Module 17 : Cardiac Auscultation Flashcards
(49 cards)
1
Q
why listen to heart sounds
A
- cardiac auscultation is quick inexpensive method to detect and track the progression of valvular heart disease
2
Q
progression of events
A
- doctor will hear murmur before sending patient for an Echo
- once echo is performed the doctor can correlate the present disease state with the echo findings
- if quality of murmur changes that could indicate that the disease has progressed
- new echo is then ordered
3
Q
auscultation is performed with what
A
- stethoscope
4
Q
the four heart sounds
A
- represent different mechanical eents
- first = S1
- second = S2
- third = S3
- fourth = S4
- normally hear S1 and S2
5
Q
first heart sound S1
A
- lub sound
- represents MV and TV closure
- S1 composed of M1 (mitral) and T1 (tricuspid) sounds
- normally M1 precedes T1 slightly when normal conduction through bundle branches
- T1 may precede M1 with the left bundle branch block
6
Q
second heart sounds S2
A
- dub sound
- caused by Av and PV closure
- divided into A2 and P2
- normally A2 precedes P2
- A2 and P2 widen slightly with inspiration (more right heart filling so valves stay open longer)
- a very wide split of A2 and P2 may result form RBBB pulmonic stenosis and atrial septal defect
7
Q
third heart sound S3
A
- lub dub ta
- seldom heard heart sound
- normal in young athletes pregnancy (high preload strong early filling)
- abnormal later in life
- may signify CHF
- caused by increases volume of blood in the ventricle when the MV opens, coincides with early filling
- NOT CAUSED BY VALVES
8
Q
fourth heart sound S4
A
- a PRESYSTOLIC heart sound (precedes S1)
- NOT A NORMAL SOUND
- REPRESENTS BLOOD BEING FORCED INTO A VERY STIFF VENTRICLE FROM TEH ATRIA
- occurs during late filling phase
- does not occur with afib
+ no result of coordinated contraction
9
Q
murmurs
A
- sound produced by turbulent flow in the heart through valves/shunts/vessels
- ABNORMAL heart sound
- usually during systole or diastole
10
Q
causes of murmurs
A
- turbulence
- high flow rate
- forward flow - abnormal valves
+ stenosis - back flow - regurge
- abnormal connections - VSD PDA
11
Q
common valvular pathologies causes murmurs - mitral
A
- mitral stenosis MS
- mitral regurge MR
- mitral valve prolapse MP
12
Q
common valvular pathologies causin murmurs - tricuspid
A
- tricuspid stenosis TS
- tricuspid regurge TR
13
Q
common valvular pathologies causing murmurs - aortic
A
- aortic stenosis AS
- aortic regurge AR
14
Q
common valvular pathologies causing murmurs - pulmonary
A
- pulmonary stenosis PS
- pulmonary regurge PR
15
Q
clicks
A
- valve openings are usually silent but valvular stenosis can produce ejection click or snaps during valve opening
16
Q
murmur physiology
A
- a valve hat fails to close properly allows regurge of blood flow wen it should not be happening
- produces a sound because o turbulent blood flow when the valve normally would be closed
17
Q
6 factors to assess and describe murmurs
A
1) which phase (systole, diastole, pan hollow)
2) which portion of the phase (early or late)
3) location where murmur is best heard
4) radiation ? to where (carotids /axilla)
5) quality /shape of murmur (harsh/cresendo/decresendo/blowing)
6) intensity (grade 1-6)
18
Q
location of murmurs
A
- sounds produced by the valves are best heard over a particular region of the chest
- lower apex = mitral
- more midline lower = tricuspid
- high left = pulmonic
- high right = aortic
19
Q
radiation of murmurs
A
- sometimes radiate to other areas like carotid or axilla
20
Q
crescendo / decrescendo
A
- helpful to to relate doppler qualities to the quality of murmur
- crescendo = increasing in pitch
- decrescendo = decrees in pitch
21
Q
heart quality and shape - stenosis of semi lunar valves
A
- crescendo / decrescendo
22
Q
heart quality and shape - stenosis of AV valves
A
- diastolic rumble
- lower pitch
23
Q
heart quality and shape - regurge
A
- holophasic or pan phasic
- means through the whole cycle
24
Q
timing of heart sound - systolic aortic ejection murmur (AS)
A
- occurs during systole between S1 and S2
- crescendo decrescendo
25
timing of heart sound - pan systolic murmur (mitral incompetence)
- spray sound
| - even throughout cycle
26
timing of heart sound - pan systolic murmur aortic or pulmonary incomp
- occurs in diastole
- after S2
-
27
timing of heart sound - delayed diastole murmur mitral stenosis
- gap after S2 during IVRT
| - early undulate diastole
28
timing of heart sound - continuous murmur of patent ductus arterioles
- systole and diastole
29
intensity of murmurs and click
- levine scale
| - grade 1-6
30
grade 1 murmur
- lowest intensity (barely audible)
31
grade 2 murmur
- low intensity
32
grade 3 murmur
- medium intensity (no palpable thrill)
33
grade 4 murmur
- medium intensity (palpable thrill)
34
grade 5 murmur
- loud intensity (palpable thrill)
35
grade 6 murmur
- loudest intensity
- largest palpable thrill
- heard with stethoscope above chest
36
palpable thrill
- vibration felt on thrill
37
describing stenotic murmurs - AV/PV
- harsh quality (murmur/flow)
- radiation - to where
+ AV > carotids
- closing sound may be muted or absent when valve is thickened
38
describing stenotic murmurs - MV TV
- diastolic
- at apex
- little radiation
- rumbling quality
39
stenotic murmurs - AV valves
- starts with opening snap
| - low pitched/ decrescendo / rubbing
40
regurge murmurs - AV/PV
- diastolic
| - blowing , decrescendo
41
regurge murmurs - MV/ TV
- pan systolic holosystolic
- mitral regurge
+ at apex
+ radiates to left axilla
+ loud
- tricuspid regurge
+ pan systolic
+ left sternal border
42
less common murmurs
- rub
- knock
- muffled heart sounds
- changes with respiration/ provocative maneuvers
-
43
rub murmur
- beating of heart agains inflamed pericardium without fluid between the layers
- caused by tiny crystals in the pericardium sounds like sand paper
44
knock murmur
- beating of heart against hardened pericardium with fluid between the layers
- pericardium is like a hard shell from pericarditis s
45
muffled heart sound murmurs
- in presence of pericardial effusion
| - fluid dampens the sound
46
Changs in respiration / provocative manoeuvres murmurs
- split S1 S2 , paradoxical splitting
| - sound intensity increases with valsalva
47
systolic murmurs
- maybe innocent
- nervous, anxiety , functional
- if pathological they could be
+ AS pS MR TR
48
diastolic murmurs
- usually pathology
| - AR PR MS TS
49
phonocardiogram
- graphic display of heart sounds and murmurs
- obsolete with event of echo can now demonstrate and quantify valvular abnormalities
- similar to stethoscope microphone on Chest
