Heart Sounds
ฝัง
- เผยแพร่เมื่อ 19 ต.ค. 2024
- A lecture on the recognition and physiology of both normal and abnormal heart sounds with numerous audio examples. Covered sounds include S1, S2, S3, S4, clicks, an opening snap and pericardial knock. The scientific evidence for the diagnostic utility of abnormal sounds is also discussed. For the most accurate reproduction of the heart sounds, I recommend listening with headphones instead of standard external computer speakers.
Use of the VA and Stanford name/logos is only to indicate my academic affiliation, and neither implies endorsement nor ownership of the included material.
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ERIC!! You are KILLING it on the 'Tube man. Congratulations of edutaining the world!
+ZDoggMD Thanks man, but are you kidding me, yo? Weren't you just on a magazine cover yesterday? And loved the last video. Brought back memories...(waking up on overnight call feeling unusually refreshed - anything more than 3 hrs of sleep - to find I had slept through 10 pages!)
+Strong Medicine THE STRUGGLE IS SO DANG REAL HOMIE.
Excellent video. I auscultated my heart after experiencing heart palpitations (which I attributed to stress) and identified an S2 split with inspiration and expiration. I had a friend of mine (ED physician) take a listen and he agreed. Made an appointment with my cardiologist (I was diagnosed with postural orthostatic tachycardia syndrome a while back...it's not a big deal) and told him I wanted an echo to rule out an ASD. Well, the echo confirmed my suspicion!
It's great to hear confirmation of the value of good auscultation skills!
This is a GREAT video. I never knew I wanted S1, split S2 and S3 in the same clip until I listened to it here. Thank you Doctor Strong.
I have never commented on a video on youtube
i signed in just to thank you,,, you just saved my life :)
i really can't thank you enogh !
The general point you are making is very valid - we don't fully understand the physics of what generates S1 and S2 (or S3, S4 either). Whether S1 and S2 are caused by sudden approximation of the cusps, vibration of the cusps, or vibrations within the blood is debated and not known for certain. However, the distinction is prob. of minimal clinical relevance, and in the interest of clarifty for beginners, I usually simplify it and describe the sounds as just being caused by valve closure....
If you initially struggle with the more obscure findings such as MVP click, opening snap, abnormalities of S2 splitting, don't worry - these relatively minor details will not hold you back from becoming an outstanding doctor. But if you work hard at the improving your cardiac exam over years, I think you'll find this skill to be helpful in diagnosis, as well as personally rewarding.
The internet is amazing. Wish we had it in the 80's
Studying medicine is difficult in presence of internet
Dr. Strong, I'm in nursing school right now and your video about heart sounds has been the clearest presentation of the material that I have seen so far. Thank you for that. I'm wondering if you have a similar video about auscultation of adventitious lung sounds.
extremely comprehensive. thank you from a doctor in australia. Keep up the outstanding work.
LBBB causes a soft S1 through two closely related mechanisms. First, it leads to a longer delay from atrial contraction to LV contraction, mimicking the same effect as a long PR interval. Second, the force of LV contraction in early systole is diminished in LBBB as the ventricle is depolarized in a relatively uncoordinated and inefficient fashion. The consequence of both these mechanisms is a less vigorous closure of the mitral valve, and thus softer S1.
Brazil's medical students says thank you for your lectures! Saving our souls in exam seasons!
16:29 haha sounds like Iron Maiden to me. The best educational TH-cam channel, no question, thank you for these great videos.
Im a postmaster nurse practitioner student! This was an excellent presentation! I have stored in my library for frequent use! Thanks Dr. Strong :)
Dr. Strong, That makes much sense for you to use really clear examples, especially for us beginners! Once we understand and can differentiate the classic sounds, then we have a basis to which we can compare the variations. Thank you!
I agree. Thanks Dr. Strong. I'm also an R.N. (applying for FNP school). This video is one of the most helpful I've seen (and I've seen a lot).
which has 2 subtypes - atrial and ventricular. Although "abnormal", it is not necessarily dangerous, though would require explanation if you were young and otherwise healthy. The only way to diagnose this is to get an EKG at the exact moment you are having the problem. Depending on where you live, an event monitor or something called a Ziopatch could help diagnose this, but depending on the other components of your medical history and exam, your doctor may not feel it's necessary.
WOW... excellent video, the way yuo present the theory and de audio clips is very helpful. I've just finisihed med school, and I'm currently in a 1 year program of basic and clinical research, ( my area is neurodegenearative diseases and biomarkers in the skin), in the next months I'm goint to present the "ENARM test",in order to qualify for a medical residency, and I'm happy to get back to the basics I spend to much time in the lab, and I've got a little bit rusty in some clinical skills.
Thanks so so much Dr Eric for this informative video and for your time!
Im a student of medicine from india just beginning to get an idea of abnormal heart sounds..and I should say the content you have presented is the best iv seen so far compared to any book or video iv seen yet! Thanks a lot doctor :)
My preferred video on this particular topic. Thank you, Dr. Strong.
Med Student at University of Witwatersraand SA. Really useful! Thanks for the lecture!
Dear Eric! This video saved me from congenital cardiac anomalies! Thank you so much (especially for the pathophysiology of S2 split part - that explanation was crucial for me)!
How?? Did you listen to your own hearth?
What you want to say I am confuse ?❓
What I tried to explain in this comment actually was that this video saved me from (learning and studying) congenital cardiac anomalies.
Thank you Dr Strong. I never master then, not sure i am now either. But with you said in modern, it might be less important. You are a great instructor. I wish to have internet then too. I cant thank you enough.
Dear Eric, thank you very much, for all the work you've done, so far, in spreading the knowledge in cardiology in the best possible I was able to find n the internet. As a geophysicist, who spent more than 30 years in understanding the complex interference of the reflected seismic waves, bounced from thin layers, I am witnessing, that today's reflection seismic imaging, suffers from paradigms, inherited form old acquisition technology and "way of thinking", which still exist in the 21st century .
Stethoscope, as a dominant diagnostic tool, today, should and must be abandoned, due to plenty of reasons. The main one is the subjective audio perception capabilities of an practitioner, that should lead to "quantitative" estimation of the audio signal.
By analogy of 12 lead ECG acquisition equipment, in the same time, proper audio equipment should be designed, where each of the channels should be properly and precisely corrected for the frequency and phase spectrum in order to eliminate plethora of parameters in regard to specific patient (i.e. obesity, subtle difference in acoustic parameters of the patient's tissue, etc).
Further more, in order to perform separation of superimposed signals should be analysed by frequency decomposition *in order to detected close events, both in qualitative and quantitative manner.
In other words, new, audio acquisition equipment should be designed in audio consistent way, prior to mentioned objective manner of sound event separation, as well as it's quantitative analysis.
Once again, thank you for fantastic work you've done.
Kind Regards,
Aleksandar Dzunic
Aleksandar Dzunic impressive. Pocket ultrasound goes a long way as well
I too am in nursing school and this lecture was the most clear explanation I have heard on heart sounds, and gave me some great tips when I perform my assessments(TAKE MY TIME). I will definitely recommend this video to my classmates. Thanks Doctor Strong!!!
Khakalukia, it takes a long time and years of intentional practice to get really good at cardiac auscultation. But you don't necessarily need to strive to become an expert. Most physicians will never get there. What you should focus on first is being sure to not miss the critical findings: S3 in a patient with dyspnea of unknown etiology, new AR murmur in a patient with bacteremia, etc...
sooo helpful... thank u doctor. i was referencing harrisons while watching this..and ur video is more comprehensive and easy to understand. thank u for the the audio aid. i will recommend it to everyone.
just found this channel, thank u very much. These videos have been soo useful for my cardiology exam!!
udaypmishra: The conventional wisdom is that severe MR decreases LV afterload by providing a second route by which blood can exit the LV. This shortens the time it takes for LV pressure to drop below aortic pressure, which then causes A2 to occur earlier. There are several reasons why this explanation may not hold up, and in reality, we aren't really sure why this happens. Bottom line however, a wide S2 from MR is an obscure finding whose specific clinical relevance is probably minimal.
Thank you sooo much! This made me burst into applaud as the heart sound audios are phenomenal!
Thank you Doctor , This is my second time listening to this lecture. Actually i nearly skip this topic, I did not get it at all, can you imagine at that time, professor would lecture you about heart sound ,writing in blackboard and no sound demonstrable like you have now. I was evasive about cardiology, despite there were many abnormal heart sound around at that time. Many rheumatic hear disease in pediatrics , MR , even infective endocarditis,
Now as you spent about of time discuss about evidence that weather this is helpful in modern medicine about this skill. one would go directly to the EKG and echocardiogram.
Awesome work doc!! highly informative,useful and best compiled.
Thanks doc for making students like us learn
Great job, very helpful explaining the sounds and conditions associated.
Unfortunately, I can't really offer more specific or directed advice since I don't have access to this other info. I would probably start by making sure your doctor checked a standard EKG, and asking about whether an "ambulatory EKG" such as an event monitor was appropriate.
Thank you for for the excellent lecture. Only thing I want to point out is in cases of isolated Pulmonary hypertension, due to decrease in hangout interval, there will be shortened inspiratory spilt of s2. The video mentioned it in wide split. That can happen in case when there is associated RV failure with PAH, in which case it can have a fixed split s2.
Thank you for all your effort. Priceless education to the world.... Please do continue to hold the forte and teaching :)
+Kritika Sriram how r u?
she doing fine
funny plus
Having said that, the sensation you are describing sounds like what doctors technically refer to as "palpatations" - a subjective sensation that your heart is beating either irregularly or more quickly than normal (yours is more the irregular type). The cause of palpatations vary depending upon your age and medical history. For example, if you told me that you are 60 years old and had a heart attack last year,
Hello Dr. Strong. Thank you for a wonderful presentation. I think this video is a must for all medical doctors.
Thank you so much Dr. Eric. You save my life
Literature evidence on this phenomenon exists but is scant (see PubMed#5945151). The wide split with pulm HTN is seen only in cases where the RV is starting to fail from pressure overload. As a result of RV failure, the rise in RV pressure during systole is delayed, and RV relaxation is delayed, which then delays the closing of the pulmonic valve. The fact that the PA pressure is high more affects the speed with which the valve closes (i.e. loud P2), and less affects the timing of closure.
I'm sorry, but I'm not familiar with the abbreviation, CVS. Is that the cardiovascular system? If so, I won't be able to make a video outlining the remainder of the CV exam (venous waveforms, arterial pulsations, precordial movements, etc...) for some time as a high quality video would require actors for demonstration, and better AV equipment than I have available. I suggest taking a look at my colleagues' website for "The Stanford 25" for more info on this. (Choose the 2nd google result.)
...If one was going to make a career out of cardac physiology research, then definitely, one would want to be more specific than this. (For example, it's prob. true that the tricuspid valve contributes very little to the audible S1 in normal individuals - though can in patients with significant right sided pathology). The most clear review of these issues that I'm aware of is in Bedside Cardiology by Jules Constant - an all-around favorite book of mine.
Excellent video! Thanks! Do you have a video describing "rubs"?
Thanks for the response. I'm afraid I don't have one covering rubs yet.
helpd a LOT IN CLINICAL POSTING.
WOW. Dr. Strong thank you for your lectures.
Preeti, the best way to differentiate them is by their duration. S3 and S4 are brief - simulated by tapping your finger on a wooden surface. Murmurs last longer - simulated by modestly forceful exhalation through pursed lips. If you compare the audio examples from this lecture to those in my accompanying lecture on heart murmurs, I think it will be more clear. Thanks for watching!
This is amazing.I have been hearing all sorts of sounds and calling them different names.Sometimes I call it "added sounds"
Please Dr Eric,how do one download the videos? Some of us that are living in low income countries where internet connection is a privilege may want to go through these videos severally.May I plead that you that you give us access to download it?
Super :) Very interesting video. It helps a lot to well hear the different heart sounds . Thank to you .
4:31 av dissociation
7:42 split s2
9:31 Wide split s2
11:45 pulmo ht loud p2
13:12 s3
14:18 s4
15:50 s4 and s3 no s2 split
16:06 s3and s4 hr 80
16:19 hr 100 s3/s4
16:30 hr 120 s3/s4
19:15 mechanical av click
Thank you for your prompt answer! Your lecture is very useful!
Thank you Mr. Strong. This helped me a lot.
You know what I did all these years in med school -- just skip the murmur questions..... and feel like a complete fraud! NOW NO LONGER!
cspvlncspvln, I'm glad you found it helpful. I don't have a lung sounds video yet, but I'm planning to post one in the next couple of months. (I'm still waiting for really clear examples of some abnormal sounds in my patients...)
Thank you for this lecture and many others. Very educational. Just wondered if you have any lectures on chest sounds? Many thanks
No videos on lung sounds yet. Lungs sounds have proven surprisingly tricky to record with a fidelity that I'm satisfied with, but I'm hoping to finally get it posted this spring.
Eric's Medical Lectures Sigh...clearly didn't get posted this spring. Even with my Thinklabs One, still not happy with the quality of recordings.
+Eric's Medical Lectures
I was excited when I saw you made a video on lung sounds because your cardio one is fabulous but I was not able to find it using the above link.
+Christine Nathan I'm very sorry, but I don't know which link you are referring to. I still remain unsatisfied with the quality of recording of lung sounds, so haven't yet tackled this topic.
thank you for the excellent lecture
Sure, no problem!
Well done! More power to you Doc!
Besides this details, thanks for the nice, well done presentation.
yonatan703, I'm not sure I understand what you mean by "cap"...
Nice video. Is there a mistake at 10:33 in the Reversed Split diagram? I thought that the 'reverse' bit pertained to the widening with expiration - not that the P2 came before A2?
+Eddie Coates No mistake. During inspiration, venous return to the RV is increased while return to the LV is decreased. Since the duration of systole is dependent upon venous filling (i.e. the more filled the ventricle is, the longer the pulmonic or aortic valve will be open during the next contraction), inspiration almost always causes the pulmonic valve to close later, and the aortic valve to close earlier (a large ASD is one of the few exceptions to this). Thus, the only way the S2 can be split during expiration and not inspiration is if something is either causing the pulmonic valve to close unusually early (e.g. a right-sided accessory pathway) or causing the aortic valve to close unusually late (e.g. LBBB). If you happened to have Googled split S2, you may have seen diagrams which show A2 happening before P2 during expiration in a split S2 still happened before P2 with a split S2, But to be honest, they are simply not correct.
Your are best sir... No match for u🙏
There is a small correction in this video 9:18 Pulmonary hypertension causes narrow split
Thank you so much for sharing this, it's very good for reviewing this topic!
I have a murmur but it changes with each position, its worse when I sit down and lean forwards. it goes (inspiration) dum dumdum dum dumdum (expiration) dumdum dumdum dumdum dumdum. its like the s2 but is it dangerous?
Katie I'm really sorry, but I can't give out individual medical advice on here. Even if I wasn't concerned about legal issues, there is no way to diagnose the likely cause of a murmur without being able to listen to it, and preferably examine the rest of the patient too. If you're concerned about your murmur or abnormal sound, I advise talking to your primary care provider.
+Katie When anyone inspires, the S2 heart sound is split even in normal people. *not a doctor* find one if you're concerned
Thank you so much! - making medical school just a little more manageable!!
Hi doc its a great lecture
i am very happy to see this of clarity explanation.
i am having a small doubt
Is opening snap high pitched or low pitched?
some references are showing its High pitched ...kindly give your opinion.
thank you
+VAMSI KRISHNA DIABETOLOGIST Thanks for your comment! I've always thought of the opening snap as a relatively low pitched sound, but after you posted this, I looked into it some more.
First, there are definitely some places on the web that describe it as high pitched, and it's also described as high pitched in Bates' Guide to Physical Examination. My go-to resource for uncommon cardiac exam questions is Bedside Cardiology by Jules Constant, which has only this to say about the pitch of the OS: "Although the quality, frequency, and duration of an OS usually do not differ much from those of a P2, occasionally the OS may consist mostly of low frequencies, especially if the valve is heavily calcified".
That left me incompletely satisfied, so I did a literature search. Unfortunately, I was unable to locate any primary, peer-reviewed scientific articles that discuss the pitch of the opening snap. There are a handful of papers about the S2-OS interval, and about the relative intensity of the OS - but not one discusses the pitch. So I don't know. Opening snaps in the US are rare enough that my personal experience at the bedside is completely inadequate to make a definitive statement about this, but without knowing what the original source is for the supposition from Bates and a handful of sites on the web that describe it as a high pitched sound, I don't think we can rely on that either.
+Strong Medicine thank you doc,
i am enjoying your lectures and explanation.
you are truly a great teacher........thank you
Excellent presentation
Thank you very much for a very informative lecture.
Oh Doctor you nailed it!!! Awesome 💓
mdafzalhussain, I'd love to be able to dub my lectures into a number of other languages, but unfortunately, I only know English and a bit of New Guinea pidgin (not kidding!). I would place a public request for help to translate these, but it would seem to be quite challenging to synch the audio with the slides without speaking the language. Maybe after Khan Academy realizes they should hire me I'll have the technical support needed...
Hey i can help you with spanish and french !
I can help with Arabic
very nicely made video, very informative.
Thank you ! I like your lectures!
Ella
Very good video, great content !
Thank very much Dr Eric this lecture was very very helpful during my internal medicine rotation. I wanted to ask you could you please provide a link for this power point presentation or at least to the figures and tables they are so organised i wan to make them a reference for me in the future in case i need to revise them. Again thank you.
@ddd, If you (or anyone else on here) emails me your own email address, I'm happy to provide detailed lecture notes to accompany this video, as well as the one on heart murmurs. (My email is easily Googleable. I don't want to post it directly on here out of concern, possibly misplaced, that doing so will increase the amount of spam I receive).
Eric's Medical Lectures I sent you an email titled "lecture notes request", I don't know if you got it or not
Yes. I attempted to reply yesterday, but got a strange error message in response. I figured I'd wait a day and retry, to see if the problem worked itself out, and it seems to have done so.
kirbymaster, first, I want to stress that you should not substitute what I'm about to say for your own doctor's assessment, as he/she knows your medical history, can ask you many specific questions, has the ability to listen to your heart directly, and the ability to examine your EKGs, etc...
very helpful lecture, thank you very much.
great help as always, thank you .
Holding my damn heart watching this
Very interesting and useful
I have extremely high anxiety at times which why I am not meds but which sound on here is where the heart sounds like it’s in extreme high anxiety thank You
thx for your lectures, thy r very good and helpful!!!!
What an explanation 👍
Me: Dam panic attack 🤢, I need a video to calm me down.
TH-cam: Ima just gonna head out of here..
do you make any videos that are also covered in the emt scope of practice or are all of your videos under the emt scope of practice
I'm really sorry, but I'm not sure I understand you mean.
Eric's Medical Lectures He's asking if your videos are applicable to Ambulance Officers and Emergency Medical Teams (EMT), or are all your videos under their scope of practice.
thanks sorry about the mix up I didn't quite realize the way that my question sounded but yeah that's what I was asking about thanks Gummyy Bear
Great video! Ive had asd closure 2 months ago, heart sounds s1 and s2 normal but then it discordinates when i breath in.
Thank you so much! Excellent lecture!
Dr Strong, I'd really like to be able to make these heart sounds into Anki flashcards as part of learning this series and reviewing it into the future. Is it feasible for you to place the heart sounds online somewhere for download - preferably in small file sizes? After I've made the deck I would be happy to share it here for other students to make use of. Thank you for these excellent videos, they are the best thing out there for learning hospital skills.
Did you made one?
@@AliRaza-ro8ev sadly not
@@mathesondaniel I wish someone did that...i love his ECG series as well...hope someone made notes...and we can devour them
I just found a stethoscope in my house. I started listening to my heart (I have a murmur.) I also chugged a Dr. pepper and listened to it in my stomach! It was awesome!
Thats cool :•
Was very helpful, thank you for sharing you video
It WAS very helpful, thank you for sharing your video, highly appreciated.
Thank u sir for this wonderful lecture:))))
Thank you sir its really great
I like this presentation
At time of S1 the mitral and tricuspid valves are closing, but normally that's not that what we hear at auscultation! The healthy valves doesn't make enough sound to be heard be human ear. S2 is rather the sound of vibrations on the blood-column caused by the heart muscles. What do you think?
thank you .it is very helpful
Thank you sir 😭
Cool. Great job, Doctor!
أنت أفضل وأحد
شكرا لك
excellent video.
26:00 Diminished A2 in aortic stenosis patients ; +LR = Sensitivity / 1 - Specificity ===> 0.78 / 1 - 0.98 = 0.78 / 0.02 = 39 ; NOT 43 .
29:03 Neither of which was " statistically significant " because the 2 confidence intervals ( CI ) s included 1 .