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Heart Sounds Flashcards

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1
Q

what valves are open and closed during systole?

A

Mitral & Tricuspid (A-V) valves close

Aortic & Pulmonic valves open

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2
Q

what valves are open and closed during diastole?

A

Mitral & Tricuspid (A-V) valves open

Aortic & Pulmonic valves close

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3
Q

heart sounds are created by what two things?

A

the changing of intracardiac pressure
closing of heart valves

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4
Q

which part of the stethoscope can you hear low pitched sounds better?
what conditions/sounds could be heard?

A

bell - S3, S4, mitral stenosis
diaphragm - high pitched sounds - S1, S2, AR, MR, pericardial friction rub

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5
Q

how should the pt be positioned during a PE in general?

A
  • Lying supine with their head at 30°
  • Listen over all precordial areas with diaphragm
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6
Q

what position and post can you listen to S3, S4, and MS better? using what part of the stethoscope?

A

Left lateral decubitus
With the bell at the MV post

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7
Q

if you hear something at the aortic post, what position should they be and have the pt do? why?

A
  • sit up, lean forward, and listen again with diaphragm after deep exhalation
  • Helps distinguish aortic murmurs, esp. AR
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8
Q

what position Decreases venous return, arterial BP and stroke volume

A

standing

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9
Q

standing position affects which valvular disorders (3) how?

A

Increases MVP
increases outflow obstruction of HCM
decreases intensity of AS murmur

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10
Q

what position Increases venous return, LV volume, arterial BP?

A

squatting

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11
Q

squatting position affects which valvular disorders (3) how?

A

Decreases MVP
decreases obstruction of HCM
increases intensity of AS

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12
Q

which position is the same as standing? what does it do?

A

valsalva
increases intrathoracic pressure, leading to a reduction in preload to the heart

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13
Q

Produced by closure of the mitral valve
Marks the beginning of systole
what is this heart sound?

A

S1

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14
Q

Produced by closure of the aortic valve
Marks the end of systole and beginning of diastole
what is this heart sound?

A

S2

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15
Q

Result of opening of AV (dilated aorta, AS, or bicuspid AV) or PV (dilated pulmonary artery, pulm HTN, or pulmonic stenosis)
Immediately follows S1
what is this heart sound?

A

Ej (or Ec) - Ejection click

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16
Q

Caused by opening of MV, as in MS
Follows S2
what is this heart sound?

A

OS - opening snap

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17
Q

What abnormal heart sound
Occurs in early diastole
Dull, low pitched

A

S3 - “Kentucky” gallop

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18
Q

S3 - “Kentucky” gallop is best heard with (Bell/diaphragm) at where, with the pt in what position?

A

bell at apex
left lateral decubitus

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19
Q

S3 - “Kentucky” gallop is physiologic and pathologic in who? reason of pathology?

A
  1. Physiologic - kids, young adults, 3rd trimester of pregnancy
  2. Pathologic - older adults d/t change in ventricular compliance
    - Specifically decreased myocardial contractility, CHF, and volume overload of ventricle
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20
Q

what abnormal heart sound
Occurs in late diastole, immediately before S1
Marks atrial contraction
Dull, low pitch heard

A

S4 - “Tennessee” gallop

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21
Q

S4 - “Tennessee” gallop’s dull, low pitch is heard best with (diaphagram/bell) at where, in what position?

A

bell at apex
left lateral decubitus

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22
Q

why does S4 occur?

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A
  1. result of change in ventricular compliance
    - D/t increased resistance to ventricular filling
  2. Caused by HTN heart disease, CAD, AS and cardiomyopathy
23
Q

where is S1 softer and louder than S2

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A

Softer than at base
louder than at apex

24
Q

what conditions make S1 sound diminished (3)

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A

first degree AVB
mitral regurg
reduced LV contractility

25
when can variations in S1 be seen? (conditions)
S1 varies in a complete heart block and any irregular rhythm, such as A. Fib
26
when/where can split S1 be normal? abnormal?
1. normal - along left lower sternal border where TV component is heard 2. Abnormal - RBBB and in PVCs
27
where and how is S2 _physiologic_ splitting best heard?
1. 2nd and 3rd left intercostal space where pulmonic valve 2. Accentuated by inspiration and disappears on expiration
28
when is _pathologic_ S2 splitting heard? causes?
1. Persists thru the respiratory cycle - Delayed closure of the PV (PS, RBBB) or early closure of the AV (mitral regurg) - ASD or RV failure
29
Murmurs are differentiated from extra heart sounds by their ____ ____
longer duration
30
Describing a murmur should include the following points: (7)
1. Timing 2. Shape 3. Location of maximum 4. Radiation 5. Intensity 6. Pitch 7. Quality
31
murmur timing types
1. Systolic - Midsystolic - pansystolic (holosystolic) - late systolic 2. Diastolic - Early - mid-diastolic - late diastolic 3. Continuous - Both systolic & diastolic components - PDA, pericardial friction rub, venous hum
32
parts of murmur features
1. Shape - Crescendo - Decrescendo - Crescendo-decrescendo - Plateau 2. Location of Maximal Intensity - Where murmur originates 3. Radiation - direction of blood flow and intensity of murmur
33
features of murmur intensity
1. Graded on a 6-point scale 2. Influenced by thickness of chest wall and presence of intervening tissue 3. Grades - I - very faint, have to “tune in” to catch - II - quiet, but can hear immediately with stethoscope - III - moderately loud - IV - loud, with palpable thrill - V - very loud with thrill; may be heard with stethoscope partly off chest - VI - very loud with thrill; may hear with stethoscope fully off chest
34
features of pitch and quality murmurs
1. Pitch - High, medium, or low 2. Quality - Blowing, harsh, rumbling or musical 3. Be mindful of positioning 4. Comment on positioning and whether murmur changes with certain maneuvers or with respirations
35
Pathologic Arising from blood flow from a chamber of high pressure to one of low pressure through a valve that should be closed what type of murmur What conditions is it commonly heard?
Pansystolic (holosystolic) Mitral regurgitation, tricuspid regurgitation, ventricular septal defect (VSD)
36
Most common heart murmur May be innocent, physiologic, or pathologic what type of murmur
Midsystolic
37
when is midsystolic murmur innocent?
1. turbulent blood flow 2. grade I-III murmur typically heard between 2nd - 4th L ICS w/ minimal radiation 3. Disappears/decreases with sitting 4. blowing, mid-systolic 5. No other associated PE findings
38
how is midsystolic physiologic
1. Similar to innocent, but may have signs of an underlying cause 2. Normal blood turbulence enhanced by conditions that increase blood flow - anemia, pregnancy, fever and hyperthyroidism
39
when is midsystolic pathologic? (sound, condition)
Harsh, mid-systolic murmur Aortic stenosis, HCM, pulmonic stenosis
40
_pathologic_ diastolic murmurs can be heard when? reasons?
1. **early or mid-late** - Early decrescendo = regurgitation through incompetent semilunar valves, most often _aortic regurg_ - Mid-late diastolic = stenosis of AV valve, MC _mitral stenosis_
41
Produced by turbulence of blood flow in jugular veins Common in kids Characterized by a continuous murmur that is louder in diastole Soft, low pitched what type of murmur?
Venous hum
42
Venous hum is best heard where?
above the medial third of the clavicles with radiation into the 1st and 2nd intercostal spaces
43
A result of inflammation of the pericardium what is this condition
pericardial friction rub
44
what 3 components can a pericardial friction rub have?
Atrial systole (diastole) ventricular systole ventricular diastole
45
what sound does a pericardial friction rub produce? describe features of this murmur
1. High pitched, scratching/scraping noise - Similar to rubbing the back of your stethoscope 2. Increases when leaned forward, exhales, and holds their breath 3. Location varies 4. Radiation is not typical
46
Congenital abnormality resulting in a channel between the aorta and pulmonary artery
patent ductus arteriosus
47
1. Loudest in systole and fades in diastole 2. Best heard at left 2nd intercostal space, radiating to left clavicle 3. Harsh, machinery-like, medium pitched 4. Typically associated with a thrill what condition/murmur?
Patent Ductus Arteriosus
48
Transthoracic (TTE) 2D echocardiogram w/Doppler imaging gives info about what? it gives images of what?
1. size of all 4 chambers 2. regional and global systolic function 3. chamber wall thickness 4. Provides excellent images of valve motion, intracardiac masses, cardiac abnormalities / anomalies, and pericardial fluid Non-invasive and requires no radiation or prep!
49
provides color flow, gives a visual image of blood flow velocities superimposed over anatomic 2D images what is this diagnostic method?
doppler
50
Allows viewer to see turbulence from valvular stenosis or regurgitation Also picks up any intracardiac defects what diagnostic method?
Doppler
51
how to improve visualization of wall motion with doppler?
add contrast agents
52
another option that is used if surface sound transmission is poor for a TTE what is this diagnostic method?
Transesophageal echocardiography (TEE) with Doppler ultrasound
53
benefits of TEE vs TTE
1. better view of posterior heart structures, esp atria, atrial appendage, and A-V valves - Better than a TTE for dx LAA thrombus 2. Prosthetic heart valves and intracardiac masses difficult to see on TTE 3. helps define septal defects or a PFO 4. detects aortic dissection and severe atherosclerosis of the ascending aorta
54
Cons of TEE
1. NPO for 6-8 hrs prior 2. risks include: - Aspiration - Throat irritation - Esophageal perforation 3. IV sedation and a local anesthetic to reduce gag reflex 4. has to be monitored during procedure (O2, HR, BP) 5. Signed consent required

Cardiovascular (24 decks)

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