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Hey there, friend!

Today we are talking about a *little* subject called heart sounds. Even though they’re little and hard to hear sometimes, they’re kind of a big deal. Knowing the normal rhythm of the heart as well as the most common abnormal heart sounds will help you identify serious problems in a patient’s heart. This can be lifesaving!

But first! Did you miss the last few weeks where we talked about how to do a full nursing cardiac assessment?

Don’t worry, you can find them here:
The 25 Cardiac Assessment Questions You Need to Ask – Plus a FREE Cheat Sheet
Your Ultimate Guide to the Cardiac Physical Assessment

Make sure to download the FREE Cheat Sheets that go along with them.

I know what you’re thinking: Whatttt? Did she just say FREE cheat sheet? She must be crazy to do all that for me!

That’s what BFF’s are for, right? I got your back. 🙂 Simply submit your name and email below and I’ll send them right over!

Normal Heart Sounds

If you remember from the last post, the sound “LUB” “DUB” is commonly associated with the normal sound of the heart.

The first sound (LUB) is caused by the tricuspid and mitral valves slamming shut as the ventricles contract. This sound is called S1.

The second sound (DUB) is caused by the pulmonic and aortic valves slamming shut at the end of ventricular systole. This sound is called S2.

Take a listen to this audio recording of a normal S1 and S2 sound. And remember that these sounds are caused by the closing of their corresponding valves.


If you look at the anatomy of the heart, you can see that the tricuspid and mitral valves sit lower in the heart than the pulmonic and aortic valves.

Valves of the Heart (1)

Do you remember your stethoscope positions for heart sounds? If not, you can review them here.

Here’s what those stethoscope positions look like on the heart itself:

APETM Valves of the Heart

You can see that the positions of the stethoscope line up nicely with the valves of the heart. So when you are listening in a particular place, you know what valve you are listening to.

You can see that you would hear the S1 sound more loudly in the lower two stethoscope positions and S2 more loudly in the upper two positions. S2 and S1 are heard equally at Erb’s point.

S1 and S2 Placements

S3 and S4 sounds

There are two additional beats that you need to be familiar with as a nursing student. These beats are referred to as S3 and S4.

S3 is an extra beat that happens after S2. S3 occurs when there is a high blood volume that rapidly fills the ventricles while the heart is relaxing (diastole).

It’s a low-pitched sound and is often referred to as sounding like the “y” in Ken-tuck-y. S3 is considered normal for children and athletes as their hearts are more flexible to accommodate rapid ventricular filling. In adults, it may indicate heart failure, heart attack, or pulmonary edema. This sound is also referred to as a ventricular gallop.

S4 is an extra beat that happens just before S1. The sound is created as the atria strongly force the blood into the non-flexible ventricles. It is caused by hypertrophy of the ventricle due to aortic stenosis, hypertension or a heart attack. This sound is often referred to as sounding like the “Ten” in Ten-nes-see. S4 is also referred to as an atrial gallop.

Take a listen to this video of S3 and S4.

S3 begins right away.
S4 begins at 4:43.


Don’t beat yourself up if you can’t identify each of your patient’s abnormal heart sounds right away. That skill may take a while to develop. Just keep on practicing!

Although you’re not expected to be super stellar at identifying heart sounds as a student nurse, it is important to be able to tell when something is just not quite right.

As always, notify your RN if you feel that something is off or if you need help identifying a heart sound. Don’t be shy or embarrassed if you can’t identify it, just the fact that you take the time to ask tells me you are a fantastic RN at heart. 🙂

Cheers to you, my friend!

Comment below and tell me one thing that makes you a FANTASTIC RN at heart.