Depending on your specialty, her cardiac evaluate probably is composed of listening to an apical pulse end the mitral valve and also sagely nodding her head.

You are watching: A heart murmur that sounded "lub-dup-shush" would indicate which of the following?

It’s to be years due to the fact that you’ve thought around heart sounds, and in every honesty, they were sort of confuse to start with. There was all the “lub” and also “dub” and diastole and also systole - enough to make a education student’s head rotate round.

However, if girlfriend take the moment to hear to them, heart sounds can actually tell girlfriend a great deal about a patient.

Instead of stable for great old “lub-dub”, put that stethoscope to higher use and also reacquaint yourself v the sound of the heart.

Also read: Chest ache Assessment: What come Do as soon as Your Patient has actually Chest Pain

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Where carry out I Listen?

Okay, let’s do this simple. We room going to listen to the heart over the valves, and nothing more. No Erb’s point or something esoteric. It simply doesn’t matter in your everyday assessment. Now, if you hear a murmur over the valve… us are acquiring somewhere.

You know there are four valves in your heart: aortic, pulmonic, tricuspid, and mitral. It helps to think of castle in this order. They make a type of elongated ‘z’ on the chest, through the aortic valve beginning at the top right, 2 intercostal spaces under at the sternal border.

The pulmonic valve is easy sufficient to find. The right throughout the sternum in ~ the left sternal border.

To find the tricuspid valve area, continue to be on the left side and also count down four intercostal spaces.

The mitral valve is fairly easy to find if friend are supplied to taking an apical pulse. If not, walk to the fifth intercostal an are at the mid-clavicular line.

Listen to healthy Heart Sounds:


What did I simply Hear?

Now that you understand where to put your stethoscope, you need to make feeling of what you space listening to. The first sound friend hear in the cardiac bike is the “lub”, and also it is a sound full of meaning.

“Lub” method that the love is in systole, or the ejection phase of the heart. That is the sound that the mitral and tricuspid valves closing as the body empties the ventricles right into the lung (see crucial Lung sound Made Easy) and body. It is additionally known together S1.

“Dub”, or S2, is the start of diastole, or the relaxation phase of the heart. The is the sound the the aortic and pulmonic valves closing. During this time, the ventricles fill and also the atria contract.

Occasionally, you might hear a ‘split’ S2 that sounds favor “du-dub”. This is the aortic valve close up door slightly before the pulmonic valve and is regularly a regular sound heard top top inspiration. You have the right to have a split S1 too once the mitral valve closes before the pulmonic valve, and also it deserve to sometimes show a bundle branch block. It is necessary to listen closely to hear when the sounds split.

What Does that Mean?

This is where most people’s eyes begin to glaze over, but it is wherein you deserve to learn something advantageous to your patient. Friend will must listen to the heart v the bell of your stethoscope to hear the abnormal heart sounds.

To hear a ventricular gallop, or S3, you need to listen end the mitral valve v the bell. It will sound like a weird plopping noise right after girlfriend hear the “dub”. The whole heartbeat will certainly sound prefer the win in the word ‘Kentucky’. This heart sound have the right to indicate love ischaemia or heart failure. The ventricles room stiffening and resisting the influx of blood in diastole. However, the is a typical sound in young adult under 30.

S4 is the love sound because that atrial gallop, and the heartbeat will certainly sound choose the beats in words ‘Tennessee’. Hear over the mitral valve with the bell that the stethoscope. You will certainly hear the plopping noise just before the “lub” starts, which method it happens right before systole starts. This heart sound can tell you quite a bit. The is heard after love attacks and can suggest aortic stenosis, ischemia, love failure and hypertension.

Heart Murmur Audio:


Heart murmurs are the other heart sounds you will certainly hear if you hear to sufficient hearts. They will regularly sound like the indigenous ‘rush’ or ‘hush’ and also can critical throughout the heartbeat.

The above sample is the a ventricular septal defect (VSD) holosystolic heart murmur, brought about by an opening in the dividing walls the the left and right love ventricles.

Other murmurs deserve to be led to by stiff and narrowed valves the cannot pardon the rapid flow of blood through them. Many civilization walk roughly with a murmur and experience no problems, yet they may show something major if they begin suddenly, for example, love failure, shock or a ruptured papillary muscle. Murmurs can additionally indicate ischaemia, infection, medicine toxicity and also genetic disease, in part cases.

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Many cardiologists and cardiac nurses have the right to pinpoint i beg your pardon valve the murmur come from, as soon as in the heart cycle that starts, and also what grade the murmur rates. For those who room not for this reason specialised, identifying the a murmur is present and also calling it to the attention of the doctor is likely all friend need.