at the apex of the heart so in the mitral area it's going to be like love dub lub dub love will be louder than dub which is S1 now S2 2 is louder at the base so it'll be more like love dub lub dub so listening at those different areas can help you distinguish also another thing you can do is if your patient is on a bedside EKG monitor this helps whenever you are looking at your QRS complex the r-way will correlate with S1 so as you're listening with your stethoscope watch that bedside monitor every time you see that peak of the r wave and you hear that noise that's S1 so that helps you distinguish that or you can have the patient while you're listening you can feel on the carotid arteries pulsation whenever you feel a pulsation you hear the sound that is S1 because they go hand in hand so those are some tricks on how you can distinguish those because it's important you distinguish those so you can hear those other extra heart sounds if they have them like S3 S4 and things like that um also note a patient can have splitting of S1 and S2 so that's another thing you're listening for and what that is is as we were talking about through the blood flow of the harp the AV valves over ventricular valves which are your tricuspid and bicuspid they are closing usually normally they are closing at this opening and closing at the same time but sometimes if they have a split one will close before the other and that's just what you're hearing and that can also happen with s to remember your s semilunar valves represent S2 and your aortic or your pulmonic valves are not closing at the same time so you're hearing them close a little bit differently now S1 a typical cause of S1 just to let you know could be a right bundle branch block that's where the right bundle is being blocked through the electrical conduction system of the heart I have a video on the electrical conduction system if you're not familiar with that and that is why the patient may have an S1 now let's talk about those extra heart sounds that you may or may not hear s3s4 and murmurs okay S3 what you need to know is when it's heard what are the causes this is typically heard after S2 and let me explain the pathophysiology behind this okay what's it going to sound like it's going to sound like represents S one the closure of S1 your AV valves um dub represents S2 the closure of those semilunar Valves and then you hear ta now remember when your semilunar valves close what does that represent it's the end of it's the end of Sicily contraction and now it's what's going to happen is the heart's going to relax and allow it to fill up again so what's happened your semilunar valves shut because they've already done their job by shooting the blood out and then the hearts and dastly where you have the atrium flowing the blood down through the ventricles and what you're hearing is that vibration noise of the ventricles feeling up so that's why you're hearing it after S2 and a cause of that could be by could be fluid volume overload or heart failure and this is typically again best heard if you put the patient on the left side and use the bell of the stethoscope because it's a low pitched noise okay let's look at S4 now S4 is heard before S1 so it's going to sound like you're going to hear that extra sound before the love duck which is the opposite of how S3 was you heard it after the loved up and this is usually caused due to that Atria kick that during that precisely part and where the atrium is trying to push blood down into those resistant ventricles so the ventricles are resistant they don't want to do their job so the A3 just has to get one more kick and what you're hearing is that murmurs water murmurs heart murmurs are where you hear with your chest piece whenever you're listening throughout the heart you will hear either like a blowing or a swishing noise and this is due to the turbulence of blood flow either through the blood Chambers or through the valves maybe there's a wall defect or the valve like the mitral valve any of the valves are too narrow which are like mitral stenosis or they're having regurgitation issues where the valve isn't shutting all the way and blood is back flowing and you're hearing that and it can be at different levels how loud they are they are braided as the following a grade one it's hard to hear but you can hear it you barely hear it a grade 2 is faint but you hear it grade three is easy to hear grade four and onward the patient will have a thrill and this grade four is usually loud with a thrill um a grade five is very loud with a thrill and you can lift just the corner of your chest piece of your stethoscope off and you can still hear it and a grade six is the loudest of them all and they'll have a thrill and you could lift the whole chest piece off of the chest and you can still hear the murmur okay so that is a little bit about heart sounds the basics of what you need to know for nursing school now thank you so much for watching be sure to go take that quiz to test your knowledge on this and be sure to check out my next video where I will be performing the assessment skill on how to auscultate heart sounds and thank you so much for watching and please consider subscribing to this YouTube channel