A patient reports fainting and persistent fatigue; which heart sounds would indicate normal cardiovascular status?

• A. S3
• B. S4
• C. S1, S2
• D. Murmurs

Answer: (C)

Fainting and fatigue can be caused by many factors, but the best sign of normal cardiovascular status on auscultation is hearing the two primary heart sounds without any extra noises. S1 represents the closure of the atrioventricular valves at the start of systole, and S2 represents the closure of the semilunar valves at the end of systole. When these two sounds are present and crisp, with no additional sounds, murmurs, or gallops, it suggests normal valve function and cardiac cycle.

S3 is a rapid “ventricular” filling sound that can indicate volume overload or heart failure, especially in older adults. S4 is an atrial gallop reflecting a stiff or noncompliant ventricle, seen with diastolic dysfunction or hypertensive heart disease. Murmurs indicate turbulent blood flow often due to valvular lesions or structural abnormalities. So, the presence of S1 and S2 alone points to a normal cardiovascular status.