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Aortic valve sounds heard in 2nd intercostal space at right sternal margin Pulmonary valve sounds heard in 2nd intercostal space at left sternal margin Mitral valve sounds heard over heart apex (in 5th intercostal space) in line with middle of clavicle Tricuspid valve sounds typically heard in right sternal margin of 5th intercostal space Anatomy of the intrinsic conduction system showing the sequence of electrical excitation 1 The sinoatrial (SA) node (pacemaker) 2 The impulses pause (0.1 s) at the atrioventricular (AV) node. 3 The atrioventricular The Purkinje fibers (AV) bundle 4 The bundle branches 5 The Purkinje fibers Anatomy of the intrinsic conduction system showing the sequence of electrical excitation QRS complex Sinoatrial node Atrioventricular node P-Q Interval S-T Segment Q-T Interval QRS complex Sinoatrial node Atrial depolarization Ventricular depolarization Ventricular repolarization Atrioventricular node P-Q Interval S-T Segment Q-T Interval Left heart Electrocardiogram “Lup” = Heart sounds Pressure (mm Hg) “Dup” = Ventricular volume (ml) Atrial _________ EDV = ESV = SV = Atrioventricular valves Aortic and pulmonary valves Open Closed Open Closed Open Closed Ventricular Ventricular _________ _________ Left heart QRS Electrocardiogram P T 1st Heart sounds P 2nd Atrial SYSTOLE Aorta Atrial systole Left atrium EDV = End Diastolic Volume ESV = End Systolic Volume EDV SV SV = Stroke Volume ESV Atrioventricular valves Aortic and pulmonary valves “Dup” = closing of Aortic valve (2nd heart sound) Left ventricle Ventricular volume (ml) Pressure (mm Hg) Dicrotic notch “Lup” = closing of L AV valve or Mitral valve (1st heart sound) Open Closed Open Closed Open Closed Ventricular Ventricular SYSTOLE DIASTOLE