Heart Sounds Flashcards
What are the two normal heart sounds - what do they indicate ?
S1- Tricuspid and Mitral Valve closing.
S2 - Aortic and pulmonary valve closing.
When is systole ?
What is systole ?
Between S1 and S2
When ventricles are contracting and pushing blood out.
When is Diastole ?
What is it ?
Between S2 and S1 of the next cycle.
When blood is filling the heart.
When is S3 heard?
What is S3 ?
Right after S2. Lub dub “ta”
- In trained athletes and pregnancy, this is normal.
- Can be a sign of too much volume - Can be a sign of congestive heart failure when there is too much blood coming into the ventricles.
When is S4 heard ?
What is S4?
” ta” lub dub
Heard before S1.
Usually due to stiffness of hypertrophy ( increase in size).
Usually a sign of pressure overload or severe hypertension.
What are heart murmurs ?
- The result of turbulent blood flow
- Graded on 1-6, depending on how they are.
- Some children have “innocent heart murmurs” because their walls are thin.
When is a systolic murmur heard ?
Between S1 and S2
” LUB” whoosh “DUB”
- This is when the aortic and pulmonary valves are normally open, and the mitral and tricuspid valves are closed.
Caused by
- Aortic or Pulmonary valve which is unable to fully open (stenosis) - Will hear an ejection click with this and is often called a cresendo- decrescendo murmur.
- Or from Mitral or Tricuspid valve which is unable to fully close ( regurgitation)
Where is aortic stenosis heard?
2nd and 3rd rib on the right hand side of sternal border.
Where is pulmonary stenosis heard?
2nd and 3rd rib on the left-hand side of the sternal border.
Where is tricuspid regurgiation heard?
How do you tell where a cardiac murmur takes place in a cycle ?
Until you have that skill concentrate on identifying the two heart sounds then confirm which is which by palpating the carotid pulse at the same time. This pulsation is a marker of the start of systole and so immediately follows the 1st heart sound.
Where is the systolic murmur of mitral regurgitation best heard ?
- The systolic murmur of mitral regurgitation is best heard in the axilla, due to the displaced apex beat, with the diaphragm (Fig.9).
Where is the ejection systolic murmur of aortic stenosis best heard ?
- The ejection systolic murmur of aortic stenosis radiates to the neck and is best heard at this site with your patient’s breath held in inspiration. Use the diaphragm of the stethoscope (Fig.10).
When is the mid-diastolic murmur of mitral stenosis best heard ?
- The mid-diastolic murmur of mitral stenosis is best heard at the mitral area of the precordium using the bell with your patient rolled slightly onto their left side (Fig.11).
When is the diastolic murmur of aortic regurgiatoin best heard ?
- The diastolic murmur of aortic regurgitation is best heard in expiration whilst auscultating (with the diaphragm of your stethoscope) at the left lower sternal edge with your patient sitting forward (Fig.12). It has a number of characteristic features (Fig.13)
