foreign Ninja nerds in this video we're going to be talking about heart sounds and heart auscultation if you like this video please give it a thumbs up don't forget to like and comment down below and check out our website conditioner.org let's get started all right ninja nerd so heart sounds we're going to be talking about them today and what we need to really focus in on is how does the heart make these sounds it's not necessarily the heart that's making the sounds but it's the valves inside the heart particularly the valves closing so let's back it up a little bit and quickly what valves we have in our heart so we know we have four Valves and we've watched our structure video before and we understand that within the heart there's four chambers there's four valves within the valves they can be categorized into two different types we have the atrial ventricular Valves and the semilunar let's focus in first on the two atrioventricular so we know that atrial ventricular means that it's going to be the valves between the Atria and The ventricle so we have the right ventricle and Atria here and the left atrium ventricle here and between them are our valves that divide them between the Atria and The ventricle so on the right side we have what do we call this valve right here the one that is between the Atria and The ventricle on the right side of the heart do you remember this valve right here is what we call the tricuspid and then on the other side we have the left atrial left ventricle and the valve between those two we're going to put in pink here is our what we call it the mitral good so we have our two atrial ventricular valves those two valves group together as one and they can make a heart sound so when these valves close they make a sound and what's that sound that we are going to be using in this term or in nursing in in the medical field we use that sound as known as our S1 sound and you've also probably heard it as our love okay so the mitral and the tricuspid valve are two atrioventricular valves close at the same time when they close they make this S1 this lub sound and then we're going to move on to our two semilunar valves and our two semilunar valves are the valves that connect our heart chamber to the rest of the circuit that it runs through so we have our right side of the heart and our right side of the heart has the right ventricle pushing blood out through the pulmonic trunk so we know that this semilunar valve here is our what our pulmonic and then on our left side we have the left Atria through the mitral through the left ventricle and out into our systemic circuit through the aorta we know that this valve is the aortic and you're like Kristin we already know this we already know the valves I know I know it's just a review so now we know that the semilunar pulmonic and aortic valves they're going to close at the same time and the the sound that they make is our dub and we call that rs2 so just so we have an idea here now what we're talking about we're talking about S1 and S2 and remember the valves make the sound when they are closing so that raises the question now why do valves close what what's going on why are our valves closing like do they know how to close why do they close the purpose of them closing let's talk about that really quick is to prevent backflow okay and what does that mean basically within the heart and within our body we want blood beef flowing from the right Atria to the right ventricle and out left at your left ventricle and out and not having any backflow we don't want blood from the right ventricle going back through the tricuspid or going back through the mitral valve we want them to be keep going through the heart and what that has to do is we don't want unoxygenated blood and oxygenated blood mixing and we don't want any type of issues with insufficiency uh giving us issues with our pumping and our workload our cardiac output so we're going to prevent that backflow and we have words that we're going to be talking about right we have these words systole and diastole and you know that plays a role in blood pressure but it also plays a role within the heart and what the heart is doing so systole is the word that we're going to use which means contract because when we talk about heart valves and we talk about the sounds we're talking about particularly things happening right within the ventricles because it has to do with blood going in and filling and then going out and being ejected so systole is the word that we're going to use for contract and if you can't remember that remember that the word contract comes from the words or means the word systole and the word asystole when someone is Asus or they're Flatline they have no heartbeat right that means they have no contraction that's without contraction so the word Sicily means to contract and then diastole is our word for relax and you can remember that as unfortunate as it is that if you die you're kind of in a relaxed State nothing's contracted nothing's moving at all so diastole means to relax so our valves are closing they're preventing that backflow and we want to make sure that we understand how this all works how does the S1 sound that loved sound the S2 sound the dub sound and the Sicilian diastole all work together so right here in this little picture here I picture it as a circle we have a lot of information that we can get just from this and these are the types of things when I take an exam or I take the NCLEX you get a free piece of paper or you can write hopefully on the back of the test if you're still doing paper and pencil you can write little things down that'll help you just quickly be like okay I remember this information now I can go into this test confidently with confidence so S1 we know what do we know from already this video we know that the S1 is our av valves right that means they're closing we know that this makes our lub sound right and then we fill them down here our S2 we know that this is our semilunar valves closing and that's going to be our dub and then our valves have to close to prevent that backflow so when the blood is flowing in it's going to go from the right atrium to the right ventricle all right so this blood is going to start flowing in when it flows in this Blood starts to fill up okay so we're going from a low pressure to a high pressure room I mean a higher to a lower because there's no blood in here so from the right nature to the right bench we start filling as this fills the pressure starts to build and this tricuspid closes right so we hear lub boom closes so where does blood need to go now if it's in the right ventricle and it you hear love blood is now in the right ventral it needs to go where it's going to go out through our pulmonic so systole how do we get blood out we know that means the word contract right so this is our contraction and what is blood doing if the heart is Contracting the blood is ejecting great so we have filling of the the ventral we have lub we have this ejection occurring right and now we have dub so we're going in this circle here from dub all of these valves now have closed right we have our semilunar valves closing so what's going to happen now as this is all relaxing over here this is all relaxing so now we have again filling we have ventricular filling right because now we are relaxed and if you just think about this little picture for a second in a nice little circle you'll understand that S1 love systole eject the Blood Out S2 dub and then we start filling again diastole back into S1 this is a nice depiction here of what is happening in the heart as our valves are opening and closing okay but I'm going to show you another way that we can do that in a nice linear form with some pictures all right so we just went over that little cycle there that I showed you guys and you're probably like Kristen what the heck you talking about these fillings and this this S1 this S2 sound I'm going to show you again the same thing but in a little more pictorial type of diagram here so in this heart here we have S1 we go systole S2 diastole and understand that this is just going to keep going over and over as the heart pumps S1 S2 so lubbed up love dub lubbed up and what we're looking at here is we're trying to understand where the blood's moving what the heart is doing so that way when we have to identify murmurs and we're listening we know what we're listening to okay so with S1 let's remember let's just write this all down again S1 is what this is when our AV valves close right valves okay and this S1 is the thing that we say love with right and S2 was our semilunar valves and this is our dub right and then from we have here we have systole right and what did the word Sicily mean so in this space here we have a contraction and what does diastole mean dastly means we have a relax so the muscle here is relaxing the muscle here is Contracting and we're going to be focusing on what's happening within our S1 so we have love we have S1 so our AV valves here are closing because we're going to hear that right so let's grab what are our colors here green and pink so tricuspid is closed right mitral is closed okay and we have blood wear okay where is blood right now if the valves are closed because we we did what we filled our ventricles in so ventricles are filled blood needs to be ejected out right it can't go back through hopefully hopefully it's not going back through the valves that it just came through because those are nice and closed tightly shut and we're going to contract when we contract where is that blood going going out right it's going to go into our pulmonary and systemic circuit went out here going out here and when this Blood goes out of the heart right it's filling the rest of the circuits here this blood is going out we know what valves are now closed are pulmonic all right it's closed and aortic semilunar valves are now closed which makes sense right so let's look at it again we have this S1 Club we go into Sicily our 80 valves are closed so we're going to push that blood we're going to eject it out as we eject the blood out we hear S2 because now once that blood is exited the heart our semilunar valves close and then we have to go in relaxation so I drew the third heart here so that you understand we now have blood out of the heart so what would be after our S2 we go back to S1 right and when we go back to S1 we have blood from here filling into our ventricles and as it fills we get love and it's a cycle over and over again so remember S1 it's our lob it's our av after that boom we hear love boom we have systolic Sicily which is our contraction and that's when our blood is sitting in our ventricles it's going to get pushed out so it's going to get ejected so we eject out the blood from here blood is in the systemic and aortic circuits or aortic and semilunar valves is now closed and then we have to have what filling here we go back into filling right makes sense it makes a lot more sense if you understand this because then when you start understanding where murmurs occur if they're occurring between S1 and S2 or or after S2 before S1 then you're going to understand the type of memory you have so get this in because it's only going to make you understand murmurs better but now we understand at least S1 and S2 we understand love dub we know that it's either the AV valves or the S the semilunar valves so now let's learn about how we're going to listen to our heart right so our heart and we assess the heart we're trying to listen to all these vowels we're trying to listen to these sounds and we know that there's two sounds but there's actually five different places that we can listen to these valves in a very a good a good auscultation so we have our aortic our pulmonary and pulmonic right these are two valves that we know we have this thing here called herbs Point you're like who the heck's herb what's his point and we have tricuspid and mitral what we're looking at here are five different areas that we are going to auscultate so that we can assess our patients valves and heart in each individual spot so some people have mnemonics here for the a b e a p e t m right so it's like all Physicians earn too much or all patients they do something here take medication whichever way you like to remember it I just remember that there's four valves an edge that herb in the middle super easy and we know here that what pulmonic and aortic make our S2 and our tricuspid and our mitral rrs1 okay so let's go through we've got this chart here to fill in we got our aortic and we're going to do our timing of our sound we just know we know we just learned this right that the aortic is a semilunar valve and that its sound should be heard on the S2 but where do we listen on the body on our rib cage here we have all these spaces here right we got these openings between each rib and what do we call those our intercostal spaces and in those areas is where we're going to try to listen with our stethoscope so we can hear each individual valve the first one here the aortic we're going to listen to right here and what is this spot here just so we don't get confused this is our right so our second intercostal space right sternal border okay so that way you at least remember this so it's a secondary console space on the right sternal border fantastic and we are listening and we should be hearing a nice loud sound on our S2 perfect and then we move across the chest so let's do our pulmonic super easy to remember you go from the right side to the left put your stethoscope in the second intercostal space on the left so second intercostal space left sternal border and we should be getting a b hearing again an S2 sound fantastic great wonderful now we're going to move into herb who's herb so herbs point is the area and when we listen to the chest we should be able to hear S1 and S2 equally we should be able to hear it it's the best spot to listen to both sounds at the same time and what you can do as a nurse if your patient is hooked up to Telemetry or the EKG monitor you can actually listen and look up up there to see if all the sounds are correlating with the Beats as well so herbs point where is that super easy we move down one intercostal space and now we are listening on our third inner causal space of the left sternal order and what it should be hearing here you can hear S1 and S2 you can hear both fantastic awesome then you're going to go into the tricuspid which is easy move down one more space and we're gonna be listening to where if we move now one more we're at the fourth intercostal space of the left sternal border and we should be hearing S1 fantastic the last thing we're going to listen to is our mitral our mitral is the little little tricky guy so what you can do on your patient they're laying flat you're listening to their heart you can palpate along their Stern or they're um clavicle and you're going to be trying in the midpoint when you find the midpoint you're going to go down one more intercostal space you're going to go to the fifth intercostal space midclavicular line and you're going to be listening for an S1 all right so when you're listening to all these and you're listening to your patient's valves you just want to make sure your hearing Amplified sounds so on aortic and pulmonic you should be hearing S2 nice and clear tricuspid and mitral you should be hearing it on the S1 and sit there and listen you want to make sure you're listening and you're able to hear it nice and clear and then you can go to herbs point and then see if you hear both equally all right intro nerds that is it that is our video on heart sounds and auscultation I hope it made sense and as always until next time [Music]