Auscultations: Heart and Lung Sounds Flashcards
What is the purpose of the diaphragm and bell on a stethoscope?
a) Diaphragm: Identify high-pitched sounds.
b) Bell: Used to identify lower-frequency sounds such as atrial and ventricular gallops.
What are the main steps in heart auscultation?
- listen over the 4 designated areas systematically
- assess rate, rhythm, and for extra sounds or murmurs
What is the S1 heart sound and what does it signify?
S1 is the ‘lub’ sound, signifying the closure of the mitral and tricuspid valves and the onset of ventricular systole.
What is the S2 heart sound and what does it signify?
S2 is the ‘dub’ sound, signifying the closure of the aortic and pulmonary valves and the onset of ventricular diastole.
What causes the S1 heart sound?
The closure of the mitral and tricuspid valves.
What causes the S2 heart sound?
The closure of the aortic and pulmonary valves.
What is the characteristic difference between S1 and S2?
- S1 has a lower pitch and longer duration.
- S2 has a higher pitch and shorter duration.
What is an S3 heart sound?
S3 - An extra heart sound heard during early diastole, associated with increased ventricular compliance (can be normal in children).
What is an S4 heart sound?
S4 - An extra heart sound heard before S1, associated with atrial contraction into a stiff ventricle.
What conditions are associated with an S4 heart sound?
- hypertension
- hypertrophic heart disease
- pulmonary disease
- myocardial infarction
What is a ventricular gallop?
An S3 (lub-dub-dub / Ken-Tu-Cky)
heart sound, commonly found in ventricular failure.
What is an atrial gallop?
An S4 (la-lub-dub / Ten-Ne-See)
heart sound, associated with a stiff or hypertrophic ventricle.
What is a heart murmur?
- A longer-duration sound caused by the disruption of blood flow, such as through a stenotic or regurgitant valve.
- “Soft, blowing, or swishing”
What causes a systolic murmur?
- Typically due to ejection or regurgitation between S1 and S2, heard as a ‘swishing’ sound.
What causes a diastolic murmur?
Caused by aortic or pulmonary regurgitation or mitral stenosis, heard immediately following S2.
What is a mitral valve prolapse?
A condition where the mitral valve does not close properly, causing a clicking sound during systole.
What are vesicular breath sounds?
Soft, low-pitched sounds heard during inspiration over distal airways.
What are bronchial breath sounds?
Loud, tubular sounds normally heard over the trachea, with a shorter inspiratory phase.
What are bronchovesicular breath sounds?
- softer than bronchial sounds
- heard over the mainstem bronchi
- continuous between inspiration and expiration
Differences between diminished and absent breath sounds?
a) Diminished breath sounds: Breath sounds that are less intense than expected, often due to conditions like hyperinflation or obesity.
b) Absent breath sounds: No audible breath sounds, often due to lobectomy, morbid obesity, or pneumothorax.
What does it mean when bronchial breath sounds are heard outside their normal location?
This indicates consolidation or compression of lung tissue, facilitating sound transmission.
What are adventitious breath sounds?
Abnormal sounds such as crackles, wheezes, and pleural friction rubs.
- Adventitious - “added sounds”
What are crackles (rales)?
Discontinuous, high-pitched popping sounds, often associated with fluid or secretions in the lungs.
What causes wet and dry crackles?
- Wet: Conditions like pulmonary edema or pleural effusion, where fluid is present in the lungs.
- Dry: Caused by the sudden opening of closed airways, seen in atelectasis or pulmonary fibrosis.
What are wheezes?
Continuous high- or low-pitched sounds, often heard during exhalation, indicating airway obstruction.
What are Rhonchi and Stridor?
- Rhonchi: Low-pitched continuous sounds associated with mucus, common in chronic bronchitis or pneumonia.
- Stridor: A severe, high-pitched wheeze heard in the upper airway, often due to obstruction and considered an emergency.
What is pleural friction rub?
A sound resembling two pieces of leather rubbing together, associated with pleural inflammation.
What is bronchophony?
Increased vocal resonance with greater clarity and loudness, indicating lung consolidation.
What is egophony?
A form of bronchophony where the ‘E’ sound changes to a nasal ‘A’, indicating consolidation.
What is whispered pectoriloquy?
Clearer, louder recognition of whispered words, indicating lung consolidation.
How do you auscultate the lungs?
- place the diaphragm on the chest wall
- start at the apices
- compare symmetrical points
- listen to at least one full breath cycle
What precautions should you take when performing lung auscultation?
Prevent patient dizziness, drape appropriately, and ensure deep breaths through the mouth.
What are normal vesicular breath sounds?
- soft, low-pitched sounds during inspiration with a 3:1 inspiration to expiration ratio.
What are abnormal bronchial breath sounds?
Heard outside of the tracheal area, indicating conditions like consolidation or compression.
What is the significance of diminished or absent lung sounds?
Diminished: Sounds less then what you would expect in the area
- pain
- not taking deep enough breath
- hyperinflation/emphysema (lesser)
- obesity (further away from chest wall d/t adipose tissue and harder to breath)
Absent: don’t hear anything
- Lobectomy, nothing to hear
- morbid obesity
- mucus plugging has blocked airway completely
- pneumothorax with air in space
How can abnormal voice sounds help in diagnosis?
Increased vocal resonance, as in bronchophony or egophony, indicates consolidation or atelectasis.
What is the significance of stridor in lung auscultation?
It indicates a life-threatening upper airway obstruction and requires immediate intervention.
What is the difference between wet and dry crackles?
- Wet crackles are due to fluid in the lungs
- Dry crackles result from sudden airway opening.
What is the purpose of lung auscultation?
- to confirm findings from the chart
- rule out dysfunction
- assess ventilation after treatment
