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Heart Sounds Flashcards

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1
Q

What is happening during the S1 heart sound?

A

MV and TV close, AV and PV open

noises are valves closing, systole

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2
Q

What is happening during the S2 heart sound?

A

MV and TV open, AV and PV close

diastole

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3
Q

S1 marks the beginning of ____

A

systole

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4
Q

S2 marks the beginning of _____

A

diastole

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5
Q

What causes the heart sounds?

A

Changing intracardiac pressure and closing of heart valves

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6
Q

What types of sounds is the bell better at assessing?

A

low pitched sounds such as S3, S4, mitral stenosis

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7
Q

What types of sounds is the diaphragm better at assessing?

A

High pitched sounds, such as S1, S2, AR, MR, pericardial friction rub

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8
Q

Where is the aortic area?

A

Second intercostal space, right sternal border

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9
Q

Where is the pulmonic area?

A

second intercostal space, left sternal border

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10
Q

Where is Erb’s point?

A

third intercostal space, left sternal border

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11
Q

Where is the tricuspid area?

A

Fourth (or fifth) intercostal space, left sternal border

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12
Q

Where is the mitral area or apex?

A

fifth intercostal space, left midclavicular line

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13
Q

How should a patient be positioned when listening over precordial areas with diaphragm?

A

lying supine with head at 30 degrees

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14
Q

What position should the patient be in when listening for S3, S4 & MS (mitral valve posts)

A

Left lateral decubitus

with bell

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15
Q

If something is heart at the aortic post, what should you do?

A

have the patient sit up, lean forward, and listen again with diaphragm after deep exhalation to distinguish aortic murmurs, especially AR

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16
Q

What does standing do to blood flow? What does this do to cardiac sounds?

A
  • Decreases venous return, arterial BP and stroke volume
  • Increases MVP; increases outflow obstruction of HCM; decreases intensity of AS murmur
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17
Q

What does squatting do to blood flow? What does this do to cardiac sounds?

A
  • increases venous return, LV volume, arterial BP
  • Decreases MVP; decreases obstruction of HCM; increases intensity of AS

more blood going across LV

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18
Q

What is the valsalva maneuver?

A

while patient is lying, have them bear down as if have a BM; can also place hand on patient’s abdomen and have them strain against it

same as standing, decreases venous return can hear HCM better

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19
Q

What happens during S1?

A

closure of mitral valve at beginning of systole

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20
Q

what happens during S2?

A

closure of aortic valve at end of systole and beginning of diastole

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21
Q

what is an ejection click?

A

results from opening of AV or PV immediately following S1
* due to dilated aorta, aortic stenosis, or bicuspid AV or dilated pulmonary artery, pulmonary HTN, or pulmonic stenosis

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22
Q

What is an opening snap?

A
  • Caused by opening of MV, as in MS following S2

`

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23
Q

What is a S3 heart sound?

A

“Kentucky gallop”
* Dull, low pitched sound occuring in early diastole
* Best heard with bell at apex with patient in left lateral decubitus

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24
Q

In which patients is S3 physiologic?

A
  • children and young adults
  • 3rd trimester of pregnancy
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25
What can cause a pathologic S3 sound?
* change in ventricular compliance * decreased myocardial contractility, CHF, or volume overload
26
What is a S4 sound?
"Tennessee gallop" * late diastole, immediately before S1 * Dull, low pitch heard with bell at apex while patient is in left lateral decubitus position * Marks atrial contraction
27
What is the cause of a S4 sound?
"Tennessee" gallop * Change in ventricular compliance due to increased resistance to ventricular filling * Hypertensive heart disease, CAD, AS, and cardiomyopathy
28
Where is S1 softer than S2? Where is it louder?
at the base, at the apex
29
When is S1 accentuated?
* Tachycardia * Rhythms with a short PR interval * High cardiac output states * Mitral stenosis
30
When is S1 diminished?
* First degree AVB (AV block, electrical activity not transmitted to ventricle) * Mitral regurgitation * Reduced LV contractility
31
When does S1 vary
* complete heart block and any irregular rhythm, such as A. fib
32
When would a split S1 be normal?
* Along left lower sternal border where TV component is heard
33
What conditions cause abnormal S1 splitting?
RBBB and PVCs
34
What is physiologic splitting of S2?
2nd and 3rd left intercostal space where pulmonic valve is best heard (hearing pulmonic and aortic valve close) accentuated by inspiration and disappears on expiration
35
What is pathologic splitting of S2?
* Persists through respiratory cycle * delayed closure of PV (PS, RBBB)or early closure of AV (MR) * caused by ASD, or RV failure
36
How are murmurs differentiated from extra heart sounds?
By their longer duration
37
How are murmurs described?
* Timing * Shape * Location of maximum intensity * Radiation * Intensity * Pitch * Quality
38
How would you describe a systolic murmurs timing?
Midsystolic, pansystolic (holosystolic), late systolic
39
How would you describe a diastolic murmurs timing?
Early, mid-diastolic, late diastolic
40
What does a continuous murmur mean? What are examples of causes of this?
Both systolic and diastolic components; PDA, pericardial friction rub, venous hum
41
How is the shape of a murmur described?
* Crescendo * Decrescendo * Crescendo-decrescendo * Plateau
42
What is the location of maximal intensity describing?
Where the murmur originates
43
What is radiation?
Direction of blood flow and intensity of murmur
44
How is the intensity of a murmur described?
On a 6-point scale * Grade I: very faint have to "tune in" * Grade II: quiet, but can hear immediately with stethoscope * Grade III: moderately loud * Grade IV: loud, with palpable thrill * Grade V: very loud with thrill; may be heard with stethoscope partly off chest * Grade VI: very loud with thrill; may hear with stethoscope fully off chest
45
What influences the intensity of a murmur?
Thickness of chest wall and presence of intervening tissue
46
How could you describe the pitch of a murmur?
High, medium, or low
47
How would you describe the quality of a murmur?
Blowing, harsh, rumbling or musical
48
What causes a pansystolic murmur?
Always pathologic Blood flow from a chamber of high pressure to one of low pressure through a valve that should be closed EX: mitral regurgitation, tricuspid regurgitation, ventricular septal defect
49
Should you be concerned about a midsystolic murmur?
possibly? May be innocent, physiologic, or pathologic MC heart murmur!
50
What would be innocent causes of a midsystolic heart murmur?
* Turbulent blood flow * Grade I-III murmur heard between 2nd to 4th left intercostal spaces with minimal radiation
51
What are characteristics of a innocent midsystolic heart murmur?
* Disappears or decreases with sitting * Typically blowing, mid-systolic * No other associated PE findings
52
What are characteristics of physiologic midsystolic murmur?
* Signs of underlying cause * Normal blood turbulence enhanced by conditions that increase blood flow such as anemia, fever, and hyperthyroidism
53
What are characteristics of a pathologic midsystolic murmur?
Harsh, mid-systolic murmur
54
What are causes of a pathologic midsystolic murmur?
aortic stenosis, HCM, pulmonic stenosis
55
What are characteristics of a pathologic diastolic murmur?
* Early or mid-late
56
What are causes of a early decrescendo murmur?
Regurgitation through incompetent semilunar valves, most often aortic regurgitation
57
What are causes of a mid-late diastolic murmur?
* Stenosis of AV valve, most commonly mitral stenosis
58
What is the cause of a venous hum?
turbulence of blood flow in jugular veins common in kids
59
What are characteristics of a venous hum?
* continuous murmur that is louder in diastole * soft, low pitched * heard above the medial third of the clavicles with radiation into the 1st and 2nd intercostal spaces
60
What causes a pericardial friction rub?
Inflammation of the pericardium
61
What are the 3 components of a pericardial friction rub?
atrial systole, ventricular systole, and ventricular diastole
62
What are characteristics of a pericardial friction rub?
* High pitched, scratching/scraping noise similar to rubbing the back of your stethoscope * Increases as patient leans forward, exhales, and holds their breath * Location varies * Radiation is not typical
63
What is a patent ductus arteriosus?
Congenital abnormality resulting in a channel between the aorta and pulmonary artery
64
What are characteristics of a patent ductus arteriosus?
* Loudest in systole and fades in diastole * Best heard at left 2nd intercostal space, radiating to left clavicle * Harsh, machinery-like, medium pitched * Typically associated with a thrill
65
What is the most common study ordered for cardiac disorders?
Transthoracic 2D echocardiogram with doppler imaging
66
What information can you gather from echocardiography?
Info about the size of all 4 chambers, regional and global systolic function, and chamber wall thickness * Provides images of valve motion, intracardiac masses, cardiac abnormalities/anomalies, and pericardial fluid
67
What is a benefit of echocardiography?
Non-invasive and requires no radiation or prep
68
What diagnostic test gives a visual image of blood flow velocities superimposed over anatomic 2D images?
Color flow doppler
69
What does color flow doppler allow the viewer to see?
* Turbulence from valvular stenosis or regurgitation * Intracardiac defects
70
When would a TEE with doppler ultrasound be used?
* if surface sound transmission is poor foor a TTE * If need better view of posterior heart structures, specifically atria, atrial appendage, and A-V valves * Better than TTE for dx LAA thrombus * Prosthetic heart valves and intracardiac masses difficult to see on TTE * septal defects or patent foramen ovale * aortic dissection and severe atherosclerosis of the ascending aorta
71
What are diagnostic methods for transesophageal echocardiography with doppler ultrasound?
* Patient has to be NPO for 6-8 hours prior to procedure * Patient given IV sedation and local anesthetic to reduce gag reflex * Patient monitored during procedure * Signed consent required
72
What are risks of Transesophageal echocardiography with doppler ultrasound?
* Aspiration * Throat irritation * Esophageal perforation

Cardiovascular (17 decks)

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