11 03 2014 Heart Sounds Flashcards Preview

Cardiology M2 > 11 03 2014 Heart Sounds > Flashcards

Flashcards in 11 03 2014 Heart Sounds Deck (36):
1

Where are the 3 pathways of getting blood back to the RA?

1. Coronary Sinus
2. Superior Vena Cava
3. Inferior vena Cava

2

What would cause a prominent increase in the A-wave in a Jugular Venous Pulsation fluctuations?

Tricuspid Stenosis
Right Ventricular Hypertrophy

* anything that would make the atria have to squeeze harder

3

What would cause a prominent increase in the v-wave in a Jugular Venous Pulsation (JVP) graph?

V-wave : diastolic filling (muscle is relaxed)

Tricuspid Regurgitation

4

What would cause a prominent y-wave in a Jugular venous pulsation (JVP) schematic?

Y : passive filling of RV (tricuspid opens)

Constrictive Percarditis

5

What are the 3 factors that affect the intensity of the S1 sound

1. Distance (PR interval) between opening of valves and ventricle contraction

2. mobility of leaflets

3. rate of rise in the ventricular pressure.

6

Pathological effects that will INCREASE the intensity of S1 sound?

1. shortened PR interverval
- leaflets are far apart and slammed shut

2. Mitral stenosis

3. Tachycardia/ high cardiac outputs (exercise or anemia)

7

Pathological effects that will DECREASE the intensity of S1 sound?

1. prolonged PR interval
- gives more time for leaflets to come back towards each other = smaller distance

2. Mitral regurgitation

3. Severe mitral stenosis

4. Stiff ventricle: systematic hypertension

8

Where is S1 best heard?

At the apex of the heart

9

What is the reasoning behind the physiological splitting of the S2 ; where does it occur; where is it best heard?

1. occurs during inspiration

2. Increase in negative pressure
- Delays Pulmonic Valve closure
(b/c of delay in back pressures from pulmonic artery)

- early Aortic valve closure
(less venous return from pulmonic vein to LA = less blood going to LV = less filling time = early aortic closure)

Best heard over the pulmonic valve area (2nd left intercostal space)

10

Explain pathophysiology of a cause that would INCREASE INTENSITY of S2?

Hypertension (systemic or pulmonary)
- velocity of blood in aorta/ pulmonary artery is augments = hits against valve harder

11

Explain pathophysiology of a douse that would DECREASE INTENSITY of S2?

Aortic or Pulmonic valve stenosis because the leaflets are fixed in position

12

what are the 3 ways S2 abnormally splits

1. widening
2. fixed splitting
3. Paradoxical splitting

13

Widening splitting

Separation of A2 and P2 in expiration and EVEN MORE SO in Inspiration

usually caused by RBBB or pulmonic valve stenosis

14

Fixed splitting

abnormal widening that is constant throughout respiratory cycle

caused by Atrial-septal defect -- delay in P2 closure due to chronic volume overload in Rt. heart

15

Pardoxical splitting

Audible separation between A2 and P2 during EXPIRATION and 1 sound during inspiration

LBBB and severe aortic stenosis
A2 is delayed so much that during inspiration it comes after P2.

LBBB: delay in contraction of A1
Severe aortic stenosis: ventricular ejection is prolongued

16

What are early extra-systolic sounds?
1. name
2. what causes sound?
3. Characteristic of sound?
4. what causes these heart sounds?

1. Ejection click
2. -opening of aortic or pulmonic valves (after S1)
3. - sharp- High pitched
heard best over respective valves

4a. Stenosis: valve reaches elastic limit and velocity with which it opens descends abruptly = click

4b. Dilation of great vessel
tensing of aortic or pulmonic root as blood rushes in.

17

Aortic ejection click

opening of aortic valve

heard best over aortic area and a base and apex of heart. Does not vary with inspiration

18

Pulmonic ejection click

opening of pulmonic valve

best heard at base of heart.
intensity decreases with inspiration (due to backflow)

19

A mid- to- late extra systolic sound is due to what?

Where is this extra systolic sound heard the loudest?

- Ejection click
- systolic prolapse of mitral or tricuspid valve during ventricular contraction

Over perspective mitral or tricuspid valve area

20

What are the two types of early diastolic Sounds?

- Opening snap
- S3

21

What causes an opening snap?

What does it sound like? best heard where?

Does it vary with respiration?

Mitral or tricuspid stenosis -- early diastolic sound

sharp, high pitched sound; mitral stenosis is best heard between apex and left sternal border.

Does not vary with inspiration; can get confused with widening split (3 heart sounds)

HOwever, the more advanced the stenosis, the shorter then interval

22

What causes S3 sound?

What does it sound like? best heard where?

when can these sounds be normal?

Overloaded ventricle -- tension on chordae tendinae. AKA a VENTRICULAR GALLOP

Dull, low pitched sound
Left-sided : loudest over apex in left lateral decubitus
Right sided: loudest over lower-left sternal borer (tricuspid is)

normal in children.

Sign of congestive heart failure in adult population

23

What causes S4 sound?

When does it usually appear-- as in timing? What does it sound like? best heard where?

Aka as Arterial Gallop
- due to a stifff heart -- usually occurs Late Diastole -- contraction of atria to try to get blood into stiff LV.

Dull, low pitched sound heard best at the apex in the left lateral decubitus position

24

What is Quadruple Rhythm?

Timing of beats?

Both S3 and S4 are heard

heard as mid-diastolic low-pitched sound often louder than S1 and S2

25

What does a pericardial knock sound like and what is it indicative of?

High pitched sound after S2 in early diastolic

Can be confused with an OS or S3 BUT it is slightly later than an OS (because after valve opening) and louder than an S3.

Constrictive pericarditis : abrupt cessation of ventricular filling in early diastole

26

What is causing the following murmur:

systolic murmur heard as Crescendo-decrescendo heart best in aortic area and radiating towards neck.

other details:
(Small gap between S1 and sound)
Usually preceded by an ejection click

Aortic Stenosis

27

What is causing the following murmur:

systolic murmur heard as Crescendo-decrescendo heart best left 2nd or 3rd intercostal sapce). can radiate to neck or left shoulder

other details:
(Small gap between S1 and sound)
Usually preceded by an ejection click

Pulmonic stenosis

* if severe enough it will extend past A2 sound = widening split

28

What is causing the following murmur:

High pitched blowing sound that is uniform in intensity heard between S1 and S2.

Heart best at apex of the heart and radiates into left axilla.
No gap betwen S1 and murmur

Pansytolic or holosystolic

Mitral Regurgitation

29

What is causing the following murmur:

High pitched blowing sound that is uniform in intensity heard between S1 and S2. Does increase with inspiration

Heart best at left lower sternal border and radiates to right sternum.
No gap betwen S1 and murmur

Pansytolic or holosystolic

Tricuspid Regurgitation
* increases with inspiration due to increase venous return during inspiration to RA.

30

What is causing the following murmur:

High pitched blowing sound that is uniform in intensity heard between S1 and S2.

Sometimes associated with a palpable thrill

Best heard at 4th-6th left intercostal space. does NOT radiate to axilla

Pansytolic or holosystolic

Ventricular Septal Defect
* the smaller the defect the louder the murmur is.

31

What is causing the following murmur:

Late systolic murmur that initially has a click noise but then continues with uniform intensity. Terminates with S2.

Mitral valve prolapse
* preceded by ejection click

32

What is causing the following murmur:

Early diastolic murmur begins after S2 and terminates before the next S1; high pitched and decrescendo in shape.

Best heard at lefts sternal border with patient leaning forward and exhaling

Aortic valve regurgitation

33

What is causing the following murmur:

Early diastolic murmur; begins after S2 and terminates before next S1; high pitched and descrescendo in shape.

Intesity increases with respiration. Located in 2-3rnd intercostal space on left border of sternum.

Pulmonic valve regurgitation
* usually occurs due to pulmonary artery hypertension

34

What is causing the following murmur:

Mid- late diastolic low pitched sound begining after S2 and preceded by a sharp high-pitched sound.

Loudest after S2 then decrescendo (or totally disappears) and then reapears and crecendos during late diastole right before next S1.

Heart best with bell at apex in left lateral decubitus position

Sharp high-pitched sound was an opening snap

Mitral stenosis ( severe mitral stenosis does not let the intensity towards middle of murmur sound disappear)

35

What is causing the following murmur:

Mid- late diastolic low pitched sound begining after S2 and preceded by a sharp high-pitched sound.

Loudest after S2 then decrescendo (or totally disappears) and then reapears and crecendos during late diastole right before next S1.

Heart best with at lower sternum border near xiphoid process

Tricuspid Stenosis
* less common!

36

What is causing the following murmur:

Begins in early systole (right after S1). It maximizes at S2 and decroscendos to S1

What can these murmurs also be mistaken for?

Continuous murmur:

Patent ductus arteriosis : abnormal communication between pulmonary artery and aorta

Can be mistaken for the "to- and fro" combined murmur : aortic stenosis + aortic regurgitation or pulmonic stenosis + pulmonic regurgitation
* however, usually the second sound (regurgitation) does not extend from S2 to next S1.