Auscultation and Cardiac Sounds

Question 1

Aortic valve

Answer 1

2nd right intercostal space at the sternal border

Question 2

Pulmonic valve

Answer 2

2nd left intercostal space at the sternal border

Question 3

Tricuspid valve

Answer 3

4th left intercostal space at the sternal border

Question 4

Mitral valve

Answer 4

5th left intercostal space at the midclavicular line

Question 5

S1

Answer 5

“lub”; normal closure of mitral and tricuspid valves; marks begining of systole - decreased with 1° of AV Block

Question 6

S2

Answer 6

“dub”; normal closure of aortic and pulmonary valves; marks end of systole - decreased in aortic stenosis

Question 7

S3

Answer 7

This heart sound is associated with ventricular filling, occurs soon after S2 - In older individuals may be indicative of CHF (LV)

Question 8

S4

Answer 8

This heart sound is associated with ventricular filling and atrial contraction; occurs just before S1 - Associated with pathology: CAD, MI, Aortic stenosis or Chronic hypertension

Question 9

Bruit

Answer 9

This is an adventitious sound or murmur (blowing sound) of arterial or venous origin; common in carotid or femoral arteries - indicative of atherosclerosis

Question 10

Gallop

Answer 10

An abnormal heart rhythm with three sounds in each cycle; resembles the gallop of a horse. (i.e., either S1,S2,S3 or S4,S1,S2 is heard during auscultation)

Question 11

Systolic murmur

Answer 11

With regards to murmur or extra sounds, this one falls between S1 and S2. May indicate valvular disease (e.g., mitral valve prolapse or may normal

Question 12

Diastolic murmur

Answer 12

With regards to murmurs or extra sounds, this one falls between S2 and S1. Usually indicates valvular disease

Question 13

Thrill

Answer 13

An abnormal tremor accompanying a vascular or cardiac murmur; felt on palpation

Question 14

Grade 1

Answer 14

Scale used to measure grade of heart murmur. This grade indicates the softest audible murmur

Question 15

Grade 6

Answer 15

Scale used to measure grade of heart murmur. This grade indicates murmur is audible with stethoscope off the chest

Question 16

Ausculation Landmarks

Aortic Valve

Pulmonic Valve

Tricuspid Valve

Bicuspid Valve

Answer 16

Aortic Valve = 2nd R intercostal space @ sternal border

Pulmonic Valve = 2nd L intercostal space @sternal border

Tricuspid Valve = 4th L intercostal space @ sternal border

Bicuspid Valve = 5th L intercostal space @ midclavical

Question 17

Heart Sounds S1 vs S2

Answer 17

S1 = “LUB” = normal closure of mitral valve and tricuspid valves; marks beginning of systole (decreased in 1st degree heart block)

S2 = “DUB” = normal closure of aortic and pulmonary valves; marks end of systole (decreased in aortic stenosis)

Question 18

Pathologic Heart Sounds

Murmurs (1 = softest, 6 = loudest)

Systolic, Diastolic, Thrill, Bruit, Gallop

Answer 18

Systolic Murmur: between S1 and S2 = MVProlapse

Diastolic Murmur: between S2 and S1 = valvular dx

Thrill: abnormal tremor accompanies murmur

Bruit: blowing sound = in artery = atherosclerosis

Gallop = S3: after S2 - LVF; S4: after S1 - CAD, MI, aortic stenosis, chronic HTN