15 - Heart Sounds Flashcards
When listening to the heart, where would you listen to the aortic area?
upper right sternal edge (AS)
When listening to the heart, where would you listen to the pulmonary area?
upper left sternal edge (PS,PR, ASD, OS of MS)
When listening to the heart, where would you listen to the tricuspid area?
lower left sternal edge (AR, PR, TS, VSD)
When listening to the heart, where would you listen to the mitral area?
apex (1st, 3rd, 4th heart sounds, MS, AR)
When listening to the heart, where would you listen to mitral radiation?
posterolateral to apex
When listening to the heart, where would you listen to aortic or pulmonary radiation?
upper chest
Where else is a a place where we listen to the heart?
Carotids
Describe the sequence of S1, S2, S3 and S4… What do they mean?
S1 ________ S2 __*_____**_ S1
S1-->S2 = systole S2-->S1 = diastole * = S3 will occur here if present (pathologic) ** = S4 will occur here if present (pathologic)
What is physiological splitting?
Physiological splitting
This happens when someone takes a deep breath
This is normal
What is pathological splitting?
Pathological splitting
This happens when there is a atrial septal defect
A fourth heart sound is almost always abnormal
Common to hear S3 in an MI or with some heart failure going on
What is the scale for murmur intensity?
1 - very faint
2 - quiet, usually not heard immediately
3 - moderately loud (NO THRILL)
4 - loud with a thrill (THRILL)
5 - very loud with a thrill (barely touch chest with stethoscope and hear it)
6 - no stethoscope is need to hear (with a thrill)
How do you describe a murmur?
- Pitch – high or low
- Quality – blowing, harsh, musical
- Timing - systolic or diastolic, continuous vs. cresendo-decresendo
- Where it is best heart (aortic, apex)
- Radiation (axilla = ventricular hypertrophy)
What is S1 related to?
- Mitral and tricuspid valve closure
When does S1 occur?
S1 occurs just before the upstroke of the carotid pulse
Can you hear S1 better with the diaphragm or the bell?
Diaphragm
Where is S1 usually louder?
Usually louder over the apex and along lower left sternal border
When will you hear decreased S1 sounds?
Decreased conduction of sounds with COPD, pulmonary disease and pericardial effusion
When would a wide split of S1 occur?
A widely split occurs in complete right bundle branch block
What can an S1 split be confused with?
A relatively loud S4 preceding S1 may sometimes be confused with a split S1
What does it mean when S1 varies from beat to beat in intensity?
Variation in the intensity of S1
- This means it varies from beat to beat
- Common feature of atrial fibrillation
- The first thing you should think of when someone older
- They will have SOB, they get tired, they feel palpitations
- They can go in and out of atrial fib and can’t feel it if they’re older
What is S2?
The sound of aortic and pulmonary valve closure
A2 = aortic valve closing P2 = pulmonic valve closing
Is S2 best heard with the diaphragm or the bell?
Diaphragm
Where is S2 best heard?
Location – left second interspace close to the sternal border
Describe S2 splitting
Physiologically normal
- S2 is usually single during expiration
- Separation of A2 and P2 occurs during inspiration
