19: Cardiac Sounds And Murmurs Flashcards
Seven phases of the cardiac cycle
- Atrial contraction
- Isovolumetric contraction
- Rapid ejection
- Reduced ejection
- Isovolumetric relaxation
- Rapid filling
- Reduced filling
Valves on the right vs left side of the heart
Right: tricuspid, pulmonic
Left: bicuspid, aortic
Which two valves are low pressure and which two are high pressure systems?
Low pressure: right sided valves
High pressure: left sided valves
At what phase in the cardiac cycle does S2 occur?
End of systole
Five important auscultation locations and what is being heard there ***
- Right 2nd ICS: aortic valve
- Left 2nd ICS: pulmonic valve
- 3rd ICS: Erb’s point
- Left 4th ICS: tricuspid valve
- Left 5th ICS: mitral valve
Murmur
Vibratory sound produced when the flow of blood through a valve is turbulent or disrupted
When is a murmur concerning
When associated with symptoms
Three questions to ask yourself during auscultating a murmur
- Location - which valve am i listening to?
- Timing: diastolic or systolic
- Shape - does it change in intensity?
Good position to listen for an aortic regurgitation
Pt leaning forward
Good position to listen for a mitral stenosis
Left lateral decubitus
Grading a systolic murmur: scale
- very faint
- Equal in volume to S1/S2
- Louder than S1 and S2
- Louder with a palpable thrill
- Louder with a thrill, heard with stethoscope partly off chest
- Loudest, can be heard without stethoscope
Four types of systolic murmurs
- Aortic and pulmonary stenosis
2. Tricuspid and mitral regurgitation
Four types of diastolic murmurs
- Tricuspid and mitral stenosis
2. Pulmonic and aortic regurgitation
Grading diastolic murmurs
1/4: barely audible
2/4: faint but immediately audible
3/4: easily heard
4/4: very loud
How does increased preload decrease aortic murmur in HOCM?
Pushes septum away from aortic outflow track -> blood can be more easily ejected
How does increased preload improve MVP murmur
Allows prolapsed leaflets to return to normal orientation
Three low yield murmurs to be aware of
Atrial septal defect, ventricular septal defect, patent ductus arteriosus
Valsava phase and movement that correlates with increased preload and afterload
Valsava release phase, squatting -> increase in preload and afterload
Two murmurs that are crescendo-decrescendo
Aortic stenosis, HOCM
Two murmurs that are holosystolic
Tricuspid and mitral regurgitation
Opening snap murmur vs mid-systolic click
Opening snap: mitral stenosis
Mid-systolic click: mitral valve prolapse
Murmur that is early blowing diastolic murmur
Aortic regurg
Associated conditions for aortic stenosis
SAD: syncope, angina, dyspnea
Murmur associated with IV drug use
Tricuspid regurg
