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Cardiology > Auscultation Notecards > Flashcards

Auscultation Notecards Flashcards

1
Q

Normal Heart Sounds

A

S1, S2

valvular

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2
Q

Added Heart Sounds

A

S3, S4

ventricular wall

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3
Q

Systolic murmurs (3)

A

aortic stenosis
mitral regurgitation
triscupid regurgitation

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4
Q

Diastolic murmurs (2)

A

aortic regurgitation

mitral stenosis

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5
Q

What two physics components generate heart sounds?

A

Direction and velocity change

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6
Q

S1

A

cessation of forward flow from body and lungs

  • tricuspid (from body via vena cava to RV)
  • mitral (from lungs via pulmonary veins to LV)
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7
Q

S2

A

cessation of forward flow from heart to lungs and body

  • pulmonic (from RV to lungs)
  • aortic (from LV to body)
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8
Q

Are right or left sided sounds louder?

A

left sided sounds are louder in intensity, while right sided are softer

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9
Q

Is S1 or S2 softer?

A

S1 is softer than S2

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10
Q

What sounds are represented by S1?

A

simultaneous mitral and tricuspid

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11
Q

What sounds are represented by S2?

A

simultaneous aortic and pulmonic

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12
Q

Describe S3

A

early-mid diastolic, groaning

ventricular wall noise from resistance to filling

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13
Q

Describe S4

A

late diastolic, at the end of ventricular filling

ventricular wall resistance to atrial kick; not found in atrial fibrillation

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14
Q

Where are S3 and S4 best heard?

A

apex of the heart, left lateral recumbent

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15
Q

What is a gallop?

A

when both S3 and S4 are heard

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16
Q

Describe a fixed S2 and what can cause it

A

Sharp, brief, end systole

caused by increased RV load: delays PV closure, ASD with L to R shunt

best heard at pulmonic post

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17
Q

Describe an S3 as compared to a fixed S2

A

S3 is dull, sloppy, early diastole

LV wall distension

best heard over LV

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18
Q

What are the 4 components of naming a murmur

A

grade - cycle - intensity - radiation

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19
Q

Name 2 examples of adventitious sounds

A

Hypertrophic cardiomyopathy

Pericarditis

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20
Q

Name 3 left systolic murmurs/sounds

A

Aortic stenosis

Hypertrophic cardiomyopathy

Mitral regurgitation

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21
Q

Name 2 right systolic murmurs/sounds

A

pulmonic stenosis

tricuspid regurgitation

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22
Q

Aortic Stenosis:

  1. Location/Radiation
  2. Murmur Type: Side/Phase
  3. Causes (4)
  4. Best Heard Where/How?
A
  1. Radiates along aortic outflow path to carotids
  2. Left sided, systolic
  3. Age, calcification, congenital disease (bicuspid valve), infective endocarditis (rheumatic)
  4. Aortic Area at 2nd ICS, sitting
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23
Q

Hypertrophic Cardiomyopathy:

  1. Description/Cause
  2. Murmur Type: Side/Phase
  3. Best Heard Where/How?
A
  1. Left ventricular outflow track obstruction: worse when dry, improves with high volumes
  2. Left sided, systolic, split S2
  3. right 2nd IC space, with DIAPHRAGM
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24
Q

Mitral Regurgitation:

  1. Location/Radiation
  2. Description
  3. Causes (6)
  4. Best Heard Where/How?
A
  1. Radiates along left sternal border
  2. Permits backward flow during SYSTOLE from LV to LA
  3. MVP from myxotamous degeneration, endocarditis, rheumatic fever, connective tissue disease (Marfan’s), MI with papillary rupture, pulmonary HTN
  4. Apex, supine, left lateral recumbent
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25
Q

Describe the pathology behind mitral valve prolapse, aka click-murmur syndrome, as well as what sounds are characteristic of it

A
  • partial/induced MR
  • occurs late in systole; mitral valve pops open: high LV pressure and/or loose tethering of valve edge (or papillary rupture)
  • opening snap then blowing murmur of MR: decreased systolic volume moves OS earlier: wall closer sooner
  • increased systolic volume moves the OS later
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26
Q

Pulmonic Stenosis:

  1. Causes/Associations
  2. Side/Phase
A
  1. Congenital structural disease, rheumatic valvular disease, carcinoid syndrome
27
Q

Tricuspid Regurgitation:

  1. Causes (4)
  2. Best Heard Where/How?
  3. Side/Phase
A
  1. Infection (IV drug use), rheumatic valvular disease, dilated annulus from CHF/pulmonary htn, fenphen drug
  2. tricuspid area, supine
  3. Right sided, mid-systolic
28
Q

Name 2 left diastolic murmurs/sounds

A

aortic regurgitation

mitral stenosis

29
Q

Name 2 right diastolic murmurs/sounds

A

pulmonic regurgitation

tricuspid stenosis

30
Q

Aortic Regurgitation:

  1. Causes (4)
  2. Best Heard Where/How?
  3. Location/Radiation
  4. Side/Phase
  5. Special Type
A
  1. endocarditis, root dilation, congenital (bicuspid valve), CT disorders (Marfan’s)
  2. Aortic area at 2nd ICS, sitting
  3. Radiates along left sternal border
  4. Left sided, early diastolic (but can have systolic component)
  5. Austin Flint type is severe case
31
Q

Systolic murmur found at the aortic post

A

aortic stenosis

32
Q

Systolic murmur found at the apex

A

mitral regurgitation

33
Q

Systolic murmur found parasternal

A

tricuspid regurgitation

34
Q

Diastolic murmur found at aortic post

A

aortic regurgitation

35
Q

Diastolic murmur found at apex

A

mitral stenosis

36
Q

Mitral Stenosis:

  1. Location/radiation
  2. Causes (2)
  3. Best Heard Where/How?
  4. Side/phase
  5. Characteristic changes
A
  1. Radiates to precordial area
  2. Infectious endocarditis, calcific changes (age)
  3. Apex, left decubitus position
  4. Left sided, diastolic, opening snap
  5. Increases at end diastole by atrial contraction, worsened by increased flow/volume
37
Q

Pulmonic Regurgitation:

  1. Causes (4)
  2. Side/phase
  3. Best Heard Where/How?
A
  1. Rheumatic valvular disease, carcinoid syndrome, pulmonary hypertension, CT disease, dilation
  2. right sided, diastolic
  3. Sitting, bell
38
Q

Tricuspid Stenosis:

  1. Causes (3)
  2. Side/phase
  3. Best Heard Where/How?
A
  1. Rheumatic valvular disease, congenital heart structural disease, age/calcification
  2. right sided, diastolic
  3. left lateral decubitus, bell
39
Q

Pericardial friction rub:

  1. Causes (6)
  2. Best Heard How?
  3. Description
A
  1. viral, SLE, RA, neoplastic, renal failure, dressler’s, MI
  2. Lean forward, exhale
  3. Adventitious sounds - non valvular sounds, sounds like cabasa, triphasic
40
Q

Describe the physiology of the valsalva maneuver

A
  1. increased arterial pressure by direct pressure (rise in SVR)
  2. decreased venous return (less to pump) so pressure (MAP) drops
  3. B/P x HR = K; heart rate rises therefore constriction increases SVR
  4. exhale: pressure drop lowers MAP, SVR drops
  5. Increased venous return; step 2 is reversed
  6. brief overshoot in MAP causes reflex drop in HR (BP x HR = K)
41
Q

Which two murmurs fade with the application of the valsalva murmur?

A

aortic stenosis and pulmonic stenosis

42
Q

Which murmur becomes louder/increase with the application of the valsalva maneuver?

A

hypertrophic cardiomyopathy - ventricular walls are closer, LVED and SV less

43
Q

K = ?

A

MAP x HR

44
Q

Describe the effect of standing on heart sounds in general physiological terms

A

drops venous return and thus SV

45
Q

Which murmur increases with the effect of standing?

A

hypertrophic myocardiopathy (increases effect of outflow track obstruction)

46
Q

Which 2 murmurs are decreased by standing?

A

aortic and pulmonic stenosis - less flow

47
Q

Describe the effect of exercise on hypertrophic myocardiopathy

A

HCM intensity is increased, due to increased flow and increased contractile force

48
Q

Describe the effects of vigorous exercise on stenotic murmurs

A

effects are increased due to decreased downstream resistance

murmurs are worsened both sonically and clinically

49
Q

Describe the physiological effect of hand grip on heart sounds

A

increases systolic gradient and intraventricular pressures

50
Q

Which two murmurs are increased by hand grip?

A

tricuspid regurgitation and mitral regurgitation

51
Q

How is aortic stenosis intensity affected by hand grip?

A

varying effect - increases SVR, but may not have much effect

52
Q

Describe the physiological effects of squatting on heart sounds

A

increase SVR and VR

increased back pressure on AV

53
Q

Which murmur is lessened by squatting?

A

hypertrophic cardiomyopathy

54
Q

Describe the physiological effects of deep breathing on heart sounds

A
  • increases pulmonary venous return by negative chest pressure (Suction)
  • decreases LV filling (capacitance): flow across AV ceases sooner, moves S2 (LV/aortic) earlier
  • opposite of ASD’s moving PV closure later**
  • result is split S2
55
Q

What is the result of deep breathing on heart sounds?

A

split S2

56
Q

Describe the effect of Aortic regurge on:

  1. VSD and MR sounds
  2. HCM murmur
A
  1. increases VSD and MR sounds due to increased LV filling/volume, re-pumping of blood
  2. decreases HCM murmur due to increased return and greater LV filling
57
Q

Click Murmur Syndrome (MVP) changes with:

  1. sudden standing and valsalva
  2. squatting
  3. hand grip
A
  1. decreases LVESV, moves opening click earlier in systole
  2. squatting increases systolic volume and SVR which delays opening click, decreases intensity
  3. hand grip increases sound intensity by increased LV pressures, increasing regurge
58
Q

Hypertrophic Cardiomyopathy changes with:

  1. Standing
  2. Squatting
  3. Valsalva
  4. Hand Grip, squatting, leg lifting
A
  1. standing decreases LV volume, decreasing wall distance, increasing stenosis intensity
  2. squatting increases LV volume, decreasing intensity by increasing wall distance
  3. Valsalva bearing down stage reduces return and LV volume, decreasing wall distance
  4. hand grip, squatting, left lifting all increase return or SVR, decreasing obstruction
59
Q

Mitral regurgitation changes with:

  1. Hand grip
  2. Squatting
A
  1. hand grip increases SVR and LV pressure; increases gradient across the MV
  2. squatting increases return and SVR, raising gradient
60
Q

How do right heart murmurs change with inhalation? Why?

A

increase with inhalation because of increased flow, increased inflow to lungs

61
Q

How should you augment Aortic stenosis?

A

lean forward and exhale

62
Q

How are S3 and S4 best heard?

A

with patient in left lateral recumbent with doctor to the patient right

63
Q

One major fact to note about S3 and S4

A

they are the equivalent!

Cardiology (3 decks)

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