All of the following sounds are diastolic sounds, except:
The high-pitched opening snap (OS) of MS occurs after a very sho interval after the second hea sound. The A2 - OS interval is inversely propoional to the height of the left atrial-left ventricular diastolic pressure gradient. The intensity of both S1 and the OS of MS decreases with progressive calcification and rigidity of the anterior mitral leaflets. The pericardial knock (PK) is also highpitched and occurs slightly later than the OS, corresponding in timing to the abrupt cessation of ventricular expansion after tricuspid valve opening and to an exaggerated y descent seen in the jugular venous waveform in patients with constrictive pericarditis. A tumor plop is a lower-pitched sound that rarely can be heard in patients with atrial myxoma. It may be appreciated only in ceain positions and arises from the diastolic prolapse of the tumor across the mitral valve. The third hea sound (S3) occurs during the rapid filling phase of ventricular diastole. It can be a normal finding in children, adolescents, and young adults; however, in older patients, it signifies hea failure. A left-sided S3 is a low-pitched sound best heard over the LV apex. A right-sided S3 is usually better heard over the lower left sternal borderand becomes louder with inspiration. A left-sided S3 in patients with chronic hea failure is predictive of cardiovascular morbidity and moality. Interestingly, an S3 is equally prevalent among hea failure patients with and without LV systolic dysfunction. The fouh hea sound (S4) occurs during the atrial filling phase of ventricular diastole and indicates LV presystolic expansion. An S4 is more common among patients who derive significant benefit from the atrial contribution to ventricular filling, such as those with chronic LV hyperophy or active myocardial ischemia. An S4 is not present with atrial fibrillation Ref - Harrison's internal medicine 20e pg 1672
S3
S4
Opening snap
Ejection click
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