1. CV intro Flashcards
Normal Heart Sounds in Adults:
S1 (Lub) & S2 (Dub)
The S1 (Lub) sound is caused by the closure of which valves
The AV (atrioventricular) valves.
The AV valves include which 2 valves
the tricuspid (R side) and Mitral (L side)
Where is the S1 sound loudest?
At the apex of the heart (midclavicular, 5th intercostal space)
The S1 sound marks the end of ___ and the beginning of ___
diastole;
systole
The S2 (Dub) sound is caused by the closure of which valves?
The semilunar valves.
The semilunar valves include which valves
The pulmonic and aortic valves.
Where is the S2 sound loudest?
At the base of the heart (right sternal border, 2nd intercostal space).
The S2 sound marks the end of ____ and the beginning of ____
systole;
diastole
S2 (dub) splits on inspiration or expiration?
Inspiration
Wide, fixed splitting of S2 (dub) is caused by ___
RBBB (right bundle branch block)
S2 (dub) is louder with which condition?
Pulmonary Embolism
Each of the 4 valves has an auscultatory point on the chest wall. What are these points?
- Aortic Area
- Pulmonic Area
- Erb’s Point
- Tricuspid Area
- Mitral (apical) area
Where is the aortic area?
Anatomically, it is at the 2nd intercostal space (ICS), right sternal border. It is the base of the heart. It is where S2 (“Dub”) is loudest.
Where is the mitral area?
Anatomically, it is at the 5th intercostal space (ICS), midclavicular line. It is the apex of the heart where S1 (“Lub”) is the loudest.
Where is the pulmonic area?
Anatomically, it is at the 2nd ICS, left sternal border.
Where is Erb’s point?
It is at the 3rd ICS, L sternal border.
Where is the tricuspid area?
It is at the 4th ICS, L sternal border.
What are abnormal heart sounds?
S3, S4, Pericardial Friction Rub, Murmurs
Describe S3: Caused by; when does it occur; where is heard best; what it is associated with?
-S3 caused by a rapid rush of blood into a dilated ventricle.
-S3 occurs early in diastole, right after S2.
-S3 heard best at the apex with the bell of the stethoscope.
S3 is associated with heart failure; it may occur before crackles.
-Associated with high LV pressure.
-Ventricular gallop, “Kentucky.”
***S3 is also caused by Pulm HTN and Cor Pulmonale. Also, mitral, aortic or tricuspid insufficiency.
Describe S4: Caused by; when does it occur; where is heard best; what it is associated with?
-S4 caused by atrial contraction of blood into a noncompliant ventricle.
-Occurs right before S1.
-Best heard at the apex with the bell of the stethoscope.
-Associated with myocardial ischemia, infarction, hypertension, ventricular hypertrophy, and aortic stenosis.
-Atrial gallop, “Tennessee.”
Pericardial Friction Rub:
It’s due to pericarditis and associated with pain on deep inspiration.
May be positional.
Murmurs:
-Valvular Disease.
-Septal Defects (atrial or ventricular)
Equation for Pulse Pressure:
Systolic - Diastolic = Pulse Pressure
What is a normal pulse pressure
40-60 mmHg (e.g. 120/80)
What is systolic BP a measurement of?
It’s an indirect measurement of the cardiac output and stroke volume.
What does a decrease in systolic pressure with little change or an increase in diastolic pressure do?
It causes a narrowing of pulse pressure; it’s seen most often with severe hypovolemia or a severe drop in cardiac output (CO); e.g. 100/78.
What is diastolic pressure a measurement of?
It’s an indirect measurement of the systemic vascular resistance (SVR).
What does a decrease in diastolic pressure with little change in sBP indicate?
A decrease in diastolic pressure that widens pulse pressure may indicate vasodilation, a drop in SVR; often seen in sepsis, septic shock (eg. 100/38)
Which is longer? Systole or Diastole?
Diastole is normally one-third longer than systole: needs time for filling
When are coronary arteries perfused?
During Diastole
