S3/s4

[expo]

Hello everyone, I am MS I and I just want to ask you the following.

I understand that any additional heart sound other than S1 and S2 are either a gallop or split, but what would be the best way to differentiate S1 split from S4 and S2 split from S3.

Thanks

---

Members don't see this ad.

 

[Reductio]

Hello everyone, I am MS I and I just want to ask you the following.

I understand that any additional heart sound other than S1 and S2 are either a gallop or split, but what would be the best way to differentiate S1 split from S4 and S2 split from S3.

Thanks

S1-splitting is almost undetectable UNLESS the pt. has something like an ASD. If you hear what you think is an S4, it's probably an S4. Practice listening to patients, and check out CDs on heart sounds. Get the rhythm and timing down - they're noticeably different.

Differentiate S2-splitting from the S3 by switching between the diaphragm and bell of your stethoscope. The S3 is audible with the bell, and disappears with the diaphragm. Listening only with the diaphragm: S2-splitting will be heard, S3 will not. Easy.

 

[smq123]

Moved to allopathic.

 

[ArcGurren]

S1-splitting is almost undetectable UNLESS the pt. has something like an ASD. If you hear what you think is an S4, it's probably an S4. Practice listening to patients, and check out CDs on heart sounds. Get the rhythm and timing down - they're noticeably different.

Differentiate S2-splitting from the S3 by switching between the diaphragm and bell of your stethoscope. The S3 is audible with the bell, and disappears with the diaphragm. Listening only with the diaphragm: S2-splitting will be heard, S3 will not. Easy.

Good stuff. A little background since he's M1 (and for other people's benefit if they're reading):

S4 occurs prior to S1, and is usually distinct (at least on exams, in real life it takes a LOT of practice). This usually indicates a stiff left ventricle against which the atrium is contracting.

S3 occurs after S2 and indicates volume overload of the left ventricle and the incoming preload hitting the volume overloaded ventricle. As such it's an indication of an inability to pump adequately and therefore, congestive heart failure.

You can also sometimes hear S4-S1 S2-S3, which indicates a compensated CHF.

 

[PMPMD]

Some people also use "Kentucky" and "Tennessee" to help remember these.

S3 = "Kentucky". S1 = "Ken", S2 = "tuck", S3 = "y"

S4 = "Tennessee" where S4 = "Tenn"

 

[Knicks]

Good stuff. A little background since he's M1 (and for other people's benefit if they're reading):

S4 occurs prior to S1, and is usually distinct (at least on exams, in real life it takes a LOT of practice). This usually indicates a stiff left ventricle against which the atrium is contracting.

S3 occurs after S2 and indicates volume overload of the left ventricle and the incoming preload hitting the volume overloaded ventricle. As such it's an indication of an inability to pump adequately and therefore, congestive heart failure.

You can also sometimes hear S4-S1 S2-S3, which indicates a compensated CHF.

I like, I like. 👍

 

[jdh71]

Some people also use "Kentucky" and "Tennessee" to help remember these.

S3 = "Kentucky". S1 = "Ken", S2 = "tuck", S3 = "y"

S4 = "Tennessee" where S4 = "Tenn"

I like

"I believe" = S3

and

"Believe me" = S4

better

I think the syllables line up better for the heart sounds.

Remember that S4 is absent in atrial fibrillation, and while tests will have you listening with the bell for the S3 and S4, you can usually hear them, when present, with the diaphragm just fine.

 

[Reductio]

...

 

[Reductio]

Some people also use "Kentucky" and "Tennessee" to help remember these.

S3 = "Kentucky". S1 = "Ken", S2 = "tuck", S3 = "y"

S4 = "Tennessee" where S4 = "Tenn"

S3 = "slosh'ing in - slosh'ing in"
S4 = "a stiff wall - a stiff wall"

 

[ArcGurren]

Some people also use "Kentucky" and "Tennessee" to help remember these.

S3 = "Kentucky". S1 = "Ken", S2 = "tuck", S3 = "y"

S4 = "Tennessee" where S4 = "Tenn"

Haha there's so many of these sound mnemonics that I ended up just getting confused between them. But if these work for people, all the better.

 

[mmmcdowe]

Another trick is where you are hearing them. You are going to hear physiologic splitting best in the pulmonary/aortic regions. Physiologic splitting of S2 increases on deep inspiration as well. I'm trying to remember if positional and valsalva changes in pre-load or afterload can alter s3/s4, dosanyone recall?

 

[Knicks]

I like

"I believe" = S3

and

"Believe me" = S4

better

I think the syllables line up better for the heart sounds.

Remember that S4 is absent in atrial fibrillation, and while tests will have you listening with the bell for the S3 and S4, you can usually hear them, when present, with the diaphragm just fine.

You're right, that way is better [for me, at least].

 

[knope321]

If you have trouble keeping the physio straight, I like of S4 = hitting the stiff floor and for S3, the 3 kind of looks like an S, so S3 is like sloshing.