C17: Cardiac Auscultation Flashcards
(55 cards)
whats the purpose of performing cardiac auscultation
quick method to detect and track progress of valvular heart disease
why is cardiac auscultation in combination w/ an echo useful for tracking diseases progress?
once the echo is performed the doctor can correlate the present diease state w/ the findings of the echo and if the quality of the murmur changes than it could indicate the disease has progressed (new echo ordered)
which 2 heart sounds arent usually heard
S3 and S4
what does S1 (Lub) represent… what are its 2 parts and which comes first?
- MV and TV closure
- 2 parts are M1 and T1 sounds… M1 before T1 when theres norm conduction through the bundle branches
when might T1 precede M1 in the S1 sound
in a LBBB
why does M1 occur before T1
the LV has higher press than the RV so ventricular press rises faster in the LV
which phases of the cardiac cycle precede and follow S1?
diastole precedes S1 and systole follows
which phases of the cardiac cycle precede and follow S2?
systole precedes S2 and diastole follows
what does S2 (Dub) represent… and what are its 2 parts and which comes first?
- the AV and PV closure
- 2 parts are A2 and P2… A2 before P2
the valves in which side of the heart always close first?
in the L heart
when does the gap b/w A2 and P2 widen and why
There’s increased R heart filling w/ inspiration which causes a change in RV/PA press relationships causes P2 to be delayed
what can be the cause of a very side A2 P2 split
- a RBB
- pulmonary stenosis (valve doesnt open enough so takes longer to exit the ventricle)
- atrial septal defect (takes longer b/c there’s more blood volume in the RA/RV b/c blood is shunted from LA to RA)
when does the S3 sound occur?
is it often heard? when would hearing this heart sound be considered normal vs abnormal?
after the ‘Dub’ (sound is also Ken-tuc-ky)
-not heard often….
- norm in youth, athletes, pregnancy… e.g. those w/ high preload and strong early filling
- abnorm later in life
what causes the S3 heart sound and what phase does it coincide w/
-increased preload… coinciding w/ early filling
NOT caused by valves but Mv is opening at this stage
when does the S4 sound occur?
is it normal?
what does it represent and when does it occur
- presystolic heart sound (precedes S1)
+ not norm
- represents blood being forced into a stiff ventricle from the atria.. indicating that the patient is likely in heart failure
+ occurs in late filling
would an S4 sound occur w/ A fib
No, because the atria arent actually contracting, just fibrillating
which area of the ECG coincides w/ S4
end of the P wave
what are heart murmurs? what causes them
-an abnormal heart sound produced by:
+ turbulent flow
+ high flow rate (eg preg)
+ forward flow through abnormal valves (stenosis)
+ back flow (regurg)
+ abnormal connections (VSD, Patent ductus arterioles)
if a patient had a Patent ductus arterioles, what kind of signal does it often produce w/ cardiac auscultation?
continous signal
why might we not hear a murmur if a patient has an abnormality that would normally cause one?
the flow isnt turbulent enough
does MV prolapse cause a murmur
yes
w/ stenosis, how might the opening of a valve sound
like a click or snapping during opening
are the opening of valves normally silent
yes
why do valves w/ regurg produce murmurs?
what type of sound would be typically hear w/ regurg
because theres turbulent flow when the valve should be closed
-spraying
