Abnormalities of the heart sounds

Question 1

What are the steps in auscultation?

Answer 1

Listen in the mitral area with the diaphragm lightly applied (MS, S3) then firmly applied.
Then listen with diaphragm applied firmly in the tricuspid area (5 LICS)
Then in the pulmonary (2 LICS) then aortic (2 RICS)

Question 2

S1 is

Answer 2

mitral and tricuspid valve closure (AV valves)

start of systole

Question 3

S2 is

Answer 3

semilunar valve closure

Question 4

Why is the P2 later?

What does inspiration do to the P2 and why?

Answer 4

less pressure ejecting blood to pulmonary vessels

increases venous return to the right ventricle, prolonging pulmonary valve closure, causes prolonged splitting of S2

Question 5

What are the causes of a loud S1?

Answer 5

Is when mitral or tricuspid valves remain wide open at end of diastole and shut forcefully at systole
Mitral stenosis - narrowed valve means blood still flowing until late in diastole causing a thud when it shuts with blood against it
tachycardia

Question 6

What are the causes of a soft S1?

Answer 6

mitral regurgitation

first degree heart block

Question 7

What causes a loud A2 (and S2)?

Answer 7

Forceful aortic valve closure due to high pressures.
Systemic hypertension
Aortic stenosis

Question 8

What causes a soft S2?

Answer 8

when aortic leaflet movement is reduced as in aortic regurgitation

Question 9

What causes a split S1?

Answer 9

right bundle branch block

Question 10

What causes increased normal splitting of S2?

Answer 10

any delay in RV emptying or increased RV volume load
RBBB
pulmonary stenosis
VSD
mitral regurgitation

Question 11

What causes a fixed split S2?

Answer 11

atrial septal defect

Question 12

What causes reverse splitting?

Answer 12

P2 comes first and it happens in expiration not inspiration.

Question 13

What are the features and the causes of a left ventricular S3?

Answer 13

LV failure
aortic regurgitation
mitral regurgitation
VSD

Question 14

what causes RV S3?

Answer 14

right ventricular failure

constrictive pericarditis

Question 15

What is the S4?

Answer 15

Diastolic heart sound tennessee

Can’t occur in AF

Question 16

What causes a LV S4?

Answer 16

due to poor LV compliance in 
aortic stenosis
acute mitral regurgitation
ischaemic heart disease
systemic hypertension
with age

Question 17

what causes a right ventricular S4?

Answer 17

poor LV compliance
pulmonary hypertension
pulmonary stenosis