HEART SOUNDS

Question 1

S1 represented by which on the QRS?

Answer 1

R wave

Question 2

Which side of the stethoscope is best to listen to high pitch S1/S2, aortic/mitral murmurs?

Answer 2

Diaphragm

Question 3

Which side of the stethoscope is best used to listen to low pitch sounds S3/S4, mitral stenosis murmurs?

Answer 3

Bell

Question 4

Lub dub tuh is which ❤️sound

Answer 4

S3

Question 5

Tuh Lub Dub is which ❤️sound

Answer 5

S4

Question 6

Which area of the ❤️is best to auscultate for the splitting of S2 during inspiration?

Answer 6

Pulmonic Area

Question 7

Which area of the ❤️is best to auscultate for the S3/S4, mitral stenosis murmurs?

Answer 7

Tricuspid and mitral area

Question 8

When using the bell to listen for S3 sounds, is it best to use light or firm pressure?

Answer 8

Light

Question 9

Why would I ask my patient to sit up and lean forward with auscultation?

Answer 9

To listen for aortic and pulmonic murmurs

Question 10

Systolic murmurs are caused by which area of stenosis?

Answer 10

Aortic and pulmonic stenosis

Tricuspid and mitral regurgitation

Question 11

Crescendo decrescendo murmurs are heard in?

Answer 11

Aortic stenosis

Question 12

Systolic ejection murmur is heard in?

Answer 12

Aortic stenosis

Question 13

If a murmur radiates to my neck/carotid area what’s the cause?

Answer 13

Aortic stenosis

Question 14

Aortic regurgitation, pulmonic regurgitation, tricuspid and mitral stenosis occurs during which phase of the ❤️cycle?

Answer 14

Diastole

Question 15

Halo/pan systolic murmurs are best heard where?

Answer 15

Apex of the ❤️

Also known as the mitral area

Question 16

If a murmur radiates to my axilla/armpit which murmur is it?

Answer 16

Mitral regurgitation

Question 17

Which ventricle is the workforce of the body?

Answer 17

Left ventricle

Question 18

Describe mitral regurgitation

Answer 18

As S1 occurs blood flows backwards in LA because the MV doesn’t close fully.
The Pressure in LV > than LA when the AV is closed.
The AV opens up but the pressure difference remains unchanged causing regurgitation to occur the entire cycle.
The LA becomes compliant.
Flat murmur occurs because the intensity of the blood flow does not change.

Question 19

During MV Prolapse what causes the mid systolic click?

Answer 19

Tension of the cordae tendinae prevents leaflets from fully collapsing into LA

Question 20

A mid systolic click with a late systolic murmur is heard during which condition?

Answer 20

MV prolapse?

Question 21

Describe aortic stenosis

Answer 21

MV closes and the ❤️begins to close against a closed valve. When enough pressure build up the AV snaps open causing and ejection click.
Blood begins to flow and as the force increases the murmur increases.
When filling is completed the murmur decreases.
Hence crescendo-decrescendo name

Question 22

Which condition causes early diastolic murmur?

Answer 22

Aortic regurgitation

Question 23

A decrescendo murmur is heard during which condition?

Answer 23

Aortic regurgitation

Question 24

Describe aortic regurgitation

Answer 24

AV doesn’t close fully and the pressure in the aorta is > the LV
And this is where the murmur is more intense in sound
The intensity decreases as the pressure in LV eventually increases due to simultaneous filling from the LA

Question 25

What is pre-systolic accentuation?

Answer 25

At the end of diastole when the atria contracts to push the remaining blood into the LV

Question 26

Opening snap with a mid diastolic rumble is heard during which condition?

Answer 26

Mitral stenosis

Question 27

Describe mitral stenosis

Answer 27

MV doesn't close fully and the pressure in LA > LV at the start of diastole The leaflets snap open and rapid filling occurs This causes a rumble As the pressure begins to equalize the murmur decreases Finally the intensity increases again as the LA contracts to push out the remaining blood (pre-systolic attenuation)

Question 28

Volume overload occurs during which abnormal ❤️sound?

Answer 28

S3

Question 29

Define concentric hypertrophy and it's cause

Answer 29

When the ❤️ contracts again increases pressure it increase in size making the ventricle stiff Causes such as HTN

Question 30

Pressure overload occurs during which abnormal ❤️sound?

Answer 30

S4

Question 31

Ventricular gallop and atrial gallop refers to which abnormal ❤️sounds?

Answer 31

S3 and S4

Question 32

S3 is heard when?

Answer 32

After S2

Question 33

S4 occurs when?

Answer 33

At the end of diastole when the LA is contracting to send blood into a stiff LV Right Before S1

Question 34

Describe the occurrence of S4

Answer 34

The ❤️contracts against increased pressure causing concentric hypertrophy. The sound is heard @ the end of diastole when the LA is contracting to send blood into the stiff LV right before the start of S1

Question 35

A patient should lay in which position to best gear S3 and S4?

Answer 35

Left lateral decubitus