Cardiac Conditions Associated with Sudden Death

Hypertrophic Cardiomyopathy Sounds

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An early peaking, harsh diamond shaped systolic murmur starts at the beginning of systole and ends well before the second heart sound. A fourth heart sound gallop is also present in diastole as you can readily see on the wave form tab.

S1 is increased due to a hyperdynamic left ventricle. S2 is single.

On the anatomy tab you can see that the contraction of the left ventricle is strong and occurs in a reduced amount of time. Anatomically, the septal wall is very much thicker than the rest of the ventricle but this is not shown in the animation.

The strong contraction of the left ventricle causes the anterior leaflet to be sucked into the ventricle, blocking the flow into the aorta and causing an aortic murmur. At the same time turbulent flow from the left ventricle to the left atrium causes a second murmur. Since the two murmurs occur at the same time you hear a single murmur.

You can hear the difference between the two murmurs by moving the stethoscope head the aortic to the mitral valve area. First, you will hear the diamond shaped aortic murmur and later the rectangular pansystolic murmur.

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The recommended auscultation position for the stethoscope is the Mitral position. For this sound, use stethoscope's Diaphragm.

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The recommended patient position is Supine

Phonocardiogram

This waveform plots sound amplitude on the vertical axis against time on the horizontal axis.

Heart Animation

Lessons

1	Hypertrophic Cardiomyopathy
2	Aortic Stenosis - Severe 2
3	Arrhythmogenic RV Dysplasia
4	Mitral Valve Prolapse (Click with Late Systolic Murmur)
5	Myocarditis
6	Commotio Cordis
7	Ebstein's Anomaly

Practice Drill

Listening Tips
A synopsis of important sound features and timing for this abnormality.
S1: Increased intensity. Can be loudest at tricuspid area (4th ICS).
Systole: Diamond-shaped, early peaking, harsh.
Diastole: S4 gallop is present.

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