Heart Sounds vs Heart Rhythm

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Okay, okay, okay. I'm in the last semester of school and seem to have not gotten down something I thought is really simple. It is the idea of, when documenting, what is heart sounds vs heart rhythm.

Heart sounds can be normal or abnormal, and heart rhythms can be regular or irregular, according to my school's teachings. Now, when they say, are the heart sounds normal or abnormal, I'm thinking, the actual question is: are there any murmurs, s3, s4, or out of sync beats (like an extra beat that you'd hear with a.fib or something)? If yes, then the heart sounds are abnormal, if no, then they are normal.

For heart rhythm, I'm thinking the question behind it is, is the beat steady. If we have an s3, but the beat is steady and constant, then the rhythm is regular. If, for example, we have a 3rd degree heart block, then of course the rhythm is irregular.

Is this correct? And if I'm not correct, what is the difference between Sound vs Rhythm with an example. Because my teaching was describing it to me in a way that made it sound like they were basically the same thing, making one of the categories redundant...

Also, if you can give examples of, Normal Heart Sounds with an Irregular Rhythm, and also Abormal Heart Sounds with a Regular Rhythm, that would be sweeeeet.

What the lump?

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Specializes in Trauma, Teaching.

Heart sounds are what you hear, not to be Captain Obvious here lol. Lub Dub. If you hear an S3 or S4 you have an abnormal heart sound, as well as clicks with malfunctioning valves, or murmurs. Murmurs can be systolic, diastolic or pan systolic, depending on the time you hear it. Lub/swish/dub, or lub/dub/swish, or just faint lubs with lots of swish.

Rhythm is the pattern, can be palpated or listened to. Regular, regularly irregular, irregularly irregular. For instance, with Afib you'll have lub/dub, but no pattern (irreg irreg). Trigeminy: three rapid beats together (one example is 2 normal and an ectopic beat).

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Awesome explanation by JBudd, and Captain Obvious Junior here wanted to mention that rhythm can also be seen in the form of an EKG or if the patient is on a cardiac monitor.

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You wanted an example of normal heart sounds with an abnormal rhythm: easy-peasy. Slow atrial fibrillation c normal S1 & S2. Or really, any rhythm with a normal mitral/tricuspid and aortic/pulmonic valve action, which is where the S1 and S2 come from. A paced rhythm would do that, too. Anything that has decent LV function would meet that criterion.

S3 and S4 are sounds made by blood banging around in a sick ventricle. You can have a perfectly lovely PQRST and an awful S3-S4.

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Heart sounds are what you hear, not to be Captain Obvious here lol. Lub Dub. If you hear an S3 or S4 you have an abnormal heart sound, as well as clicks with malfunctioning valves, or murmurs.

I agree, it does seem obvious, but I'm not sure you read my entire post... For clarification purposes, would you call a.fib normal heart sounds as GrnTea did? Because my teacher wouldn't, but I would. Now I'd like your opinion as it seems according to my quote, that you wouldn't consider it normal sounds. This is where I'm confused, and seemingly other people too.

Thanks a ton!

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Specializes in Emergency, Telemetry, Transplant.
For clarification purposes, would you call a.fib normal heart sounds as GrnTea did?

If S1 and S2 are there and there are no extra sounds--S3, S4, rubs, murmurs--they, based on quality, be "normal." In the setting of AF, they will not be regular.

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Specializes in Medical-Surgical/Float Pool/Stepdown.
I agree, it does seem obvious, but I'm not sure you read my entire post... For clarification purposes, would you call a.fib normal heart sounds as GrnTea did? Because my teacher wouldn't, but I would. Now I'd like your opinion as it seems according to my quote, that you wouldn't consider it normal sounds. This is where I'm confused, and seemingly other people too.

Thanks a ton!

OK, let's see if I can pull it off explaining it on my phone! You've already made the connection that you can have an abnormal rhythm (by hearing, feeling, or seeing on an ECG) with normal heart sounds(by hearing) and vice versa. Your normal heart sounds of lub-dub correlate with the QRS firing on the ECG or the ventricles squeezing giving you a pulse beat and the sounds of lub-dub. For a normal or abnormal heart sound you are only listening to the sounds that are happening at that moment. Normal = S1 & S2, abnormal add a murmur or any extra valve noises such as an S3, S4, valve click, etc. I personally always listen to a patients apical heart sounds first, figure out what I'm hearing, leave the stethoscope in place and put my index finger over their radial pulse. First, are the apical and the radial regularly beating together? Do I hear the lub-dub of the apical and feel the radial pulse beat at the same time? Now I'm just listening for the entire beat of the heart sound (S1 & S2 and whatever else) to correlate with a radial pulse beat at the same time...now for the rythm...is the apical or the radial beats beating evenly like ...beat...beat...beat or are they beating...beat.....beat....beat.......beat? First rythm is regular and the latter is irregular. To see what type of regular or irregular rythm you are dealing with you're going to have to look at a cardiac telemetry monitor or ECG strip showing what is going on with the electrical pathways of the heart beats and figure the rest out from there. I'm a surgical trauma nurse by heart but love tele! Apologies again, don't know how to do paragraphs using my phone! As GrnTea pointed out, you can have normal heart sounds (lub-dub) with an irregular rythm as in afib...beat....beat.......beat...beat! Wait til you see a regular a-flutter :nailbiting:

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No, no, no! S3 and S4 are NOT valve sounds, and S1 and S2 are not ventricular sounds.

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Specializes in Critical Care, Education.

Accurate detection and interpretation of abnormal heart sounds, really does require a high level of expertise - and this only comes with experience. You first need to know where to listen for them- where to place your stethoscope. Picking up on abnormalities will come in time - after you have listened to a bazillion 'normal' hearts, it becomes easier. HERE is a great explanation along with recordings that will help you distinguish "kentucky" from "tennessee" and "ohio" - LOL.

A very important consideration when it comes to cardiac function - never assume that electrical (waveform or tracing) is absolutely indicative of mechanical (actual blood flow). The two may not be connected at all - e.g., EMD or a duplicative artifact. That a-fib patient may have perfectly normal heart sounds whenever the ventricles are triggered - just because there's a conduction problem does not mean that there is also a valvular problem. Both data sources should be evaluated independently before you could draw any conclusions.

Never stop being curious and trying to find out more - that's the path to expertise.

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Specializes in Medical-Surgical/Float Pool/Stepdown.
No, no, no! S3 and S4 are NOT valve sounds, and S1 and S2 are not ventricular sounds.

If this was meant towards me then I think this is one of the main reasons why I wax and wane at times on this site when deciding whether or not to help out. Please re-read... I did not say that the S1 & S2 were ventricule sounds, only that you should be hearing them apically when feeling a radial pulse. It's been a few years and that was a lot of typing so please forgive me if I lumped the S3 inadvertently with the other valve sounds, you had already explained it previously and the intention was to mean it was an extra heart sound. Either way, we should both be professionals but...wow either way. :( I feel the inadvertent need to get the carpet cleaned :roflmao: Here's a decent resource I think on describing heart sounds if it is not then please feel free to have an mini MI. CHFpatients.com - Heart Failure FAQ - Heart Sounds, S3, S4

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Specializes in Medical-Surgical/Float Pool/Stepdown.
Extra Heart Sounds (S3 and S4). Another website I like. Give me a break I just learned how to copy and paste on my phone.
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or any extra valve noises such as an S3, S4,

Your normal heart sounds of lub-dub correlate with the QRS firing on the ECG or the ventricles squeezing giving you a pulse beat and the sounds of lub-dub.

made me say this:

No, no, no! S3 and S4 are NOT valve sounds, and S1 and S2 are not ventricular sounds.

I stand by my assertion that S3 and S4 are not extra valve noises, and the lub-dub (properly called S1 and S2) are not the result of the ventricles squeezing and delivering a pulse, and my subsequent correction of those misapprehensions.

I really, really, didn't want the OP to go away with confusion on that, as his/her instructor had already given enough reason for confusion.

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