Auscultation Notecards Flashcards
(63 cards)
1
Q
Normal Heart Sounds
A
S1, S2
valvular
2
Q
Added Heart Sounds
A
S3, S4
ventricular wall
3
Q
Systolic murmurs (3)
A
aortic stenosis
mitral regurgitation
triscupid regurgitation
4
Q
Diastolic murmurs (2)
A
aortic regurgitation
mitral stenosis
5
Q
What two physics components generate heart sounds?
A
Direction and velocity change
6
Q
S1
A
cessation of forward flow from body and lungs
- tricuspid (from body via vena cava to RV)
- mitral (from lungs via pulmonary veins to LV)
7
Q
S2
A
cessation of forward flow from heart to lungs and body
- pulmonic (from RV to lungs)
- aortic (from LV to body)
8
Q
Are right or left sided sounds louder?
A
left sided sounds are louder in intensity, while right sided are softer
9
Q
Is S1 or S2 softer?
A
S1 is softer than S2
10
Q
What sounds are represented by S1?
A
simultaneous mitral and tricuspid
11
Q
What sounds are represented by S2?
A
simultaneous aortic and pulmonic
12
Q
Describe S3
A
early-mid diastolic, groaning
ventricular wall noise from resistance to filling
13
Q
Describe S4
A
late diastolic, at the end of ventricular filling
ventricular wall resistance to atrial kick; not found in atrial fibrillation
14
Q
Where are S3 and S4 best heard?
A
apex of the heart, left lateral recumbent
15
Q
What is a gallop?
A
when both S3 and S4 are heard
16
Q
Describe a fixed S2 and what can cause it
A
Sharp, brief, end systole
caused by increased RV load: delays PV closure, ASD with L to R shunt
best heard at pulmonic post
17
Q
Describe an S3 as compared to a fixed S2
A
S3 is dull, sloppy, early diastole
LV wall distension
best heard over LV
18
Q
What are the 4 components of naming a murmur
A
grade - cycle - intensity - radiation
19
Q
Name 2 examples of adventitious sounds
A
Hypertrophic cardiomyopathy
Pericarditis
20
Q
Name 3 left systolic murmurs/sounds
A
Aortic stenosis
Hypertrophic cardiomyopathy
Mitral regurgitation
21
Q
Name 2 right systolic murmurs/sounds
A
pulmonic stenosis
tricuspid regurgitation
22
Q
Aortic Stenosis:
- Location/Radiation
- Murmur Type: Side/Phase
- Causes (4)
- Best Heard Where/How?
A
- Radiates along aortic outflow path to carotids
- Left sided, systolic
- Age, calcification, congenital disease (bicuspid valve), infective endocarditis (rheumatic)
- Aortic Area at 2nd ICS, sitting
23
Q
Hypertrophic Cardiomyopathy:
- Description/Cause
- Murmur Type: Side/Phase
- Best Heard Where/How?
A
- Left ventricular outflow track obstruction: worse when dry, improves with high volumes
- Left sided, systolic, split S2
- right 2nd IC space, with DIAPHRAGM
24
Q
Mitral Regurgitation:
- Location/Radiation
- Description
- Causes (6)
- Best Heard Where/How?
A
- Radiates along left sternal border
- Permits backward flow during SYSTOLE from LV to LA
- MVP from myxotamous degeneration, endocarditis, rheumatic fever, connective tissue disease (Marfan’s), MI with papillary rupture, pulmonary HTN
- Apex, supine, left lateral recumbent
25
Describe the pathology behind mitral valve prolapse, aka click-murmur syndrome, as well as what sounds are characteristic of it
- partial/induced MR
- occurs late in systole; mitral valve pops open: high LV pressure and/or loose tethering of valve edge (or papillary rupture)
- opening snap then blowing murmur of MR: decreased systolic volume moves OS earlier: wall closer sooner
- increased systolic volume moves the OS later
26
Pulmonic Stenosis:
1. Causes/Associations
2. Side/Phase
1. Congenital structural disease, rheumatic valvular disease, carcinoid syndrome
27
Tricuspid Regurgitation:
1. Causes (4)
2. Best Heard Where/How?
3. Side/Phase
1. Infection (IV drug use), rheumatic valvular disease, dilated annulus from CHF/pulmonary htn, fenphen drug
2. tricuspid area, supine
3. Right sided, mid-systolic
28
Name 2 left diastolic murmurs/sounds
aortic regurgitation
| mitral stenosis
29
Name 2 right diastolic murmurs/sounds
pulmonic regurgitation
| tricuspid stenosis
30
Aortic Regurgitation:
1. Causes (4)
2. Best Heard Where/How?
3. Location/Radiation
4. Side/Phase
5. Special Type
1. endocarditis, root dilation, congenital (bicuspid valve), CT disorders (Marfan's)
2. Aortic area at 2nd ICS, sitting
3. Radiates along left sternal border
4. Left sided, early diastolic (but can have systolic component)
5. Austin Flint type is severe case
31
Systolic murmur found at the aortic post
aortic stenosis
32
Systolic murmur found at the apex
mitral regurgitation
33
Systolic murmur found parasternal
tricuspid regurgitation
34
Diastolic murmur found at aortic post
aortic regurgitation
35
Diastolic murmur found at apex
mitral stenosis
36
Mitral Stenosis:
1. Location/radiation
2. Causes (2)
3. Best Heard Where/How?
4. Side/phase
5. Characteristic changes
1. Radiates to precordial area
2. Infectious endocarditis, calcific changes (age)
3. Apex, left decubitus position
4. Left sided, diastolic, opening snap
5. Increases at end diastole by atrial contraction, worsened by increased flow/volume
37
Pulmonic Regurgitation:
1. Causes (4)
2. Side/phase
3. Best Heard Where/How?
1. Rheumatic valvular disease, carcinoid syndrome, pulmonary hypertension, CT disease, dilation
2. right sided, diastolic
3. Sitting, bell
38
Tricuspid Stenosis:
1. Causes (3)
2. Side/phase
3. Best Heard Where/How?
1. Rheumatic valvular disease, congenital heart structural disease, age/calcification
2. right sided, diastolic
3. left lateral decubitus, bell
39
Pericardial friction rub:
1. Causes (6)
2. Best Heard How?
3. Description
1. viral, SLE, RA, neoplastic, renal failure, dressler's, MI
2. Lean forward, exhale
3. Adventitious sounds - non valvular sounds, sounds like cabasa, triphasic
40
Describe the physiology of the valsalva maneuver
1. increased arterial pressure by direct pressure (rise in SVR)
2. decreased venous return (less to pump) so pressure (MAP) drops
3. B/P x HR = K; heart rate rises therefore constriction increases SVR
4. exhale: pressure drop lowers MAP, SVR drops
5. Increased venous return; step 2 is reversed
6. brief overshoot in MAP causes reflex drop in HR (BP x HR = K)
41
Which two murmurs fade with the application of the valsalva murmur?
aortic stenosis and pulmonic stenosis
42
Which murmur becomes louder/increase with the application of the valsalva maneuver?
hypertrophic cardiomyopathy - ventricular walls are closer, LVED and SV less
43
K = ?
MAP x HR
44
Describe the effect of standing on heart sounds in general physiological terms
drops venous return and thus SV
45
Which murmur increases with the effect of standing?
hypertrophic myocardiopathy (increases effect of outflow track obstruction)
46
Which 2 murmurs are decreased by standing?
aortic and pulmonic stenosis - less flow
47
Describe the effect of exercise on hypertrophic myocardiopathy
HCM intensity is increased, due to increased flow and increased contractile force
48
Describe the effects of vigorous exercise on stenotic murmurs
effects are increased due to decreased downstream resistance
murmurs are worsened both sonically and clinically
49
Describe the physiological effect of hand grip on heart sounds
increases systolic gradient and intraventricular pressures
50
Which two murmurs are increased by hand grip?
tricuspid regurgitation and mitral regurgitation
51
How is aortic stenosis intensity affected by hand grip?
varying effect - increases SVR, but may not have much effect
52
Describe the physiological effects of squatting on heart sounds
increase SVR and VR
increased back pressure on AV
53
Which murmur is lessened by squatting?
hypertrophic cardiomyopathy
54
Describe the physiological effects of deep breathing on heart sounds
- increases pulmonary venous return by negative chest pressure (Suction)
- decreases LV filling (capacitance): flow across AV ceases sooner, moves S2 (LV/aortic) earlier
- opposite of ASD's moving PV closure later**
- result is split S2
55
What is the result of deep breathing on heart sounds?
split S2
56
Describe the effect of Aortic regurge on:
1. VSD and MR sounds
2. HCM murmur
1. increases VSD and MR sounds due to increased LV filling/volume, re-pumping of blood
2. decreases HCM murmur due to increased return and greater LV filling
57
Click Murmur Syndrome (MVP) changes with:
1. sudden standing and valsalva
2. squatting
3. hand grip
1. decreases LVESV, moves opening click earlier in systole
2. squatting increases systolic volume and SVR which delays opening click, decreases intensity
3. hand grip increases sound intensity by increased LV pressures, increasing regurge
58
Hypertrophic Cardiomyopathy changes with:
1. Standing
2. Squatting
3. Valsalva
4. Hand Grip, squatting, leg lifting
1. standing decreases LV volume, decreasing wall distance, increasing stenosis intensity
2. squatting increases LV volume, decreasing intensity by increasing wall distance
3. Valsalva bearing down stage reduces return and LV volume, decreasing wall distance
4. hand grip, squatting, left lifting all increase return or SVR, decreasing obstruction
59
Mitral regurgitation changes with:
1. Hand grip
2. Squatting
1. hand grip increases SVR and LV pressure; increases gradient across the MV
2. squatting increases return and SVR, raising gradient
60
How do right heart murmurs change with inhalation? Why?
increase with inhalation because of increased flow, increased inflow to lungs
61
How should you augment Aortic stenosis?
lean forward and exhale
62
How are S3 and S4 best heard?
with patient in left lateral recumbent with doctor to the patient right
63
One major fact to note about S3 and S4
they are the equivalent!
