Abnormal Heart Sounds Flashcards
AV valves
mitral and tricuspid
Semilunar Valves
Aortic and pulmonic valves
S1
AV valve closure
S2
Semilunar valve closure
S3
abrupt deceleration of inflow across the mitral valve
Happens after S2
S4
increased LV end diastolic stiffness decreasing compliance
happens before S1
S3 systolic or diastolic
rapid filling phase of diastole
S4 systolic or diastolic
after the P wave on EKG in atrial systole
how narrow is a split S2
normally very narrow
when does S2 normally happen
normally late in inspiration
should S2 disappear during exhalation?
yes, and if not ask the patient to sit up
which is normally louder A2 or P2
A2
if P2 is louder what should you suspect
PAH
why would P2 be decreased or absent?
usually due to increased AP diameter associated with aging but also can be due to pulmonic stenosis
A2 decreased/absent
calcific aortic stenosis
A2 increased intensity
usually only heard in R 2nd IC
louder due to systemic HTN
why would splitting of S2 be louder?
delayed closure of the pulmonic valve
fixed splitting what is and why?
refers to wide splitting that does not vary with respiration
this is often due to prolonged RV systole and in ASD
systolic clicks are caused by
mitral valve prolapse
aortic ejection
base and apex not variable with respiration and may accompany a dialted aorta or aortic valve disease from stenosis or bicupsid aortic valve
pulmonic ejection
2 and 3rd ICS (L)
decreases with inspiration
dilation of pulmonary artery, PAH, and pulmonic stenosiso
opening snap
early diastolic caused by stenotic mitral valve
heard best with diaphragm
what age should you be concerned about s3
40 yrs
is S3 normal in third trimester?
yes