Heart valve chambers are lined with endocardium. Heart valves separate the atria from the ventricles, or the ventricles from a blood vessel. Heart valves are situated around the fibrous rings of the cardiac skeleton. The valves incorporate leaflets or cusps, which are pushed open to allow blood flow and which then close together to seal and prevent backflow. The mitral valve has two cusps, whereas the others have three. There are nodules at the tips of the cusps that make the seal tighter. The pulmonary valve has left, right, and anterior cusps. The aortic valve has left, right, and posterior cusps. The
Third heart sound when heard in a middle-aged or older adult, an S is often a sign of disease, indicating increased ventricular filling due to congestive heart failure or severe mitral or tricuspid regurgitation. S is thought to be caused by the oscillation of blood back and forth between the walls of the ventricles initiated by the inflow of blood from the atria. The reason the third heart sound does not occur until the middle third of diastole is probably that, during the early part of diastole, the ventricles are not filled sufficiently to create enough tension for reverberation. It may also be