8/6- Heart Sounds and Murmurs Flashcards
What is S1? Where should it be auscultated (apex or base)?
- Closure of the AV (tricuspid/mitral) valves
- Beginning of systole
- Right before ejection of blood from ventricle
- Auscultate at the APEX
What is S2? Where should it be auscultated (apex or base)?
- Closure of the pulmonary/aortic valves
- End of systole
- Auscultate at the BASE
Where to auscultate heart valves (picture)?
The diaphragm is for auscultating high or low sounds? Bell?
- Diaphragm: high frequency (high pitch) sounds like S1 and S2
- Bell: low frequency (low pitch) sounds like S3 and S4
Important picture
What is S3? When does it occur? What does it indicate?
Ventricular gallop
- Follows S2
- Sign of impaired early filling
—Volume overload
—Decompensated Heart Failure
- Rarely heard in normal subjects
What is S4? When does it occur? What does it indicate?
Atrial gallop
- Precedes S1
- Sign of impaired late filling
—Pressure overload
—LVH
—Aortic stenosis
- Rarely heard in young subjects (but possible?)
S3 follows __& results from ____________ (by a stiff non-compliant __
S3 follows S2 & results from resistance to EARLY LV FILLING (by a stiff non-compliant LV
S4 precedes __ & results from ________ “ ____”
S4 precedes S1 & results from LATE FILLING “atrial kick”
S3 is a sign of ___________ with ______ whereas S4 is a sign of _________ often detected in ___ or ________
S3 is a sign of decompensated heart failure with VOLUME overload whereas S4 is a sign of PRESSURE overload often detected in LVH or aortic stenosis.
What is the driver for the physiologic splitting of S2?
Delay in P2 mostly due to longer RV emptying!
- Pulmonic delay (and slightly earlier aortic closure sound— rarely perceptible)
Wide and fixed splitting of S2 is a hallmark of what?
ASD- Atrial Septal Defect
- Right atrium is getting blood from Left atrium
- Pts have greater volume in right atrium and ventricle
- Pts will always have delayed pulmonic sound, regardless of breathing
- When ASD pts breathe in, they may have a little extra filling, but very small compared to big increase in filling from the shunt (therefore, no detectable further delay in pulmonic closure sound… thus “fixed”)
What characterizes an atrial septal defect?
Wide and fixed splitting of S2
Wide and fixed splitting of the 2nd heart sound is characteristic of?
A. Ventricular septal defect
B. Atrial septal defect
C. Pulmonic stenosis
D. Bicuspid aortic valve
E. Mitral valve prolapse
Wide and fixed splitting of the 2nd heart sound is characteristic of?
A. Ventricular septal defect
B. Atrial septal defect
C. Pulmonic stenosis
D. Bicuspid aortic valve
E. Mitral valve prolapse
Physiologic splitting of the 2nd heart sound is due to?
A. Inspiratory delay in LV emptying
B. Expiratory delay in LV emptying
C. Inspiratory delay in RV emptying
D. Expiratory delay in RV emtpying
Physiologic splitting of the 2nd heart sound is due to?
A. Inspiratory delay in LV emptying
B. Expiratory delay in LV emptying
C. Inspiratory delay in RV emptying
D. Expiratory delay in RV emtpying
Ventricular or S3 gallop is characterized by all of the following except:
A. Soft low pitched extra sound
B. Early diastolic extra sound
C. Late diastolic extra sound
D. A and B
Ventricular or S3 gallop is characterized by all of the following except:
A. Soft low pitched extra sound
B. Early diastolic extra sound
C. Late diastolic extra sound
D. A and B
Atrial gallop or S4 is characterized by all of the following except:
A. Normal finding in younger subjects
B. Late diastolic extra sound
C. Active atrial contraction
D. Sharp high pitched extra sound
Atrial gallop or S4 is characterized by all of the following except:
A. Normal finding in younger subjects
B. Late diastolic extra sound
C. Active atrial contraction
D. Sharp high pitched extra sound
What are 2 main categories of systolic murmurs? Due to what? Best heard where?
Crescendo-Decrescendo
- Early systolic ejection
- Sounds more pulsatile; not same intensity
- Best heard in aortic or pulmonic area (?)
- Possibly from aortic or pulmonic stenosis
Holosystolic
- Same intensity throughout
- Best hear in mitral area/apex-axilla (?)
What are 2 main categories of diastolic murmurs? Due to what? Best heard where?
Mitral stenosis
- Audible opening of the mitral valve (rare time when opening of valve is audible)
- OS (“opening snap”) then diastolic rumble (while blood is flowing through stenotic valve)
- Best heard over mitral area/apex
Aortic regurgitation (aortic “insufficiency”)
- Early diastolic murmur
- Aortic valve should be closed, but here is leaky or “insufficient” valve
- Best heard over the aortic area
What is the commonest cause of MR in the US?
A. Mitral valve prolapse
B. CAD (ischemia or infarction of papillary muscles)
C. Heart failure (MV annular dilation due to LV enlargement)
D. Rheumatic heart disease
What is the commonest cause of MR in the US?
A. Mitral valve prolapse
B. CAD (ischemia or infarction of papillary muscles)
C. Heart failure (MV annular dilation due to LV enlargement)
D. Rheumatic heart disease
What is unique about the systolic murmur of MVP? Due to what? What kind of murmur will be heard?
- Systolic murmur in MVP is due to prolapse of MV leaflets into the LA during systole
- late systolic then mid-systolic and eventually a holosystolic murmur as MVP progresses
As LV size increases, what happens to the chordae tendinae?
As LV size, increases, chordae prevents prolapse of the MV leaflets into the Left atrium
How are the auscultory sound of MVP (mitral valve prolapse) affected by position (Dynamic Auscultation)?
Standing >>> LV smaller >>> Longer/Louder MVP murmur
Squatting >>> LV larger >>> Shorter/Milder MVP murmur
A “Lub-DuDub” can be due to any of the following except:
A. Wide splitting of the 2nd heart sound
B. S3 gallop
C. S4 gallop
D. Opening snap
?
All of the following are characterized by a systolic murmur except:
A. Mitral regurgitation
B. Aortic stenosis
C. Mitral stenosis
D. Tricuspid regurgitation
?
Which of the following is characterized by a diastolic murmur?
A. Mitral stenosis
B. Mitral regurgitation
C. Aortic stenosis
D. Mitral valve prolapse
?
Which of the following is characterized by an opening snap?
A. Mitral regurgitation
B. Mitral stenosis
C. Aortic regurgitation
D. Aortic stenosis
?
