Heart Sounds Flashcards
Splitting of S2 during inspiration, but normal during expiration
Physiological splitting of S2
Splitting of S2 during expiration, but normal during inspiration
Paradoxical splitting of S2
Causes: LBBB, aortic stenosis, HOCM
Splitting of S2 through inspiration and expiration
Fixed splitting of S2
Hallmark of atrial septal defect (ASD)
Low, dull thud in early/mid diastole, heard with bell
S3
Normal in children/young adults
Causes: tensing of chordae tendineae, limitation of longitudinal ventricular expansion during early ventricular filling
Low murmur in late diastole, heard with bell
S4
Rarely normal
Causes: atrium contracting against stiffened ventricle (reduced compliance)
Low murmurs heard in early (after S2) and late diastole (before S1)
Quadruple rhythm- presence of S3 and S4
Extra heart sounds in early and late diastole that run together
Summation gallop- presence of S3 and S4 with a fast heart rate
Holosystolic murmur best heard at the cardiac apex, does not get louder during inspiration
Chronic mitral regurgitation
Early systolic decrescendo murmur
Acute mitral regurgitation
Midsystolic click with late systolic murmur
Mitral valve prolapse (MVP)
Click is later and murmur is shorter with squatting, click is earlier and murmur longer with standing
Holosystolic murmur, louder during inspiration
Tricuspid regurgitation
Triad: Carvallo’s sign- louder during inspiration, pulsatile JVD, pulsatile liver
Holosystolic murmur best heard at the lower left sternal border, does not get louder with inspiration, harsh quality
Ventricular septal defect (VSD)
Crescendo-decrescendo systolic ejection murmur, often heard best at 2nd intercostal space at the right sternal border, radiation to the carotids, louder with squatting, amyl nitrate, softer with standing. valsalva, isometric handgrip
Aortic stenosis
May also have: paradoxical splitting of S2, diminished/absent A2, aortic ejection sound/click (congenital- bicuspid aortic valve)
Crescendo-decrescendo systolic ejection murmur, gets louder with valsalva, standing, amyl nitrate, gets softer with isometric handgrip, squatting
Hypertrophic cardiomyopathy
Crescendo-decrescendo systolic ejection murmur best heard at 2nd intercostal space on left sternal border, increases during inspiration, no radiation to carotids
Pulmonic stenosis
Ejection sound/click present in congenital PS, gets softer in inspiration