S3 and More!

S3 can be related to age and congenital  issues.  In adults it can be found in patients with heart failure.  pregnancy and hypertension.  It is best heard with the bell of the stethoscope and not the diaphragm,  over the apex.   It also sounds like, "What the hell" or the -ky in Kentucky  It is also better heard at the apex if the patient is laying on their left side.

S4--- Best heard in the Apex with the bell of the stethoscope.  It can be heard in patients with MI.
It can be heard before the Lub.  It sounds like the Ten in Tennessee.  It is caused when the atria contracts forcefully as it tries to overcome a stiff or hypertrophic ventricle.

The best way to become comfortable with heart sounds is to listen frequently.  There are a ton of website with great examples.  Just remember there is never a dumb question.  If you aren't sure what you heard, ask someone else to listen!  UCLA has a great site The Auscultation Assistant.  It covers some of the most common heart sounds as well as lung sounds.  

The Auscultation Assistant

When All Else Fails!  There's An App For That! 

3M Littmann Sound Builder is available for free from apple apps store.  

iStehoscope Expert is a free download t

Heart Sound Challenge from The University of Michigan is $2.99.  It offers a way to test your skills.