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
common causes of S4
HTN heart disease
aortic stenosis
hypertrophic cardiomyopathy
common causes of S3
decreased cardiac contractility heart failure ventricular volume overload mitral regurgitation Left to Right shunts
Grade 1 murmur
very faint only a cardiologist is going to hear this
Grade 2 murmur
quiet, but heard immediately after placing stethoscope on chest
Grade 3 murmur
moderately loud
Grade 4 murmur
Loud, with palpable thrill
Grade 5 murmur
Very loud, with thrill. may be heard with stethoscope partly off chest
Grade 6 murmur
very loud, with thrill. May be heard with stethoscope entirely off chest
holosystolic mumurs
Mitral regurgitation
tricuspid regurgitation
VSD
pathological murmurs
Aortic Stenosis — carotids heard best leaning forward
s1-s2
hypertrophic cardiomyopathy — decrease with squatting increases with standing
S1
pulmonic stenosis —- harsh E1-A2
Aortic Regurgitation
best heard with patient sitting, leaning forward with breath held after exhalation
mitral stenosis
use the bell
best heard in exhalation
use handgrip to make more audible
atrial myxoma
may cause obstruction of AV valve and a mid-diastolic murmur
sounds like mitral stenosis and is presystolic
tricuspid regurgitation in infants
usually correlates with low apgar due to transient papillary muscle dysfunction
also occurs in pulmonary atresia and ebstein’s anomaly
TOF has a murmur caused by
pulmonary stenosis
