BDX3  Valve Opening, Diastolic Ejection, Mid-Systolic and Extracardiac Sounds

Michael S. Feldman, M.D., F.A.C.C.
Disclosures		The author has no relationships with commercial interests related to the content of the presentation.

Bernard Segal, M.D., F.A.C.C.
Disclosures		The author has no relationships with commercial interests related to the content of the presentation.

Michael S. Feldman, MD, is Clinical Professor of Medicine at the University of Pennsylvania School of Medicine and chairman of the Graduate Education Foundation. Bernard Segal, MD, is professor of medicine at Thomas Jefferson University Hospital, and director of the Jefferson Heart Institute. In this third of a seven-part series, they discuss the detection and differentiation among valve opening, diastolic, ejection, mid-systolic, and extracardiac sounds. Auscultatory examples of the valve opening, diastolic, ejection, mid-systolic and extracardiac sounds are provided.

Valve opening in a normal heart is usually inaudible; but in patients with mitral or tricuspid stenosis there is a sound termed an "opening snap." The authors describe the location and cause of this opening snap, noting that it doesn;t have the acoustic qualities its name suggests.

Ventricular filling sounds include the normal physiologic third heart sound and atrial and ventricular diastolic gallops. Gallop rhythms are filling sounds that are inaudible under normal physiologic conditions, and the authors illustrate how and where atrial and ventricular gallops are best heard and how to distinguish between them. When the two occur simultaneously the term summation gallop applies.

Pulmonary ejection sounds typically occur in congenital isolated pulmonary stenosis, idiopathic dilatation of the pulmonary artery, and the Eisenmenger physiology.

Aortic ejection sounds are seen in congenital aortic stenosis, truncus arteriosus, and in extreme cases of tetralogy of Fallot.

Extracardiac sounds and mid-systolic clicks which are related to mitral and tricuspid valve prolapse, as well as prosthetic valve sounds are described … the latter producing opening and closing sounds that differ from the normal, although bioprosthetic valve sounds, say the authors, are often of an intensity and frequency indistinguishable from the norm.

The lecture concludes with a discussion of the sound and the causes of the typical three components of a pericardial friction rub, and how it differs from a pleuropericardial friction rub. Some 30 figures accompany this lecture.