Abnormalities On Auscultation Flashcards
True or false: The sound of valves is relative to where they are located in the precordium
False. Auscultation of heart sounds is where the sound travels
If you want to auscultate for aortic stenosis, what is the best location to hear this?
R 2nd ICS
What part of the heart correlates to the 2nd left ICS?
Pulmonic area
To evaluate for mitral value stenosis, you should auscultate at the __________
Left 5th ICS midclavicular line
Auscultation of the left 4th ICS is the sound of the _______ valve
Tricuspid
S1 is best heard at ______
Left 4th & 5th ICS
What sound does S1 indicate?
Closing of mitral & tricuspid Valves
S2 is the sound of the _______ valves closing
Aortic & pulmonic
The ____ valves do not close simultaneously when there is a __ (heart sound)
aortic & pulmonic
split S2
where is the split S2 heard best?
at the base of the heart -> 2nd L ICS
what can cause a split S2?
► Physiologic (related to inspiration)
► Right ventricle overload
► Delayed closure of pulmonary valve
► Delayed closure of aortic valve
if a split S2 is auscultated while performing the special auscultatory maneuver, this can indicate ____
aortic regurgitation
physiologic splitting of S2 occurs due to _____ and during ____ because there is increased venous return to the right side of the heart
decreased intrathoracic pressure
-during inspiration
a pathologic split S2 will occur during the ____ & with every ____
special auscultatory maneuver after sitting upright
-heart beat
if S2 splitting is physiological, you (will/will not) hear the split with every breath/.
what is this related to?
will not
- inspiration/expiration
when does S3 occur during the cardiac cycle?
after S2
-occurs early in diastole -> rapid ventricular filling
if present, when is S4 heard & at what point of the cardiac cycle?
late diastole BEFORE S1
-abnormal last push to get blood from atrium -> ventricles
what mechanism in the heart causes the sound of S3? what does this sound like and where is it heard best?
rapid deceleration of blood as it strikes ventricle
- Ken-tuc-ky ► Low pitched sound
- Heard best at apex and along left sternal border.
what can pathologic causes are associated with the sound of S3?
► CHF (Systolic)
► Constrictive Pericarditis
► Hypertension (prolonged)
True or false: S3 is a normal physiologic finding in asymptomatic patients < 30 years old
True -> Related to rapid ventricular filling
what is the mechanism that produces the sound of S4?
Caused by atrial contraction which causes rapid flow of blood into non-compliant (stiff) ventricle
► Ventricle does not relax appropriately in diastole
when is S4 heard in the cardiac cycle and what does it sound like?
Heard in late diastole…just before S1
► Ten-nes-see
what are pathological causes of S4?
► patients with stiffened left ventricle
► caused by hypertension
► aortic stenosis
► Cardiomyopathy
► acute MI
► rupture of chordae tendinae in acute mitral regurgitation
► Associated with diastolic heart failure
gallops are heart sounds heard during _ in the cardiac cycle
diastole
what position is best to auscultate for mitral murmurs that indicate mitral valve abnormalities?
Left lateral decubitus
-using bell over 5th ICS MCL & left 5th ICS axillary (lateral)
at what part of the cardiac cycle will a systolic ejection murmur be heard & what is it associated with?
Begin after the first heart sound
- attains a peak during mid-systole
- terminate before the second heart sound
Crescendo-decrescendo (slow, loud, slow)
-> aortic stenosis
when are Pan-systolic or holo-systolic murmurs during the cardiac cycle?
during all of systole
these murmurs are heard during all of diastole
Pan-diastolic or holo-diastolic murmus
when is a pro-diastolic murmur heard during the cardiac cycle?
early diastole
when is a pre-systolic murmur heard during the cardiac cycle?
late diastole
what does regurgitation/insufficiency indicate in regards to the heard valves?
inadequate closure of valves
a grade _ murmur is a loud murmur that also has a palpable thrill on exam
grade 4
a grade _ murmur is the loudest murmur heard with the stethoscope touching the chest which also has a palpable thrill
grade 5
True or False: a murmur in a pt that previously had this murmur has become softer. this is a good sign.
false
-problematic
what pathologies can systolic murmurs indicate?
AS MI TI PS ► Aortic Stenosis ► Mitral Insufficiency ► Tricuspid Insufficiency ► Pulmonic Stenosis
if a pt has a known hx of mitral & tricuspid insufficiency, what type of murmur do you expect to auscultate on exam and where would this best be heard?
systolic murmur
-apex
> L 4th ICS
> L 5th ICS MCL
what pathologies can diastolic murmurs indicate?
► Aortic Insufficiency
► Mitral Stenosis
► Tricuspid Stenosis
► Pulmonic Insufficiency
what type of murmur do you expect to hear for aortic regurgitation and where would you auscultate on the chest for this?
diastolic murmur
-L 3rd ICS
if a pt has a known hx of aortic stenosis, performing the valsalva maneuver will make the murmur _____
softer
- d/t less blood (venous return) being ejected from aortic valve
- less venous return to left ventricle
along with a crescendo-decrescendo murmur, there will also be ______ & ____ palpated on exam in patients with aortic stenosis
delayed carotid upstroke
-thrill
a blowing diastolic murmur is auscultated at the L 3rd ICS. what can this indicate?
aortic regurgitation
a harsh, saw like systolic ejection murmur is auscultated at the R 2nd ICS. what can this indicate?
aortic stenosis
a patient with a known hx of aortic regurgitation will have what physical exam findings?
bounding carotid pulse
-blowing diastolic murmur
why does handgrip & squatting decrease the sound of the murmur in pt’s with aortic regurgitation?
increase in pressure of arteries -> increase in afterload
with the patient leaning forward, the ___ is used to auscultate for a decrescendo murmur at the L 3rd ICS which can indicate _____
diaphragm
-aortic regurgitation
Activity will cause the ___ murmur to be ____ as activity will increase the amount
of blood moving through heart in patients with mitral stenosis
- diastolic
- increase
if a pt has a known hx of mitral stenosis, the ____ position will make it best heard upon auscultation with the ___ of the stethescope
left lateral decubitus
-bell
a mid diastolic decrescendo murmur has a _____ sound preceded by an ____ in mitral stenosis
- low pitched rumbling
- opening snap
during systole, a holosystolic/pansystolic murmur is heard with every beat. what type of heart sound is this and what can this indicate?
S3
-mitral regurgitation
where is a holosystolic murmur best heard?
apex of the heart
-left 5th ICS
on auscultation, there is a non-ejection (mid-systolic) click. what can this indicate and why does this happen?
mitral valve prolapse (MVP)
> Thought to be caused by mitral chordae snapping during systole
what is the valsalva maneuver and what does it cause?
Forced expiration against a closed glottis
► Causes an increase in intrathoracic pressure
what happens when there is an increase in intrathoracic pressure when performing the valsalva maneuver?
► Decreases venous return
► Decreased cardiac output (as there is decrease in pre-load)
► Increase in arterial pressure
► Effects heart rate (decreases immediately, then increases)
where/what position is a pericardial friction rub heard best & what does it sound like?
Rough, scratchy, crunching sound heard best during inspiration -> pt sitting up/leaning fwd
-along left sternal border
what can clicks auscultated on exam indicate other than MVP?
prosthetic valves
if a click is classified as functional, what does this mean & in what patients does this happen in?
individuals with no anatomic
cardiac defect but with a physiologic abnormality such as anemia
if a click is classified as organic, what does this mean?
occurring in individuals with a cardiac defect with or without a physiologic abnormality
