Bates-Murmurs Flashcards
Is S1 softer or louder at the base?
Softer!
Right and left 2nd interspaces
Is S1 softer or louder at the apex?
Often, but not always louder.
When is S1 accentuated?
Tachycardia, rhythms with a short PR interval, and high cardiac output states (exercise, anemia, and hyperthyroidism)
Mitral stenosis.
In these conditions, the mitral valve is still open wide at the onset of ventricular systole and then closes quickkly
When is S1 diminished?
First-degree heart block.
Also when the mitral valve is calcified and relatively immobile, as in mitral regurg AND when left ventricular contractility is markedly reduced, as in heart failure or coronary heart disease.
What are the two kinds of extra heart sounds in systole?
- Early ejection sounds
2. Clicks, commonly heard in mid-and late systole
What are systolic clicks usually caused by?
Mitral valve prolapse
Where do we listen for mitral valve prolapse?
With our DIAPHRAGM, we listen at or medial to the apex, but also at the lower left sternal border
Do we want our patients to squat or stand when listening for mitral prolapse?
STAND! Squatting delays the click and murmur, standing moves them closer to S1
When will you diagnose PHYSIOLOGIC S3?
Frequently in children and in young adults to the age of 35 or 40. It is also common during the last trimester of pregnancy
When does the physiologic S3 occur?
Diastole during rapid ventricular filling, is is later than the opening snap, dull and low in pitch, and heard best at the apex in the left lateral decubitus position.
When does an S4 sound occur?
Just before S1
Commonly called an atrial sound or atrial gallop
How do you describe an S4 murmur?
Dull, low in pitch, and heard better with the bell
When is an S4 occasionally normal?
In trained athletes and in older age groups
When it S4 most commonly due to?
Increased resistance to ventricular filling following atrial contraction
What may cause S4 (left-sided?
Hypertensive heart disease, myocardial ischemia, aortic stenosis, and cardiomyopathy
Where is S4 best heard?
Best at the apex in the left lateral position. May sound like Tennessee.
Where do we listen for mitral regurg?
Apex
Where does mitral regurg radiate?
To the left axilla, less often to the sternal border
How would you describe the intensity of mitral regurg?
Soft to loud; if loud, associated with an apical thrill
Pitch of mitral regurg?
Medium to high
Quality of mitral regurg?
Harsh, holosystolic
How does it sound different from tricuspid regurg?
Does not become louder in inspiration
What are the most common kinds of heart murmurs?
Midsystolic ejection murmurs
- They may be innocent, without any detectable physiologic or structural abnormality
- Physiologic, form physiologic changes in body metabolism
- Pathologic–arising from a structural abnormality in the heart or great vessels
Where do we often listen for innocent murmurs?
2nd to 4th left interspaces between the left sternal border and the apex
Do innocent murmurs radiate?
Meh, not really
How would the intensity of innocent murmurs be described?
Grade 1 to 2, possibly 3
Pitch of innocent murmurs?
Soft to medium
Quality of innocent murmurs?
Variable
What happens to innocent murmurs when patient sits?
usually decrease or disappear
Where do we listen for aortic stenosis?
Right 2nd interspace
Where does aortic stenosis radiate?
Often to the carotids, down the left sternal border, even to the apex
How would you describe the intensity of aortic stenosis?
Sometimes soft, but often loud with a thrill
Pitch of aortic stenosis?
Medium, harsh; crescendo-decrescendo may be higher at the apex
Quality of aortic stenosis?
Often harsh; may be more musical at the apex
When is aortic stenosis heard best?
Patient sitting and leaning forward
Where do we hear aortic regurg?
2nd to 4th left interspaces
Where does aortic regurg typically radiate?
If loud, to the apex, perhaps to the right sternal border
Intensity of aortic regurg?
Grade 1 to 3
Pitch of aortic regurg?
High, use the diaphragm
Location of mitral stenosis?
usually limited to the apex
Radiation of mitral stenosis?
Little or none
Intensity of mitral stenosis?
Grade 1 to 4
Pitch of mitral stenosis?
Decrescendo low-pitched rumble. Use the bell!
Where should we place the bell of the stethoscope when listening for mitral stenosis?
Placing the bell exactly on the apical impulse, turning the patient into a left lateral position and mild exercise all make the murmur audible. It is heard better in exhalation.
When do we hear venous hum?
Continuous murmur without a silent interval. Loudest in diastole.
How do we describe pericardial friction rub?
Scatchy, scraping
Pitch of pericardial friction rub?
High
Which of our murmurs has a blowing decrescendo quality?
Aortic Regurg
Which of our murmurs is described as a low-pitched rumble?
Mitral Stenosis
Which of our murmurs is referred to as holosystolic?
Mitral Reurg
Which of our murmurs has a crescendo-decrescendo quality?
Aortic stenosis
If a murmur is radiating to the carotids, which are we thinking of?
Aortic stenosis
What can be described as lub-click-dub?
Mitral prolapse
If we hear a murmur better with the patient and sitting and leaning forward, what is it likely to be?
Aortic Regurg
We use the bell to listen to what murmur?
Mitral stenosis
