Heart Sounds I Lecture Powerpoint

Question 1

Heart sounds are heard in the spots they are in the chest because…

Answer 1

…that is the rough direction of where blood is flowing in the vessels

Question 2

During diastole, what valves are open?

Answer 2

Mitral and tricuspid valves

Question 3

S1 heart sound occurs during what phase of the heart cycle? What about S2?

Answer 3

• At the end of diastole/start of systole

- At the end of systole/start of diastole

Question 4

Blood FLOWS during which phase of the cardiac cycle?

Answer 4

BOTH!!!!!!!!!!!!

Question 5

Diagnostic study for abnormal heart sounds

Answer 5

Echocardiogram

Question 6

Stenotic valve definition

Answer 6

A valve that is partially occluded or narrowed

Question 7

Sclerosis of valve definition

Answer 7

Thickening of valve that causes it to lose its compliance that could result in stenosis

Question 8

Insufficiency/regurgitation definition

Answer 8

When a valve leaks allowing backward flow when it should be closed

Question 9

Pulse pressure definition

Answer 9

Difference between systolic and diastolic blood pressure

Question 10

Atrial systole and diastole ___ ventricular systole and diastole

Answer 10

precede

Question 11

End systolic volume

Answer 11

Volume of blood remaining in LV following cardiac contraction and ejection of blood

Question 12

Stroke volume + end systolic volume =

Answer 12

end diastolic volume

Question 13

Ejection fraction and avg value

Answer 13

Stroke volue/end diastolic volume, should be about 55%

Question 14

Aortic area
Pulmonic area
Erb's point
Tricuspid area
Mitral area
Locations

Answer 14

• 2nd intercostal space right sternal border
• 2nd intercostal space, left sternal border
• third intercostal space, left sternal border
• 4th intercostal space, left sternal border
• 5th intercostal space, mid clavicular line

Question 15

Carotid pulsation to determine S1 vs S2

Answer 15

Should be able to feel the carotid pulse between S1 and S2 if you are having trouble determining which is which

Question 16

S1 is loudest at the ___, S2 at the ___

Answer 16

apex, base

Question 17

Physiological splitting of S2

Answer 17

Refers to splitting of S2 into A2 (aortic valve closing) and P2 (pulmonic valve closing) that is exacerbated during inspiration because of the impedance of the pulmonary circulation vascular beds

Question 18

Decreased S1 causes (2)

Answer 18

• thickened chest wall

- calcification of AV valves

Question 19

Increased S1 causes (2)

Answer 19

• increased cardiac output

- increased AV valve flow velocity (acquired stenosis)

Question 20

Wide splitting of S2 causes (4)

Answer 20

• delayed P2 from pulmonary stenosis or pulmonary hypertension
• Early A2 from mitral regurgitation or VSD

Question 21

Paradoxical splitting of S2 and causes (2)

Answer 21

Occurs where split is widened during expiration and hsortened during inspiration (with A2 after P2)

• aortic stenosis
• aortic insufficiency

Question 22

S3 gallop

Answer 22

Early diastolic sound following S2 with new blood entering a dilated ventricle, may be normal in children or indicative of CHF, CAD, or aortic/mitral insufficiency

Question 23

S4 gallop

Answer 23

Late diastolic sound right before S1 due to ejection of blood from atria during atrial contraction hitting a stiff noncompliant wall, long standing hypertension causing LV hypertrophy is key, may be normal but almost always pathologic

Question 24

Summation gallop

Answer 24

Occurs where S3 and S4 combine in a rapid heart which sounds like 3 heart sounds lined up in a row

Question 25

Aortic ejection click

Answer 25

Early systolic sound heart just after S1, does not vary with inspiration, due to a mobile but abnormally shaped or stenotic aortic valve, usually pathologic for aortic stenosis

Question 26

Opening snap

Answer 26

Opening of abnormal tricuspid or mitral valve, early diastolic sound heard just after S2 associated with mitral stenosis

Question 27

Cardiac friction rub

Answer 27

Creaking, grating, or scratching sound heard with pericardial inflammation, classically has 2 systolic and one diastolic component, heard best at the left sternal border (increased when leaning forward) when patient is not breathing