Heart Sounds - Dolphens Flashcards Preview

Adult/Ped Medicine 4 > Heart Sounds - Dolphens > Flashcards

Flashcards in Heart Sounds - Dolphens Deck (20):
1

Systole

 

Describe the cardiac cycle including its components: S1, S2, systole, and diastole. 

Contraction. 

Pressure increases closure of AV valves S1

ventricles empty pressure decreases closure of semilunar valves S2

 

2

Diastole

 

Describe the cardiac cycle including its components: S1, S2, systole, and diastole. 

Relaxation 

ventricular pressure < atrial pressure, AV valves open, ventricles filling

 

S3:  May occur during late filling of ventricles.


S4:  Can occur as atria contract late to complete emptying of atria into ventricles.

3

Cardiac Exam: Vital Signs

  • Heart Rate
  • Respiratory Rate
  • Blood Pressure
    • both upper extremity
    • one lower extremity
  • Spot oximetry

4

Cardiac Exam: Inspection

General Appearance: nutritional status, genetic abnormalities, nail clubbing

Color: pink, cyanotic, pale

Comfort: dyspnea, diaphoresis

Breathing Pattern: tachypnea, grunting, nasal flaring, bulging or retractions

Venous Distension

5

Cardiac Exam: Palpation

Chest:

  • Thrills
  • PMI

Abdomen:

  • Hepatomegaly
  • Splenomegaly

Pulses:

  • rate and rhythm
  • Brachio-Femoral dealy
  • absence of distal pulses
  • bounding pulses

6

Cardiac Exam: Auscultation

 

Describe the auscultatory process and the areas of auscultation.

Auscultatory Process: listen in 3 positions: sitting, supine, left lateral recumbent, take the time to isolate individual sounds

Areas of Ascultation

  • Aortic:  2 ICS  RSB
  • Pulmonic:  2 ICS LSB
  • 2nd Pulmonic - Erb’s point:  3ICS LSB
  • Tricuspid:  4ICS  LSB
  • Mitral or apical:  5ICS MCL 

A image thumb
7

First Heart Sound

 

Describe the cardiac cycle including its components: S1, S2, systole, and diastole. 

  • results from closing of AV valves
  • indicates beginning of systole
  • best heard at apex
  • lower pitch, longer

8

Second Heart Sound

 

Describe the cardiac cycle including its components: S1, S2, systole, and diastole. 

  • closure of semilunar valves
  • indicates end of systole
  • best heard at the (base) aortic and pulmonic areas
  • higher pitch, shorter duration
  • usually heard as a single sound, can be split

9

Splitting of Heart Sounds

 

Describe the abnormal extra heart sounds: S3, S4, and splitting.

  • occurs due to asynchrony between valves
    • A2P2 - aortic closes slightly earlier
  • heard best at peak of inspiration
  • often normal but may be pathologic

10

Third Heart Sound

 

Describe the abnormal extra heart sounds: S3, S4, and splitting.

  • occurs normally in diastole
  • normally heard to hear
  • physiologic in kids
  • pathologic after age 35
  • due to rapid filling of the ventricles
  • low pitch sound, time sequence "Ken-tuc-key"
  • best heard: left lateral recumbent at apex

11

Fourth Heart Sound

 

Describe the abnormal extra heart sounds: S3, S4, and splitting.

  • pathologic
  • occurs in diastole, later than S3 before S1
  • low pitched heard best with bell in left lateral recumbant 
  • timing: "Tenn-es-see"
  • heard with decreased ventricular compliance
    • HTN
    • cardiomyopathy
    • aortic stenosis

12

define Heart Murmur

 

Describe heart murmurs and the characteristics used to evaluate them.

disruption in the flow of blood into, through or out of heart

13

Causes of Heart Murmurs

 

Describe heart murmurs and the characteristics used to evaluate them.

diseased valves - don't open/close properly

high output demands that increase the speed of blood:

  • thyrotoxicosis
  • anemia
  • pregnancy

structural defects

  • ASD
  • PDA

diminished strength of myocardial contraction

altered blood flow in the major vessels near heart

14

Characteristics of Murmurs: Timing

 

Describe heart murmurs and the characteristics used to evaluate them.

  • Systolic Murmurs: between S1 and S2
  • Diastolic Murmurs: between S2 and S1

A image thumb
15

Characteristics of Murmurs: Location

 

Describe heart murmurs and the characteristics used to evaluate them.

  • where is it best heard i.e. aortic area

 

16

Characteristics of Murmurs: Intensity

 

Describe heart murmurs and the characteristics used to evaluate them.

loudness is graded on a six point scale

  1. Grade I:  barely audible with careful concentration
  2. Grade II:  faint but readily detected
  3. Grade III:  prominent, easily detectable
  4. Grade IV: louder still; palpable thrill associated
  5. Grade V:  audible with only rim of stethoscope touching chest wall.  Thrill easily palpable.
  6. Grade VI:  loud enough to be heard without stethoscope.  Thrill palpable and visible.
  • grade 3 or greater - significant

 

17

Characteristics of Murmurs: Pitch

 

Describe heart murmurs and the characteristics used to evaluate them.

  • high tone or low tone
  • depends on pressure and rate of blood flow
  • low tones best heard with the bell
  • high tones best heard with the diaphragm

 

18

Characteristics of Murmurs: Pattern

 

Describe heart murmurs and the characteristics used to evaluate them.

  • crescendo: progressively gets louder
  • decrescendo: progressively gets softer
  • crescendo-decrescendo: gets louder than softer
  • sustained: maintains constant loudness

A image thumb
19

Characteristics of Murmurs: Radiation

 

Describe heart murmurs and the characteristics used to evaluate them.

  • ability to hear murmur in sites other than the primary or loudest site
  • listen to carotids (aortic stenosis) and axilla

 

20

Indicated in patients with high risk of adverse outcomes from an infection:

  • prosthetic cardiac valves
  • previous infective endocarditis
  • unreparied cyanotic heart disease
  • repaired heart defects with prosthetic material (first 6 months)
  • reparied congential heart disease with residual defect
  • cardiac transplant patients with valvulopathy