Abnormal Heart Sounds Flashcards
(40 cards)
Which valves are AV vales and which are Semilunar valves?
AV valves: mitral and tricuspid valves
Semilunar valves: aortic and pulmonic valves
Closure of which valve produces S1? What phase of cardiac cycle do you hear it?
Mitral valve closure during start of systole
Closure of which valve produces S2? What phase of cardiac cycle do you hear it?
Aortic valve closure during start of diastole
S3 heart sound
Sound of rapid ventricular filling of a compliant LV at end of S2; can be normal or abnormal
S4 heart sound
Sound of atria contracting forcefully in an effort to overcome an abnormally stiff or hypertrophic ventricle; right before the “lub-dub”
Where and d/t what condition would you hear A2 with increased intensity?
What if A2 is decreased or absent?
A2 (aortic valve closure) increased intensity:
- 2nd right ICS
- systemic HTN; aortic root dilation
A2 decreased/absent:
– calcific stenosis d/t valve immobility
When do you heart P2? If it’s equal or louder than A2 what does that mean?
Under what conditions is P2 decreased/absent?
P2 (pulmonic valve closure) increased intensity;
- if equal to/louder than A2 = pulmonary HTn
- other causes of P2 = dilated pulmonary artery and ASD
P2 decreased/absesnt:
- d/t increased AP diameter or chest assoc. w/aging
- d/t pulmonic stenosis
Spitting of S2 - what is it, what causes it, is it greater on inspiration or expiration
Caused by delayed closer of pulmonic valve (d/t pulmonic stenosis or RBBB)
- or early closure of the aortic valve (d/t mitral regurg.)
- greater during inspiration (more delayed closure of valve; more split P2)
When does paradoxical/reversed S2 splitting occur?
During expiration; disappears during inspiration
– occurs in any setting that delays closure of arotic valve (i.e aortic stenosis; HOCM)
What is the most common cause of paradoxical/reversed S2 splitting?
LBBB
What are the two main kinds of extra heart sounds in systole?
- Early ejection sounds
2. Clicks (mid-and late systole)
Early Ejection Sounds
- when do they occur
- characterization of sound
- heard best with bell or diaphragm/
- indicates what disease in general
- occurs shortly after S1
- high pitch; sharp clicking
- heard w/ diaphragm
- indicates CVD
Pulmonic Ejection sound
- location
- characterization
- indicates what dzs
- 2nd and 3rd left ICS; S1 here is loud in this area (normally quiet)
- intensity decreases with inspiration
- d/t dilation of pulmonary artery, pulmonary HTN, and pulmonic stenosis
Systolic Clicks
- when/where do they occur
- d/t what abnormality
- characterization
- head best with bell or diaphragm
- affect of squatting and standing
- occur mid or late systole; medial to apex and lower left sternal border
- usually caused by MITRAL VALVE PROLAPSE
- high pitched
- heard best with diaphragm
- Squatting = delays the click/murmur d/t increased venous return
- Standing = click occurs sooner (closer to S1)
Opening Snap
- when/ where does it occur
- d/t what abnormality
- characterization
- heard best with bell or diaphragm
- occurs during early diastole; just medial to apex along lower let sternal border; if loud = radiates to apex and pulmonic area
- assoc with MITRAL STENOSIS
- High pitch
- best heard with diaphragm
S3
- physiologic in what group
- pathologic in what group
- when/ where does it occur
- characterization
- heard best with bell or diaphragm
- d/t what conditions
- physiologic (normal) in children and young adults to ages 35-40; normal during last trimester of pregnancy
- pathologic (abnormal) in adults >40 yo
- dull and low in pitch
- heard best at apex in left lateral decubitus position
- use BELL OF STETHOSCOPE
- causes: dec miocardial contractility, heart failure, ventricular volume overload from aortic or mitral regurg, and left to right shunts
S4
- physiologic in what group
- when/ where does it occur
- characterization
- heard best with bell or diaphragm
- d/t what conditions
- occasionally normal in trained athletes and older age groups
- heard just before S1; at apex
- dull, low pitch
- use BELL OF STETHOSCOPE
- causes: ventricular hypertrophy or fibrosis causing stiffness and inc. resistance (dec. compliance)
Grading of murmurs
Grade 1: very faint, really have to listen to hear; may not be heard in all positions
Grade 2: quiet, but heard immediately after placing stethoscope on chest
Grade 3: moderately loud
Grade 4: Loud + palpable thrill
Grade 5: VERY LOUD; thrill; may be heard when stethoscope is PARTLY OFF THE CHEST
Grade 6: VERY LOUD, thrill, heard with stethoscope ENTIRELY OFF THE CHEST
Systolic murmurs decrease in intensity with what movements?
Movements that reduce left ventricular volume - standing, sitting up, valsalva
Crescendo-decrescendo murmur; when is it best heard
Aortic stenosis - best heard with pt sitting and learning forward
Hypertropic Cardiomyopathy
- Location
- Radiation
- Pitch
- Quality
- Maneuvers
Location - left 3rd and 4th ICS
Radiation - down left sternal border to apex; NOT to neck
Pitch - medium
Quality - harsh
Maneuvers - DEC w/ squatting (d/t inc venous return); INC w/standing (d/t dec left vent volume)
Pulmonic stenosis
- Location
- Radiation
- Intensity
- Pitch
- Quality
- Maneuvers
Location - left 2nd and 3rd ICS
Radiation - if loud, toward left shoulder and neck
Intensity - soft to loud; if loud assoc w/thrill
Pitch - medium; crescendo-decrescendo
Quality - harsh
List the three pansystolic (holosystolic) murmurs
- Mitral regurg
- Tricuspid regurg
- VSD
Mitral Regurg.
- Location
- Radiation
- Intensity
- Pitch
- Quality
- Maneuvers
Location - apex
Radiation - left axilla
Intensity - soft to loud; if loud = assoc with apical thrill
Pitch - medium to high
Quality - harsh; holosystolic
Maneuvers - intensity dose NOT change with inspiration (same throughout)
