Abnormal Heart Sounds

Question 1

AV valves

Answer 1

mitral and tricuspid

Question 2

Semilunar Valves

Answer 2

Aortic and pulmonic valves

Question 3

S1

Answer 3

AV valve closure

Question 4

S2

Answer 4

Semilunar valve closure

Question 5

S3

Answer 5

abrupt deceleration of inflow across the mitral valve

Happens after S2

Question 6

S4

Answer 6

increased LV end diastolic stiffness decreasing compliance

happens before S1

Question 7

S3 systolic or diastolic

Answer 7

rapid filling phase of diastole

Question 8

S4 systolic or diastolic

Answer 8

after the P wave on EKG in atrial systole

Question 9

how narrow is a split S2

Answer 9

normally very narrow

Question 10

when does S2 normally happen

Answer 10

normally late in inspiration

Question 11

should S2 disappear during exhalation?

Answer 11

yes, and if not ask the patient to sit up

Question 12

which is normally louder A2 or P2

Answer 12

A2

Question 13

if P2 is louder what should you suspect

Answer 13

PAH

Question 14

why would P2 be decreased or absent?

Answer 14

usually due to increased AP diameter associated with aging but also can be due to pulmonic stenosis

Question 15

A2 decreased/absent

Answer 15

calcific aortic stenosis

Question 16

A2 increased intensity

Answer 16

usually only heard in R 2nd IC

louder due to systemic HTN

Question 17

why would splitting of S2 be louder?

Answer 17

delayed closure of the pulmonic valve

Question 18

fixed splitting what is and why?

Answer 18

refers to wide splitting that does not vary with respiration

this is often due to prolonged RV systole and in ASD

Question 19

systolic clicks are caused by

Answer 19

mitral valve prolapse

Question 20

aortic ejection

Answer 20

base and apex not variable with respiration and may accompany a dialted aorta or aortic valve disease from stenosis or bicupsid aortic valve

Question 21

pulmonic ejection

Answer 21

2 and 3rd ICS (L)
decreases with inspiration

dilation of pulmonary artery, PAH, and pulmonic stenosiso

Question 22

opening snap

Answer 22

early diastolic caused by stenotic mitral valve

heard best with diaphragm

Question 23

what age should you be concerned about s3

Answer 23

40 yrs

Question 24

is S3 normal in third trimester?

Answer 24

yes

Question 25

common causes of S4

Answer 25

HTN heart disease
aortic stenosis
hypertrophic cardiomyopathy

Question 26

common causes of S3

Answer 26

decreased cardiac contractility
heart failure
ventricular volume overload
mitral regurgitation 
Left to Right shunts

Question 27

Grade 1 murmur

Answer 27

very faint only a cardiologist is going to hear this

Question 28

Grade 2 murmur

Answer 28

quiet, but heard immediately after placing stethoscope on chest

Question 29

Grade 3 murmur

Answer 29

moderately loud

Question 30

Grade 4 murmur

Answer 30

Loud, with palpable thrill

Question 31

Grade 5 murmur

Answer 31

Very loud, with thrill. may be heard with stethoscope partly off chest

Question 32

Grade 6 murmur

Answer 32

very loud, with thrill. May be heard with stethoscope entirely off chest

Question 33

holosystolic mumurs

Answer 33

Mitral regurgitation
tricuspid regurgitation
VSD

Question 34

pathological murmurs

Answer 34

Aortic Stenosis — carotids heard best leaning forward
s1-s2

hypertrophic cardiomyopathy — decrease with squatting increases with standing
S1

pulmonic stenosis —- harsh E1-A2

Question 35

Aortic Regurgitation

Answer 35

best heard with patient sitting, leaning forward with breath held after exhalation

Question 36

mitral stenosis

Answer 36

use the bell

best heard in exhalation
use handgrip to make more audible

Question 37

atrial myxoma

Answer 37

may cause obstruction of AV valve and a mid-diastolic murmur

sounds like mitral stenosis and is presystolic

Question 38

tricuspid regurgitation in infants

Answer 38

usually correlates with low apgar due to transient papillary muscle dysfunction

also occurs in pulmonary atresia and ebstein’s anomaly

Question 39

TOF has a murmur caused by

Answer 39

pulmonary stenosis