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Cardio > Auscultation > Flashcards

Auscultation Flashcards

1
Q

What is the first heart sound (S1) caused by?

A

The shutting of mitral and tricuspid valves

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2
Q

What does the first heart sound signal?

A

The beginning of systole

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3
Q

What do systole and diastole mean?

A 
Systole = contraction
Diastole = relaxation
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4
Q

What is the second heart sound (S2) caused by?

A

The closure of the aortic and pulmonary valves

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5
Q

What does the second heart sound signal?

A

The end of systole and the beginning of diastole

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6
Q

What type of murmur coincides with the carotid pulse?

A

systolic murmurs

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7
Q

What type of murmur does not coincide with the carotid pulse?

A

Diastolic murmurs

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8
Q

Where can you best hear the physiological splitting of the 2nd heart sound?

A

The pulmonary area: left 2nd intercostal space at the sternal border DURING INSPIRATION

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9
Q

What causes the physiological splitting of the 2nd heart sound?

A

Inspiration causes a drop in intrathoracic pressure.
Resulting in increased venous return to the RHS of the heart.
This increased volume prolongs right ventricular ejection time.
Thus the pulmonary component of the 2nd heart sound may be delayed after the aortic component during inspiration.

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10
Q

In the physiological splitting of the 2nd heart sound which component is louder?

A

The first/aortic

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11
Q

What causes a 3rd heart sound?

A

The acceleration and deceleration of blood during early passive filling of the ventricle

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12
Q

What is a 3rd heart sound?

A

An early diastolic low frequency filling sound

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13
Q

When does a 3rd heart sound occur?

A

Immediately after the 2nd heart sound

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14
Q

Where is the 3rd heart sound best heard?

A

At the apex with the bell of the stethoscope

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15
Q

What is the pathology for a 3rd heart sound?

A

Left ventricular systolic dysfunction

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16
Q

If a 3rd heart sound is heard in an older patient what should you do?

A

Refer them for an echocardiography to assess left ventricular performance

17
Q

What is a 4th heart sound?

A

Late diastolic low frequency filling sound

18
Q

When does the 4th heart sound occur?

A

Shortly before the first heart sound

19
Q

What causes a 4th heart sound?

A

Atrial contraction causing rapid blood flow into a stiff ventricle

20
Q

What are common causes of a stiff ventricle?

A

Myocardial ischaemia, hypertension, aortic stenosis

21
Q

Where is the 4th heart sound best heard?

A

At the apex with the bell of the stethoscope

22
Q

What should you do with a patient with hypertension, aortic stenosis or other heart disease who has a 4th heart sound?

A

Refer for echocardiography to assess the degree of left ventricular hypertrophy and/or aortic stenosis

23
Q

What is a cardiac murmur caused by?

A

Turbulent blood flow in the heart

24
Q

What should a full description of a cardiac murmur include?

A 
Intensity (grading)
Character and pitch
Timing
Location
Radiation
25
Q

What causes an innocent cardiac murmur?

A

turbulence of blood in the right ventricular outflow tract

26
Q

What type of murmur is an innocent cardiac murmur: systolic or diastolic?

A

Systolic

27
Q

When is an innocent cardiac murmur loudest?

A

When the circulation is hyperdynamic (eg: in fever, pregnancy, anaemia, thyroxicosis)

28
Q

What are the characteristics of an innocent cardiac murmur?

A 
Soft mid systolic
Usually heard in the pulmonary area
Localised to one auscultatory area
No radiation
No other cardiac abnormalities
29
Q

What causes a pathological cardiac murmur?

A

Turbulence of blood due to a structural cardiac abnormality

30
Q

What are the characteristics of a pathological murmur?

A

Diastolic murmurs = always pathological
Ejection systolic especially late peaking and pan systolic murmurs are often pathological
Not localized - may be audible in >1 auscultatory area
May radiate
May have associated abnormalities

31
Q

Where might a pathological murmur radiate to?

A

the neck in aortic stenosis or to the axilla in mitral regurgitation

32
Q

What associated abnormalities (symptoms/signs) might you get with a pathological murmur?

A

Low volume pulse
Thrills
Palpable heaves
Displaced apex

Cardio (8 decks)

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