Added Heart Sounds

CLINICAL DIAGNOSTIC MANUAL

Added heart sounds are additional noises beyond the normal first (S1) and second (S2) heart sounds. These sounds may indicate structural or functional abnormalities of the heart. The most common added sounds include the third (S3) and fourth (S4) heart sounds, clicks, and snaps. Identifying and evaluating these sounds can provide valuable information about various cardiac pathologies and their severity.

Pathology	Suspected Diagnosis	Confirmatory Diagnosis
Physiological	Mild and transient added sounds, no other symptoms.	Clinical history, physical examination, echocardiogram.
Heart failure	Dyspnoea, orthopnoea, peripheral oedema, presence of S3 or S4.	Echocardiogram, chest X-ray, blood tests (BNP).
Cardiomyopathy	Dyspnoea, fatigue, palpitations, presence of S3 or S4.	Echocardiogram, cardiac MRI (CMR), blood tests (troponins).
Constrictive pericarditis	Chest pain, dyspnoea, hepatomegaly, pericardial knock.	Echocardiogram, CMR, cardiac catheterisation.