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Echo > Module 17 : Cardiac Auscultation > Flashcards

Module 17 : Cardiac Auscultation Flashcards

1
Q

why listen to heart sounds

A
  • cardiac auscultation is quick inexpensive method to detect and track the progression of valvular heart disease
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2
Q

progression of events

A
  • doctor will hear murmur before sending patient for an Echo
  • once echo is performed the doctor can correlate the present disease state with the echo findings
  • if quality of murmur changes that could indicate that the disease has progressed
  • new echo is then ordered
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3
Q

auscultation is performed with what

A
  • stethoscope
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4
Q

the four heart sounds

A
  • represent different mechanical eents
  • first = S1
  • second = S2
  • third = S3
  • fourth = S4
  • normally hear S1 and S2
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5
Q

first heart sound S1

A
  • lub sound
  • represents MV and TV closure
  • S1 composed of M1 (mitral) and T1 (tricuspid) sounds
  • normally M1 precedes T1 slightly when normal conduction through bundle branches
  • T1 may precede M1 with the left bundle branch block
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6
Q

second heart sounds S2

A
  • dub sound
  • caused by Av and PV closure
  • divided into A2 and P2
  • normally A2 precedes P2
  • A2 and P2 widen slightly with inspiration (more right heart filling so valves stay open longer)
  • a very wide split of A2 and P2 may result form RBBB pulmonic stenosis and atrial septal defect
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7
Q

third heart sound S3

A
  • lub dub ta
  • seldom heard heart sound
  • normal in young athletes pregnancy (high preload strong early filling)
  • abnormal later in life
  • may signify CHF
  • caused by increases volume of blood in the ventricle when the MV opens, coincides with early filling
  • NOT CAUSED BY VALVES
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8
Q

fourth heart sound S4

A
  • a PRESYSTOLIC heart sound (precedes S1)
  • NOT A NORMAL SOUND
  • REPRESENTS BLOOD BEING FORCED INTO A VERY STIFF VENTRICLE FROM TEH ATRIA
  • occurs during late filling phase
  • does not occur with afib
    + no result of coordinated contraction
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9
Q

murmurs

A
  • sound produced by turbulent flow in the heart through valves/shunts/vessels
  • ABNORMAL heart sound
  • usually during systole or diastole
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10
Q

causes of murmurs

A
  • turbulence
  • high flow rate
  • forward flow - abnormal valves
    + stenosis
  • back flow - regurge
  • abnormal connections - VSD PDA
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11
Q

common valvular pathologies causes murmurs - mitral

A
  • mitral stenosis MS
  • mitral regurge MR
  • mitral valve prolapse MP
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12
Q

common valvular pathologies causin murmurs - tricuspid

A
  • tricuspid stenosis TS

- tricuspid regurge TR

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13
Q

common valvular pathologies causing murmurs - aortic

A
  • aortic stenosis AS

- aortic regurge AR

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14
Q

common valvular pathologies causing murmurs - pulmonary

A
  • pulmonary stenosis PS

- pulmonary regurge PR

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15
Q

clicks

A
  • valve openings are usually silent but valvular stenosis can produce ejection click or snaps during valve opening
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16
Q

murmur physiology

A
  • a valve hat fails to close properly allows regurge of blood flow wen it should not be happening
  • produces a sound because o turbulent blood flow when the valve normally would be closed
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17
Q

6 factors to assess and describe murmurs

A

1) which phase (systole, diastole, pan hollow)
2) which portion of the phase (early or late)
3) location where murmur is best heard
4) radiation ? to where (carotids /axilla)
5) quality /shape of murmur (harsh/cresendo/decresendo/blowing)
6) intensity (grade 1-6)

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18
Q

location of murmurs

A
  • sounds produced by the valves are best heard over a particular region of the chest
  • lower apex = mitral
  • more midline lower = tricuspid
  • high left = pulmonic
  • high right = aortic
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19
Q

radiation of murmurs

A
  • sometimes radiate to other areas like carotid or axilla
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20
Q

crescendo / decrescendo

A
  • helpful to to relate doppler qualities to the quality of murmur
  • crescendo = increasing in pitch
  • decrescendo = decrees in pitch
21
Q

heart quality and shape - stenosis of semi lunar valves

A
  • crescendo / decrescendo
22
Q

heart quality and shape - stenosis of AV valves

A
  • diastolic rumble

- lower pitch

23
Q

heart quality and shape - regurge

A
  • holophasic or pan phasic

- means through the whole cycle

24
Q

timing of heart sound - systolic aortic ejection murmur (AS)

A
  • occurs during systole between S1 and S2

- crescendo decrescendo

25
Q

timing of heart sound - pan systolic murmur (mitral incompetence)

A
  • spray sound

- even throughout cycle

26
Q

timing of heart sound - pan systolic murmur aortic or pulmonary incomp

A
  • occurs in diastole
  • ## after S2
27
Q

timing of heart sound - delayed diastole murmur mitral stenosis

A
  • gap after S2 during IVRT

- early undulate diastole

28
Q

timing of heart sound - continuous murmur of patent ductus arterioles

A
  • systole and diastole
29
Q

intensity of murmurs and click

A
  • levine scale

- grade 1-6

30
Q

grade 1 murmur

A
  • lowest intensity (barely audible)
31
Q

grade 2 murmur

A
  • low intensity
32
Q

grade 3 murmur

A
  • medium intensity (no palpable thrill)
33
Q

grade 4 murmur

A
  • medium intensity (palpable thrill)
34
Q

grade 5 murmur

A
  • loud intensity (palpable thrill)
35
Q

grade 6 murmur

A
  • loudest intensity
  • largest palpable thrill
  • heard with stethoscope above chest
36
Q

palpable thrill

A
  • vibration felt on thrill
37
Q

describing stenotic murmurs - AV/PV

A
  • harsh quality (murmur/flow)
  • radiation - to where
    + AV > carotids
  • closing sound may be muted or absent when valve is thickened
38
Q

describing stenotic murmurs - MV TV

A
  • diastolic
  • at apex
  • little radiation
  • rumbling quality
39
Q

stenotic murmurs - AV valves

A
  • starts with opening snap

- low pitched/ decrescendo / rubbing

40
Q

regurge murmurs - AV/PV

A
  • diastolic

- blowing , decrescendo

41
Q

regurge murmurs - MV/ TV

A
  • pan systolic holosystolic
  • mitral regurge
    + at apex
    + radiates to left axilla
    + loud
  • tricuspid regurge
    + pan systolic
    + left sternal border
42
Q

less common murmurs

A
  • rub
  • knock
  • muffled heart sounds
  • ## changes with respiration/ provocative maneuvers
43
Q

rub murmur

A
  • beating of heart agains inflamed pericardium without fluid between the layers
  • caused by tiny crystals in the pericardium sounds like sand paper
44
Q

knock murmur

A
  • beating of heart against hardened pericardium with fluid between the layers
  • pericardium is like a hard shell from pericarditis s
45
Q

muffled heart sound murmurs

A
  • in presence of pericardial effusion

- fluid dampens the sound

46
Q

Changs in respiration / provocative manoeuvres murmurs

A
  • split S1 S2 , paradoxical splitting

- sound intensity increases with valsalva

47
Q

systolic murmurs

A
  • maybe innocent
  • nervous, anxiety , functional
  • if pathological they could be
    + AS pS MR TR
48
Q

diastolic murmurs

A
  • usually pathology

- AR PR MS TS

49
Q

phonocardiogram

A
  • graphic display of heart sounds and murmurs
  • obsolete with event of echo can now demonstrate and quantify valvular abnormalities
  • similar to stethoscope microphone on Chest

Echo (19 decks)

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