Abnormal Heart Sounds Exam 2

Question 1

Gallop

Answer 1

An abnormal rhythm. Sounds S3, S4 and Summation gallop.

Question 2

S3 sound

Answer 2

A ventricular filling sound. Heard after S2 (early in diastole).
Dull soft sound. Best heard at apex. Usually disappears upon sitting up.

Question 3

S3 pathological sound

Answer 3

Sound persists when sitting up. Due to decreased compliance of ventricles: Ventricle forced to dilate beyond its normal range, rapid filling during diastole.
Indicates volume overload: CHF, Mitral regurgitate.

Question 4

S4 fourth heart sound

Answer 4

Ventricular filling sound: soft and low pitch
Occurs when atria contract late in diastole
Heart just before S1 at apex.

Question 5

S4 pathological heart sound or atrial gallop (causes of left sided atrial gallop)

Answer 5

Causes: Decreased compliance of ventricles (CAD, cardiomyopathy), Systolic overload (afterload), Outflow obstruction of ventricle (aortic stenosis), Systemic hypertension.

Question 6

S4 pathological heart sounds (causes of right sided S4)

Answer 6

Less common.

Is heard at LLSB and occurs with pulmonary stenosis and pulmonary hypertension

Question 7

Summation Gallop

Answer 7

Has both S3 and S4. Sounds like a horse.

Question 8

Murmurs

Answer 8

A swooshing or blowing sound that is produced by turbulence of blood flow in the heart or great vessels

Question 9

Systolic murmurs

Answer 9

Between S1 and S2. May or may not indicate disease. 
Physiologic: Innocent, Functional
Mitral valve prolapse MVP.
Pathological: Aortic stenosis (AS) or 
Mitral regurgitation (MR)

Question 10

Physiologic Murmurs

Answer 10

Physiologic murmurs are systolic murmurs caused by physiologic conditions outside of the heart.
-Innocent or Functional.

Question 11

Innocent murmurs

Answer 11

Have no valvular or other pathologic cause

-common in healthy children or adolescents; usually outgrown

Question 12

Functional Murmurs

Answer 12

Are caused by an increased blood flow in the heart

-common causes are anemia, pregnancy, fever, hyperthyroidism.

Question 13

Mitral Valve Prolapse

Answer 13

Leaflets of the mitral valve bulge (prolapse) upward or back into the left atrium as the heart contracts.
Crescendo-decrescendo murmur.
Heard best at the apex.
Enhanced by Valsalva maneuvers and decreased by squatting

Question 14

Aortic Stenosis

Answer 14

Loudest at the second right interspace, softer towards axilla.
Loud harsh, midsystolic, crescendo/decrescendo.
Better heard when sit up and exhale.
May radiate to carotid so distinguish from bruit.
Usually no delay form onset of murmur to feeling carotid pulse.
Stiff valves.

Question 15

Mitral Regurgitate

Answer 15

Holosystolic: sounds same throughout systole
Loud blowing
Best heard at apex
Radiates to L axilla
Left lateral position augments sound

Question 16

Diastolic Murmurs

Answer 16

Between S2 and S1
Almost always indicate pathology and need referral
Softer and more difficult to hear than systolic
Usually is aortic regurgitation or mitral stenosis
Neither are common

Question 17

Aortic regurgitation

Answer 17

Best heard at 3rd left interspace at base
Decrescendo= softer at end of diastole
Sit up lean forward and exhale enhances
May occur with AS murmur

Question 18

Mitral stenosis

Answer 18

Characterized by thickening, fibrosis and hardening of mitral annulus. (Mitral valve will not open correctly)
Can lead to heart failure and pulmonary edema
Heard best at apex with person in L lateral position
Does not radiate.
Opening snap after S2 heard over large area of precordium

Question 19

Mnemonic for systolic murmurs

Answer 19

MR PASS MVP

Mitral, Regurg, Physiologic, Aortic, Stenosis, Systolic, Mitral, Valve, Prolapse.

Question 20

Mnemonic for Diastolic Murmurs

Answer 20

MS ARD

Mitral, Stenosis, Aortic, Regurg, Diastolic

Question 21

Arterial Insufficiency

Answer 21

Decreased or absent pulses distal to obstruction
Bruins
Pain with activity
Pillow with Increased 
Rubor with decreased
Delayed capillary refill

Question 22

Venous Insufficiency

Answer 22

Pulses normal
Brown pigmentation 
Edema
Aching increased throughout the day
Stasis ulcers at ankle