Abnormal Heart Sounds Flashcards
S3 heart sound
Occurs from limited rapid filling phase of diastole
S4 heart sound
Occurs during systole and a wave of atrial pulse pressure
S1 heart sound
Closure of mitral valve
S2 heart sound
Closure of aortic valve
Split S2 listening post
Best heard between the 2nd and 3rd intercostal space
Timing of S2 split
Best heard during late inspiration
A2 with increased intensity
Occurs in systemic hypertension due to increased preload
A2 decreased or absent
Calcific aortic stenosis du to immobility
P2 with increased intensity
Suspect Pulmonary HTN
Dilated cardiomyopathy
ASD
P2 with decreased intensity
Increased AP diameter of the chest associated with aging
Pulmonary stenosis
Causes of delayed closure of pulmonic valve
Pulmonic stenosis
RBBB
Causes of early closure of pulmonic valve
Mitral regurg
Prolonged right ventricular systole
Seen in ASD
Cause of delayed A2 in expiration
LBBB
An early systolic sound is from
Halting of semilunar valves
A aortic valve can be heard at base and apex
A pulmonic valve heard best at 2/3 L ICS
Opening Snap occurs
In early diastole which is caused by a stenotic mitral valve
Should use diaphragm to listen
Systolic click cause
Mitral valve prolapse
Mitral valve prolapse changes with position
Squatting delays click
Standing makes click earlier
S3 sound cause
Normal in athletes <40 y/o and Women in third trimester
Caused by decreased myocardial contractility, heart failure ventricular volume overload from mitral regurg and L-to-R shunting
S4 sound cause
Low pitched and best heard with bell at the lower left sternal border
Common in athletes and older people
Caused by fibrosis and ventricular hypertrophy
Grade 1 Murmur
very faint and may not be heard at all positions
Grade 2 Murmur
Quite but heard immediately when stethoscope is placed on chest
Grade 3 Murmur
Moderately loud
Grade 4 Murmur
Loud with a palpable thrill
Grade 5 Murmur
Very loud with a thrill even with stethoscope barely on chest
Grade 6 Murmur
Can be heard without stethoscope
Aortic Stenosis
Best heard at 2nd & 3rd R ICS
Radiates up carotid and down left sternal border
Harsh, crescendo-decrescendo
Best heard sitting and leaning forward
Hypertrophic Cardiomyopathy
Best heard at 3rd & 4th L ICS
Radiates down left sternal border to apex
Intensity decreases by squatting and increased by standing
Pulmonic Stenosis
Best heard at 2nd & 3rd L ICS
Radiates up shoulder and neck
Crescendo-decrescendo
Mitral Regurgitation
Best heard at Apex
Radiates to left axilla
Harsh, holosystolic
Tricuspid Regurgitation
Best heard at Lower left sternal border
Radiates right sternal border
Blowing, holosystolic
Increases in intensity with inspiration
Ventricular Septal Defect
Best heard at 3rd, 4th, 5th L ICS
Intensity depends on size of murmur
High, holosystolic
Aortic Regurgitation
Best heard at 2nd, 3rd, 4th L ICS
Radiates to apex and to R sternal border
High pitched - use diaphrgam
Blowing decrescendo
Best heard sitting and leaning forward
Mitral Stenosis
Usually limited to apex
Decrescendo low-pitched - use bell
Best heard at apical impulse and during exhalation
Atrial Myxoma
Mid-diastolic murmur
LA myxoma can be mistaken w/ mitral stenosis
Presystolic and crescendo
Squatting
MVP - Delay of click and murmur shortens
Hypertrophic cardiomyopathy - decreases intensity of murmur
Aortic stenosis - increased intensity of murmur
Standing
MVP - Earlier after S1 of click and murmur
Hypertrophic cardiomyopathy - increases intensity of murmur
Aortic stenosis - decreased intensity of murmur
Most common cause of S3 heart sound
Congestive heart failure
Dilated cardiomyopathy
Less common
Valvular regurgitation
Left to right shunting
Most common cause of S4 heart sound
Hypertension
Aortic stenosis
Ischemic or hypertrophic cardiomyopathy
Mitral regurgitation - abrupt onset = ruptured chorda tendinae
