Abnormalities On Auscultation

Question 1

True or false: The sound of valves is relative to where they are located in the precordium

Answer 1

False. Auscultation of heart sounds is where the sound travels

Question 2

If you want to auscultate for aortic stenosis, what is the best location to hear this?

Answer 2

R 2nd ICS

Question 3

What part of the heart correlates to the 2nd left ICS?

Answer 3

Pulmonic area

Question 4

To evaluate for mitral value stenosis, you should auscultate at the __________

Answer 4

Left 5th ICS midclavicular line

Question 5

Auscultation of the left 4th ICS is the sound of the _______ valve

Answer 5

Tricuspid

Question 6

S1 is best heard at ______

Answer 6

Left 4th & 5th ICS

Question 7

What sound does S1 indicate?

Answer 7

Closing of mitral & tricuspid Valves

Question 8

S2 is the sound of the _______ valves closing

Answer 8

Aortic & pulmonic

Question 9

The ____ valves do not close simultaneously when there is a __ (heart sound)

Answer 9

aortic & pulmonic

split S2

Question 10

where is the split S2 heard best?

Answer 10

at the base of the heart -> 2nd L ICS

Question 11

what can cause a split S2?

Answer 11

► Physiologic (related to inspiration)
► Right ventricle overload
► Delayed closure of pulmonary valve
► Delayed closure of aortic valve

Question 12

if a split S2 is auscultated while performing the special auscultatory maneuver, this can indicate ____

Answer 12

aortic regurgitation

Question 13

physiologic splitting of S2 occurs due to _____ and during ____ because there is increased venous return to the right side of the heart

Answer 13

decreased intrathoracic pressure

-during inspiration

Question 14

a pathologic split S2 will occur during the ____ & with every ____

Answer 14

special auscultatory maneuver after sitting upright

-heart beat

Question 15

if S2 splitting is physiological, you (will/will not) hear the split with every breath/.

what is this related to?

Answer 15

will not

• inspiration/expiration

Question 16

when does S3 occur during the cardiac cycle?

Answer 16

after S2

-occurs early in diastole -> rapid ventricular filling

Question 17

if present, when is S4 heard & at what point of the cardiac cycle?

Answer 17

late diastole BEFORE S1

-abnormal last push to get blood from atrium -> ventricles

Question 18

what mechanism in the heart causes the sound of S3? what does this sound like and where is it heard best?

Answer 18

rapid deceleration of blood as it strikes ventricle

• Ken-tuc-ky ► Low pitched sound
• Heard best at apex and along left sternal border.

Question 19

what can pathologic causes are associated with the sound of S3?

Answer 19

► CHF (Systolic)
► Constrictive Pericarditis
► Hypertension (prolonged)

Question 20

True or false: S3 is a normal physiologic finding in asymptomatic patients < 30 years old

Answer 20

True -> Related to rapid ventricular filling

Question 21

what is the mechanism that produces the sound of S4?

Answer 21

Caused by atrial contraction which causes rapid flow of blood into non-compliant (stiff) ventricle
► Ventricle does not relax appropriately in diastole

Question 22

when is S4 heard in the cardiac cycle and what does it sound like?

Answer 22

Heard in late diastole…just before S1

► Ten-nes-see

Question 23

what are pathological causes of S4?

Answer 23

► patients with stiffened left ventricle
► caused by hypertension
► aortic stenosis
► Cardiomyopathy
► acute MI
► rupture of chordae tendinae in acute mitral regurgitation
► Associated with diastolic heart failure

Question 24

gallops are heart sounds heard during _ in the cardiac cycle

Answer 24

diastole

Question 25

what position is best to auscultate for mitral murmurs that indicate mitral valve abnormalities?

Answer 25

Left lateral decubitus | -using bell over 5th ICS MCL & left 5th ICS axillary (lateral)

Question 26

at what part of the cardiac cycle will a systolic ejection murmur be heard & what is it associated with?

Answer 26

Begin after the first heart sound - attains a peak during mid-systole - terminate before the second heart sound Crescendo-decrescendo (slow, loud, slow) -> aortic stenosis

Question 27

when are Pan-systolic or holo-systolic murmurs during the cardiac cycle?

Answer 27

during all of systole

Question 28

these murmurs are heard during all of diastole

Answer 28

Pan-diastolic or holo-diastolic murmus

Question 29

when is a pro-diastolic murmur heard during the cardiac cycle?

Answer 29

early diastole

Question 30

when is a pre-systolic murmur heard during the cardiac cycle?

Answer 30

late diastole

Question 31

what does regurgitation/insufficiency indicate in regards to the heard valves?

Answer 31

inadequate closure of valves

Question 32

a grade _ murmur is a loud murmur that also has a palpable thrill on exam

Answer 32

grade 4

Question 33

a grade _ murmur is the loudest murmur heard with the stethoscope touching the chest which also has a palpable thrill

Answer 33

grade 5

Question 34

True or False: a murmur in a pt that previously had this murmur has become softer. this is a good sign.

Answer 34

false | -problematic

Question 35

what pathologies can systolic murmurs indicate?

Answer 35

``` AS MI TI PS ► Aortic Stenosis ► Mitral Insufficiency ► Tricuspid Insufficiency ► Pulmonic Stenosis ```

Question 36

if a pt has a known hx of mitral & tricuspid insufficiency, what type of murmur do you expect to auscultate on exam and where would this best be heard?

Answer 36

systolic murmur -apex > L 4th ICS > L 5th ICS MCL

Question 37

what pathologies can diastolic murmurs indicate?

Answer 37

► Aortic Insufficiency ► Mitral Stenosis ► Tricuspid Stenosis ► Pulmonic Insufficiency

Question 38

what type of murmur do you expect to hear for aortic regurgitation and where would you auscultate on the chest for this?

Answer 38

diastolic murmur | -L 3rd ICS

Question 39

if a pt has a known hx of aortic stenosis, performing the valsalva maneuver will make the murmur _____

Answer 39

softer - d/t less blood (venous return) being ejected from aortic valve - less venous return to left ventricle

Question 40

along with a crescendo-decrescendo murmur, there will also be ______ & ____ palpated on exam in patients with aortic stenosis

Answer 40

delayed carotid upstroke | -thrill

Question 41

a blowing diastolic murmur is auscultated at the L 3rd ICS. what can this indicate?

Answer 41

aortic regurgitation

Question 42

a harsh, saw like systolic ejection murmur is auscultated at the R 2nd ICS. what can this indicate?

Answer 42

aortic stenosis

Question 43

a patient with a known hx of aortic regurgitation will have what physical exam findings?

Answer 43

bounding carotid pulse | -blowing diastolic murmur

Question 44

why does handgrip & squatting decrease the sound of the murmur in pt's with aortic regurgitation?

Answer 44

increase in pressure of arteries -> increase in afterload

Question 45

with the patient leaning forward, the ___ is used to auscultate for a decrescendo murmur at the L 3rd ICS which can indicate _____

Answer 45

diaphragm | -aortic regurgitation

Question 46

Activity will cause the ___ murmur to be ____ as activity will increase the amount of blood moving through heart in patients with mitral stenosis

Answer 46

- diastolic | - increase

Question 47

if a pt has a known hx of mitral stenosis, the ____ position will make it best heard upon auscultation with the ___ of the stethescope

Answer 47

left lateral decubitus | -bell

Question 48

a mid diastolic decrescendo murmur has a _____ sound preceded by an ____ in mitral stenosis

Answer 48

- low pitched rumbling | - opening snap

Question 49

during systole, a holosystolic/pansystolic murmur is heard with every beat. what type of heart sound is this and what can this indicate?

Answer 49

S3 | -mitral regurgitation

Question 50

where is a holosystolic murmur best heard?

Answer 50

apex of the heart | -left 5th ICS

Question 51

on auscultation, there is a non-ejection (mid-systolic) click. what can this indicate and why does this happen?

Answer 51

mitral valve prolapse (MVP) | > Thought to be caused by mitral chordae snapping during systole

Question 52

what is the valsalva maneuver and what does it cause?

Answer 52

Forced expiration against a closed glottis | ► Causes an increase in intrathoracic pressure

Question 53

what happens when there is an increase in intrathoracic pressure when performing the valsalva maneuver?

Answer 53

► Decreases venous return ► Decreased cardiac output (as there is decrease in pre-load) ► Increase in arterial pressure ► Effects heart rate (decreases immediately, then increases)

Question 54

where/what position is a pericardial friction rub heard best & what does it sound like?

Answer 54

Rough, scratchy, crunching sound heard best during inspiration -> pt sitting up/leaning fwd -along left sternal border

Question 55

what can clicks auscultated on exam indicate other than MVP?

Answer 55

prosthetic valves

Question 56

if a click is classified as functional, what does this mean & in what patients does this happen in?

Answer 56

individuals with no anatomic | cardiac defect but with a physiologic abnormality such as anemia

Question 57

if a click is classified as organic, what does this mean?

Answer 57

occurring in individuals with a cardiac defect with or without a physiologic abnormality