Auscultation Flashcards
Upper left sternal edge
Normal
Splitting of S2 with INHALATION (A,P)
-drops pressure in chest so more blood to right heart, delaying pulmonary closure, some blood pools in lungs so less to left ventricle so aortic sound earlier
Diaphragm of stethoscope
ASD effect on S2
Fixed split, never varies
Delayed left side ejection
Paradoxic splitting
S2 split on EXPIRATION
Abnormalities in loudness of S2 splitting
Normal: A louder than P
Increased in HTN
Decreased in valve immobility
Lower left sternal edge
Normal
Splitting of S1
Asynchronous mitral then tricuspid closure
Both high frequency
Pathological Wide S1 splitting
Delayed tricuspid closure seen in RBBB
S3
At apex (L)
With Bell
Filling sound- low frequency with bell
Maybe left lateral decubitus position
Early diastolic
Augment with INSPIRATION
Normal in children
Patho: stiff LV
S4
Apex with bell
Filling sound- low frequency
Atrial kick
Late diastole
Differentiate split S1 from S4
Left lateral decubitus position
Bell at apex- low frequency S4
Diaphragm at apex- high frequency S1- closer together
Mid systolic click
Apex with diaphragm
Mid systole
High frequency
Luptttdup
MVP- like parachute reaching full expansion
Innocent murmurs
Upper left sternal edge diaphragm
Across pulmonary outflow tract of young person with vigorous circulation
Early in systole (due to turbulence alone)
Crescendo-decrescendo,short
Lubshhhhdub
Also normal S2 splitting (inhale)
4 descriptors of murmurs
Location
Timing
Contour
Frequency
Mitral regurg
Apex with diaphragm High frequency- plateau shaped Radiates to axilla Throughout all of systole- holosystolic Shhhhhhh
MVP
Apex with diaphragm
Mid systolic click- crescendo high frequency murmur
Lubsquueeee
Aortic stenosis
Systole, crescendo-decrescendo Slow rising carotid artery Upper right sternal edge with diaphragm Mid frequency, long murmur Sustained apical impulse, may have thrill
Uurrrrgggg (groaning)
Aortic regurg
Diastolic (between A2 and S1)
diaphragm high frequency
Lower left sternal edge
Decrescendo, long murmur
Lubcuuuu
Mitral stenosis
Diastole Rumbling, low frequency murmur Apex with bell Long murmur- worse stenosis Impulse at parasternal edge
Rrrrrupiter
Continuous murmur
Through S2, systolic and diastolic
Upper left sternal border
Patent ductus arteriosus
Tricuspid regurg
Lower left sternal edge with diaphragm
Augmented during INSPIRATION
More blood to right heart during inspiration
Holosystolic, high frequency
Pericardial rub
Between and apex Lower left sternal edge with diaphragm
Leaning forward
Chhh chhhh chhhh (scratchy)
Systole, late systolic, early diastole
Upper right sternal edge
Normal
Single s1, s2
S2 louder than s1