Cardio sounds Flashcards Preview

Cardio > Cardio sounds > Flashcards

Flashcards in Cardio sounds Deck (14)
Loading flashcards...
1
Q

S1

A

closure of the mitral&tricuspid valves at onset of ventricular systole □best heard at the apex

2
Q

S2

and physiological splitting

A

closure of the pulmonary and aortic valves at the end of ventricular systole □best heard at the left sternal edge □louder and higher-pitched than S1, the aortic component is normally louder than the pulmonary one.

□Physiological splitting of S2 occurs because LV contraction slightly precedes that of RV so that the aortic valve closes before the pulmonary valve. □splitting ↑ at end-inspiration ← ↑ venous filling of the RV further delays pulmonary valve closure. □separation disappears on expiration □Splitting of S2 is best heard at the left sternal edge. On auscultation, you hear ‘lub d/dub’ (inspiration) ‘lub-dub’ (expiration).

3
Q

S3

A

low-pitched □early diastolic

□best heard with the bell at the apex.

□coincides with rapid ventricular filling immediately after opening of the AV valvesheard after S2 as ‘lub-dub-dum’.

□normal in children, young adults & during pregnancy.

4
Q

Pathological S3

A

A S3 is usually pathological after the age of 40 years □commonly due to LV failure (early sign) & mitral regurgitation. ◊In heart failure S3 occurs with a tachycardia and S1 and S2 are quiet (lub-da-dub).

5
Q

S4

A

□S4 is less common

soft and low-pitched

□best heard with the bell at the apex

□occurs just before S1 (da-lub-dub)

_always pathological _

□caused by forceful atrial contraction against a non-compliant/ stiff ventricle

□often heard with LV hypertrophy (due to hypertension, aortic stenosis or hypertrophic obstructive cardiomyopathy) □cannot occur when there is AFib.

6
Q

↑intensity of S1

due to and significance

A

abnormal

in mitral stenosis

due to increased Pressure in LA

7
Q

Wide splitting of S2, but with normal respiratory variation

causes and significance

A

is in delayed RV emptying ←right bundle branch block

8
Q

Fixed splitting of S2

significance and causes

A

i.e. no variation with respiration, → atrial septal defect (RV stroke volume is larger than the left; the splitting is fixed because the defect equalizes the pressure between the two atria throughout the respiratory cycle)

9
Q

Abnormalities of intensity of S1

quiet?

loud?

variable?

A

_Quiet: _ 1.↓ cardiac output 2. Poor LV function 3.Long P-R interval (1˚ heart block) 4.Rheumatic mitral regurgitation

Loud: 1.↑ cardiac output 2. ↑ stroke volume 3.Mitral stenosis 4. Short P-R interval 5.Atrial myxoma (rare)

Variable : 1.Atrial fibrillation 2. Extrasystoles 3. Complete heart block

10
Q

Abnormalities in S2

A

Quiet: 1. ↓ cardiac output 2. Calcific aortic stenosis 3. Aortic regurgitation
Loud: 1.Systemic hypertension (aortic component) 2.Pulmonary hypertension (pulmonary component)

Split :
Widens in inspiration (↑physiological splitting):
1. Right bundle branch block 2. Pulmonary stenosis 3.Pulmonary hypertension 4. Ventricular septal defect

Fixed splitting (unaffected by respiration): Atrial septal defect

Widens in expiration (reversed splitting): 1. Aortic stenosis 2.Hypertrophic cardiomyopathy 3.Left bundle branch block 4.Ventricular pacing

11
Q

causes of a 3rd heart sound

A

Physiological : 1.Healthy young adults 2. Athletes 3.Pregnancy 4.Fever
Pathological : 1. Large, poorly contracting LV 2.Mitral regurgitation

12
Q

Opening snap

A

□mitral (rarely tricuspid) stenosis → sudden opening of a stenosed valve

□early in diastole, just after S2

□best heard at the apex

13
Q

ejection click

A

□early in systole just after S1

□congenital pulmonary or aortic stenosis

□do not occur in calcific aortic stenosis because the cusps are rigid

14
Q

midsystolic clicks

A

□mitral valve prolapse □associated with a late systolic murmur □high-pitched and best heard at the apex
○Mechanical heart valves make a sound when they close and open. The closure sound is normally louder, especially with modern valves. The sounds are high-pitched, ‘metallic’ and often palpable, and may be heard without a stethoscope. A mechanical mitral valve replacement makes a metallic first heart sound and a sound like a loud opening snap. Mechanical aortic valves have loud, metallic second heart sounds and an opening sound like an ejection click. They usually also cause a flow murmur.