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Flashcards in Heart Sounds Deck (16):

What is S1

closing of the mitral valve


What is S2

closing of the aortic valve


What is S3? What does it imply?

a mid-diastolic dull, low pitched sound of volume overload. results from tensing of the chordae tendinae during rapid expansion. "What THE hell" implies volume overload (e.g. mitral regurg, CHF)


What is S4? What does it imply?

a late diastolic, dull, low-pitched sound of the atria contracting against a stiffened ventricle. "Badum bump" implies pressure overload (e.g. MI, LV hypertrophy)


What is physiological splitting and why does it occur?

S2 splits in A2 +P2 on inspiration. Inspiration lowers the intrathoracic pressure, more blood returns to the right heart and it takes longer for the pulmonary valve to close. On expiration you should hear only S2.


What is wide, fixed and paradoxical splitting? Possible etiologies?


What is an ejection click?

sound of the aortic/pulmonic valves opening. heard in early systole. results from stenosis of the aortic/pulmonary valve.


What is an opening snap?

Heard in diastole, it is the sound of the mitral/tricuspid valve opening. It results from stenosis of the mitral/tricuspid valve (e.g. rheumatic fever) and is easily confused with a split S2


How are systolic murmurs graded?


How are diastolic murmurs graded?


What are the five general causes of murmurs?

  1. flow across a partial obstruction
  2. more flow than usual
  3. ejection into a dilated chamber
  4. regurgitant flow across an incompetent valve
  5. abnormal shunting from a high to a low pressure chamber. 


What are the general characteristics of murmurs?

Murmurs are described by their timing, intensity, pitch, shape, location, radiation, and response to maneuvers.


What is a pansystolic, uniform and late systolic murmur?


When in the cardiac cycle are the following murmurs:

  • aortic stenosis
  • aortic regurg

Stenotic: systolic

Regurg: diastolic


When in the cardiac cycle are the following murmurs:

mitral stenosis
mitral regurg

Stenosis: diastolic

Regurg: systolic


When in the cardiac cycle are the following murmurs?

  • PDA
  • VSD

PDA: systole and diastole

VSD: systole