Abnormal Heart Sounds

Question 1

S3 heart sound

Answer 1

Occurs from limited rapid filling phase of diastole

Question 2

S4 heart sound

Answer 2

Occurs during systole and a wave of atrial pulse pressure

Question 3

S1 heart sound

Answer 3

Closure of mitral valve

Question 4

S2 heart sound

Answer 4

Closure of aortic valve

Question 5

Split S2 listening post

Answer 5

Best heard between the 2nd and 3rd intercostal space

Question 6

Timing of S2 split

Answer 6

Best heard during late inspiration

Question 7

A2 with increased intensity

Answer 7

Occurs in systemic hypertension due to increased preload

Question 8

A2 decreased or absent

Answer 8

Calcific aortic stenosis du to immobility

Question 9

P2 with increased intensity

Answer 9

Suspect Pulmonary HTN
Dilated cardiomyopathy
ASD

Question 10

P2 with decreased intensity

Answer 10

Increased AP diameter of the chest associated with aging

Pulmonary stenosis

Question 11

Causes of delayed closure of pulmonic valve

Answer 11

Pulmonic stenosis

RBBB

Question 12

Causes of early closure of pulmonic valve

Answer 12

Mitral regurg

Question 13

Prolonged right ventricular systole

Answer 13

Seen in ASD

Question 14

Cause of delayed A2 in expiration

Answer 14

LBBB

Question 15

An early systolic sound is from

Answer 15

Halting of semilunar valves

A aortic valve can be heard at base and apex

A pulmonic valve heard best at 2/3 L ICS

Question 16

Opening Snap occurs

Answer 16

In early diastole which is caused by a stenotic mitral valve

Should use diaphragm to listen

Question 17

Systolic click cause

Answer 17

Mitral valve prolapse

Question 18

Mitral valve prolapse changes with position

Answer 18

Squatting delays click

Standing makes click earlier

Question 19

S3 sound cause

Answer 19

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

Question 20

S4 sound cause

Answer 20

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

Question 21

Grade 1 Murmur

Answer 21

very faint and may not be heard at all positions

Question 22

Grade 2 Murmur

Answer 22

Quite but heard immediately when stethoscope is placed on chest

Question 23

Grade 3 Murmur

Answer 23

Moderately loud

Question 24

Grade 4 Murmur

Answer 24

Loud with a palpable thrill

Question 25

Grade 5 Murmur

Answer 25

Very loud with a thrill even with stethoscope barely on chest

Question 26

Grade 6 Murmur

Answer 26

Can be heard without stethoscope

Question 27

Aortic Stenosis

Answer 27

Best heard at 2nd & 3rd R ICS Radiates up carotid and down left sternal border Harsh, crescendo-decrescendo Best heard sitting and leaning forward

Question 28

Hypertrophic Cardiomyopathy

Answer 28

Best heard at 3rd & 4th L ICS Radiates down left sternal border to apex Intensity decreases by squatting and increased by standing

Question 29

Pulmonic Stenosis

Answer 29

Best heard at 2nd & 3rd L ICS Radiates up shoulder and neck Crescendo-decrescendo

Question 30

Mitral Regurgitation

Answer 30

Best heard at Apex Radiates to left axilla Harsh, holosystolic

Question 31

Tricuspid Regurgitation

Answer 31

Best heard at Lower left sternal border Radiates right sternal border Blowing, holosystolic Increases in intensity with inspiration

Question 32

Ventricular Septal Defect

Answer 32

Best heard at 3rd, 4th, 5th L ICS Intensity depends on size of murmur High, holosystolic

Question 33

Aortic Regurgitation

Answer 33

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

Question 34

Mitral Stenosis

Answer 34

Usually limited to apex Decrescendo low-pitched - use bell Best heard at apical impulse and during exhalation

Question 35

Atrial Myxoma

Answer 35

Mid-diastolic murmur LA myxoma can be mistaken w/ mitral stenosis Presystolic and crescendo

Question 36

Squatting

Answer 36

MVP - Delay of click and murmur shortens Hypertrophic cardiomyopathy - decreases intensity of murmur Aortic stenosis - increased intensity of murmur

Question 37

Standing

Answer 37

MVP - Earlier after S1 of click and murmur Hypertrophic cardiomyopathy - increases intensity of murmur Aortic stenosis - decreased intensity of murmur

Question 38

Most common cause of S3 heart sound

Answer 38

Congestive heart failure Dilated cardiomyopathy Less common Valvular regurgitation Left to right shunting

Question 39

Most common cause of S4 heart sound

Answer 39

Hypertension Aortic stenosis Ischemic or hypertrophic cardiomyopathy Mitral regurgitation - abrupt onset = ruptured chorda tendinae