Cardiac Auscultation

Question 1

The upper portion or
atria is called _____
and the lower tip of
the ventricles is called
_____

Answer 1

the base; the apex

Question 2

The apex is clinically important because this is where we feel the _____

Answer 2

apical impulse

Question 3

If found, the PMI is normally
located in the _____

Answer 3

5th intercostal space at or just medial to the
midclavicular line.

Question 4

Traditionally, we have come to
know 5 main auscultation points

Answer 4

○ Aortic area
○ Pulmonic area
○ Tricuspid area
○ Erb’s point
○ Mitral area

Question 5

T/F Heart sounds can radiate widely
from the point of origination,

Answer 5

T

Question 6

The Diaphragm of the stethoscope use:

Answer 6

○ Better for picking up relatively high-pitched sounds (such as S1 and S2), the murmurs of aortic stenosis and mitral regurgitation, and the friction rub of pericarditis
○ Press firmly against the chest when listening with the diaphragm

Question 7

The bell of the stethoscope

Answer 7

○ Better for picking up low-pitched sounds, such as S3 and
S4, as well as the murmur of mitral stenosis.
○ When listening with the bell, it’s important that you apply the bell lightly
to the skin (just enough to produce a full air seal)

Question 8

When a patient has an S3 and/or and S4, we say that they have a ____

Answer 8

“gallop”

Question 9

An S3 gallop

Answer 9

■ If an S3 sound is heard in early diastole, it generally correlates with atrial blood hitting an elevated end-systolic intraventricular volume.
● “Sloshing In” - Suggests volume overload, as with CHF

Question 10

An S4 gallop

Answer 10

■ If an S4 sound is heard in late diastole, it generally correlates with
blood being pushed against a stiff ventricular wall during atrial kick.
● “A Stiff Wall” - Suggests a noncompliant ventricular wal

Question 11

As systole begins, the pressure rises quickly
and the ____ snap closed, causing the
S1 heart sound

Answer 11

AV valves

Question 12

What causes the S2 sound?

Answer 12

As the left ventricle ejects most of its blood
and starts to relax, the pressure in the
ventricle falls to the point where the aortic
valve snaps closed, causing the S2 sound.
○ In other words, the S2 sound essentially
marks the beginning of diastole

Question 13

An S3 heart sound might be heard
early in _____

Answer 13

diastole if the end systolic
volume is elevated

Question 14

Atrial contraction at the end of
diastole is normally ___

Answer 14

silent

Question 15

When can an S4 sound be heard?

Answer 15

if a ventricular wall is
stiff and noncompliant, an S4
heart sound can sometimes be
heard when the atrial kick
occurs

Question 16

S1 and S2 correlational areas in the EKG

Answer 16

The S1 sound correlates with ventricular contraction (QRS) and the S2
sound immediately follows ventricular repolarization (T wave)

Question 17

Location each heart sound is heard best

Answer 17

● One potentially helpful thought is that S1 is usually louder than S2 at the
apex, while S2 is louder than S1 at the base.

Question 18

What is a split heart sound?

Answer 18

● In some situations, the heart valves that normally close together don’t close
at exactly the same time, resulting in a split heart sound.
● For example, S2 can be split when the intrathoracic pressure changes during
inspiration cause the right ventricular filling time, ejection time, and stroke
volume to be increased.
● The pulmonic valve closes just after the aortic valve
● This physiologic splitting during
inspiration is not sustained or
fixed, and is commonly seen in
healthy individuals

Question 19

A split S2 can be fixed during pathological conditions, such as _____

Answer 19

Septal Defects and Pulmonary Stenosis.

Question 20

Because the P2 component is softer or quieter, a split S2 is generally best
appreciated with auscultating at ______

Answer 20

the pulmonic area (2nd left interspace)

Question 21

Carotid Thrills

Answer 21

● With very loud murmurs of aortic stenosis, sometimes thrills can be
transmitted into the carotid arteries. This might be felt as a vibration in the
carotids during palpation of the artery

Question 22

What are bruits?

Answer 22

● During auscultation, ask the patient to hold their breath for 15 seconds or so as you listen for bruits.
○ Bruits are a murmur-like sound that indicates turbulent blood flow through the artery, most commonly suggesting atherosclerotic narrowing
○ Bruits can be high-pitched or low-pitched, so best practice would be to auscultate with both the diaphragm and the bell

Question 23

Auscultation: best patient positioning

Answer 23

Fowler’s position with the HOB at 30 degrees
● Next, move the patient into the Left Lateral Decubitus position
● Then have your patient sit up and lean forward slightly, holding their breath briefly

Question 24

What will positioning a patient in the Left Lateral Decubitus position do?

Answer 24

● This brings the ventricular apex
closer to the chest wall, which
accentuates certain sounds that are
often best heard at the apex with the
bell, such as:
○ S3 and S4
○ Opening snap and diastolic
grumble of mitral stenosis

Question 25

When auscultating why would you want the patient to sit up and lean forward slightly?

Answer 25

● This brings the base of the heart
closer to the chest wall and accentuates certain sounds that are often heard best with the diaphragm, such as:
○ Murmurs of the aortic valve, including stenosis and regurgitation

Question 26

Heart Murmurs

Answer 26

● Heart murmurs are distinct heart sounds that are distinguished by their
pitch, duration, and location within the cardiac cycle.
● These sounds are attributed to turbulent
blood flow and can be diagnostic for valvular
diseases and some congenital heart
abnormalities