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PCM III > Cardiac Auscultation Lab > Flashcards

Cardiac Auscultation Lab Flashcards

1
Q

Lists the 5 Listening Posts with their location

A
  1. aortic - 2nd ICS, RSB
  2. pulmonic - 2nd ICS, LSB
  3. Erb’s point - L, 3rd ICS
  4. Tricuspid - 5th ICS, LSB
  5. Mitral - 5th ICS, mid clavicular line
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2
Q

First heart Sound (S1) represents what? Where is heard the loudest?

A
  • Closure of the mitral and tricuspid valves

- Loudest at the apex of the heart

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3
Q

Second heart sound (S2) represents what? Where is it heard the loudest?

A
  • Closure of the aortic and pulmonic valves

- Loudest at the base of the heart

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4
Q

S2 can spit into ______ during ______. Which closes first?

A

…a distinct A2 (aortic) and P2 (pulmonic) heart sound…inspiration
- aortic closes first

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5
Q

Physiology of S2 spitting:

A
  • D/T increased blood volume to the right ventricle.

- Negative intrathoracic pressure during inspiration also causes increased venous return to the right side of the heart

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6
Q

S3 is a _____ sound that occurs after ___.

A

…early diastolic…..S2

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7
Q

Pathophysiology of S3

A
  • occurs at the end of rapid ventricular filling as the ventricular wall reaches its limit of excursion.
  • Blood hitting a non-compliant ventricle.
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8
Q

Where is S3 best heard? What word does it sound like?

A
  • Best heard at the apex with the patient lying on the left side
  • Cadence of “Kentucky”
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9
Q

The most difficult heart sound to hear? Where is it best heard?

A
  • S4

- Listen at the apex with the patient in LLD position

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10
Q

When does S4 occur?

A
  • Occurs before the S1, late diastolic sound.
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11
Q

S4 Description? What word does it sound like?

A
  • Late, dull, low pitched diastolic sound.

- Cadence of “Tennessee”.

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12
Q

S4 Pathophysiology

A

Caused by vibrations of the left ventricle, mitral valve and left ventricular outflow tract as a result of atrial contraction.

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13
Q

Children and young adults often have ______ sounds. Where is it heard?

A
  • physiologic S3 filling sounds

- heard over the mitral valve

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14
Q

Abnormal Auscultation findings for; ASHD with angina pectoris and left carotid bruit

A
  • S4 over mitral valve reflects enhanced left atrial contraction into a ventricle with decreased compliance d/t ASHD.
  • systolic bruit over upper left caroti
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15
Q

Crackles in the lungs indicate:

A

pulmonary congestion

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16
Q

Abnormal Auscultation findings for: Acute anterior wall myocardial infarction

A
  • There is as S3 and S4 (gallop rhythm). S3 indicates significant LV dysfunction
  • S3, S4 heard over the
    mitral valve
  • Pulmonary valve: S2 split during inspiration and expiration
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17
Q

Two types of systolic clicks and when are they heard?

A
  1. Aortic Ejection click - head at onset of LV ejection

2. Pulmonic Ejection - heard at the onset of RV ejection

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18
Q

Midsystolic click represents what? Where is heard?

A

Mitral valve prolapse - Heard at the apex in mid or late systole

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19
Q

“Click-Murmur syndrome”

A

When a Midsystolic click is associated with a late systolic murmur of MR

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20
Q

Systolic and Diastolic Rubs: Pericardial Friction Rubs

Pathophysiology and causes

A
  • rubbing together of two inflamed pericardial surfaces.

- Causes: infectious pericarditis, MI, cardiac surgery, uremia, metastatic Ca, TB

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21
Q

Pericardial Friction Rubs: heard best? sounds like?

A
  • Have the patient sitting and leaning forward.

- Sounds scratchy, grating, rasping or squeaky.

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22
Q

Pericardial Friction Rubs triphasic component

A

systole and early and late diastole.

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23
Q

Abnormal Auscultation findings for: Acute viral pericarditis; heard best?

A

S1 and S2 are normal. Physiologic splitting of the S2. There is a three component pericardial friction rub and shows expiratory augmentation.
- heard best over tricuspid valve; faintly over pulmonary, sometimes over mitral

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24
Q

How to describe a heart murmur: (7)

A
  • Timing
  • Location
  • Radiation
  • Shape
  • Intensity
  • Pitch
  • Quality
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25
Q

Timing

A
  • Systolic: between S1 and S2

- Diastolic: between S2 and S1

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26
Q

Location

A
  • Site where the murmur originates

- Where you hear the murmur the best

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27
Q

Radiation

A
  • Does the murmur radiate – direction of blood flow
28
Q

Radiation of mitral Regurgitation

A

axilla

29
Q

Radiation of Aortic Stenosis

A

up the neck

30
Q

Shape

A

the shape of a murmur is determined by its intensity over time

31
Q

Crescendo

A

grows louder over time

32
Q

Decrescendo

A

grows softer over time

33
Q

Crescendo – Decrescendo

A

first rises in intensity then falls

34
Q

Plateau

A

same intensity throughout

35
Q

Intensity

A

Graded on a 6 point scale and expressed as a fraction.

36
Q

Intensity: Grade 1

A

very faint, heard only after the listener has “tuned in”, may not be heard in all positions

37
Q

Intensity: Grade 2

A

Quiet, but heard immediately after placing the stethoscope on the chest

38
Q

Intensity: Grade 3

A

Moderately loud

39
Q

Intensity: Grade 4

A

Loud, with palpable thrill

40
Q

Intensity: Grade 5

A

Very loud with thrill, may be heard when the stethoscope is partly off the cest

41
Q

Intensity: grade 6

A

Very loud with thrill, may be heard when the stethoscope is entirely off the chest

42
Q

Ptich

A

high, medium or low

43
Q

Quality

A

Described in terms of blowing, harsh, rumbling, or musical

44
Q

Other useful Murmur characteristics

A
  • Changes with respiration
  • Changes with position: Lying down, leaning forward, LLD
  • Other maneuvers
    Valsalva, squatting
45
Q

Positions for Auscultation

A
  • Supine (30 degrees)
  • Left lateral decubitus
  • Upright
  • Leaning forward
46
Q

Standing/strain phase of Valsalva: CV effect

A
  • Decreased LV volume dt dec venous return to heart

- dec vascular tone: dec arterial BP

47
Q

Standing/strain phase of Valsalva: Effects on systolic sounds/murmurs of mitral prolapse

A
  • increased prolapse of mitral valve
  • click moves earlier in systole and murmur lengthens
  • click and murmur gets louder
48
Q

Standing/strain phase of Valsalva: Effects on systolic sounds/murmurs of hypertrophic cardiomyopathy

A
  • increased outflow obstruction

- increased intensity of the murmur

49
Q

Standing/strain phase of Valsalva: Effects on systolic sounds/murmurs of Aortic Stenosis

A
  • dec blood vol ejected into the aorta

- dec intensity of murmur

50
Q

Squatting/Release of Valsalva: CV effects

A
  • increased LV volume dt increased venous return to the heart
  • increased vascular tone: increased arterial BP; increased peripheral vascular resistance
51
Q

Squatting/Release of Valsalva: Effects on systolic sounds/murmurs of Mitral valve prolapse

A
  • dec prolapse of mitral valve

- delay of click and murmur shortens

52
Q

Squatting/Release of Valsalva: Effects on systolic sounds/murmurs of Hypertrophic cardiomyopathy

A
  • dec outflow obstructions

- dec intensity of murmur

53
Q

Squatting/Release of Valsalva: Effects on systolic sounds/murmurs of aortic stenosis

A
  • increased blood volume ejection into the aorta

- increased intensity of murmur

54
Q

The supine position is used to evaluate:

A
  • S1 & S2 in all areas

- Systolic murmurs or sounds in all areas

55
Q

The LLD position is used to evaluate:

A
  • diastolic events at the apex with bell of stethoscope
56
Q

The upright position is used to evaluate:

A
  • S1 & S2 in all areas
  • systolic murmurs or sounds in all areas
  • diastolic murmurs or sounds in all areas
57
Q

The upright, Leaning forward is used to evaluate:

A
  • diastolic events at base with diaphragm of stethoscope
58
Q

Abnormal Auscultation findings for: Mitral prolapse (click - murmur syndrome). Where is is heard?

A
  • Mid systolic click (c) and a high frequency grade 3/6 late systolic crescendo murmur.
  • Loudest over mitral, but heard over tricuspid too
59
Q

Abnormal Auscultation findings for: Mild rheumatic mitral regurgitation.
Where is is heard best?

A
  • High frequency grade 2/6, holosystolic murmur radiates to the axilla. S1 is obscured by the murmur.
  • Heard over mitral valve
  • (small S1 split is heard over the tricuspid valve but no murmur heard here)
60
Q

Causes of Mitral Regurgitation

A

Vegatations on valve leaflets, papillary muscle dysfunction, Dilated cardiomyopathy, RF

61
Q

Abnormal Auscultation findings for: Severe congenital aortic regurgitation at the aortic valve

A
  • normal S1 followed by an ejection sound (ES) d/t upward movement of congenital abnormal valve.
  • Short grade 2/6 early systolic murmur.
  • At S2, high frequency murmur grade 2/6 d/t the aortic regurgitation. (this one is also heard on the pulmonic and tricuspid valves)
62
Q

Abnormal Auscultation findings for: Severe congenital aortic regurgitation at the mitral valve

A

“Austin Flint murmur” d/t premature closure of the mitral valve.

63
Q

Abnormal Auscultation findings for: Severe aortic stenosis d/t congenital bicuspid valve

A
  • Aortic: Normal S1 followed by ejection sound (ES). Grade 3/6 systolic murmur and ends before S2.
  • Mitral: Prominent S4 d/t atrial contraction against a thicken poorly compliant LV. The S4 indicates the AS obstruction is severe. Also a 1/6 mitral regurgitation.
64
Q

Abnormal Auscultation findings for: Ventricular septal defect

A
  • Pulmonary: Physiologic S2 splitting. Grade 1/6 early systolic murmur d/t normal turbulence.
  • Tricuspid: Grade 3/6 high frequency holosystolic murmur.
  • Mitral: Same grade 2/6 murmur transmitted from the tricuspid side.
65
Q

Abnormal Auscultation findings for: : Large patent ductus arteriosus

A
  • Pulmonary: High frequency grade 3/6 continuous systolic and diastolic murmur that peaks at S2. “Machine” or “to-and-fro” murmur.
  • Mitral: S3 followed by a short grade 2/6 mid diastolic murmur related to the increased flow across the mitral valve.

PCM III (13 decks)

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