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Echo 1 > C17: Cardiac Auscultation > Flashcards

C17: Cardiac Auscultation Flashcards

1
Q

whats the purpose of performing cardiac auscultation

A

quick method to detect and track progress of valvular heart disease

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2
Q

why is cardiac auscultation in combination w/ an echo useful for tracking diseases progress?

A

once the echo is performed the doctor can correlate the present diease state w/ the findings of the echo and if the quality of the murmur changes than it could indicate the disease has progressed (new echo ordered)

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3
Q

which 2 heart sounds arent usually heard

A

S3 and S4

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4
Q

what does S1 (Lub) represent… what are its 2 parts and which comes first?

A
  • MV and TV closure

- 2 parts are M1 and T1 sounds… M1 before T1 when theres norm conduction through the bundle branches

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5
Q

when might T1 precede M1 in the S1 sound

A

in a LBBB

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6
Q

why does M1 occur before T1

A

the LV has higher press than the RV so ventricular press rises faster in the LV

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7
Q

which phases of the cardiac cycle precede and follow S1?

A

diastole precedes S1 and systole follows

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8
Q

which phases of the cardiac cycle precede and follow S2?

A

systole precedes S2 and diastole follows

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9
Q

what does S2 (Dub) represent… and what are its 2 parts and which comes first?

A
  • the AV and PV closure

- 2 parts are A2 and P2… A2 before P2

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10
Q

the valves in which side of the heart always close first?

A

in the L heart

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11
Q

when does the gap b/w A2 and P2 widen and why

A

There’s increased R heart filling w/ inspiration which causes a change in RV/PA press relationships causes P2 to be delayed

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12
Q

what can be the cause of a very side A2 P2 split

A
  • a RBB
  • pulmonary stenosis (valve doesnt open enough so takes longer to exit the ventricle)
  • atrial septal defect (takes longer b/c there’s more blood volume in the RA/RV b/c blood is shunted from LA to RA)
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13
Q

when does the S3 sound occur?

is it often heard? when would hearing this heart sound be considered normal vs abnormal?

A

after the ‘Dub’ (sound is also Ken-tuc-ky)

-not heard often….

  • norm in youth, athletes, pregnancy… e.g. those w/ high preload and strong early filling
  • abnorm later in life
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14
Q

what causes the S3 heart sound and what phase does it coincide w/

A

-increased preload… coinciding w/ early filling

NOT caused by valves but Mv is opening at this stage

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15
Q

when does the S4 sound occur?
is it normal?

what does it represent and when does it occur

A
  • presystolic heart sound (precedes S1)

+ not norm

  • represents blood being forced into a stiff ventricle from the atria.. indicating that the patient is likely in heart failure

+ occurs in late filling

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16
Q

would an S4 sound occur w/ A fib

A

No, because the atria arent actually contracting, just fibrillating

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17
Q

which area of the ECG coincides w/ S4

A

end of the P wave

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18
Q

what are heart murmurs? what causes them

A

-an abnormal heart sound produced by:

+ turbulent flow
+ high flow rate (eg preg)
+ forward flow through abnormal valves (stenosis)
+ back flow (regurg)
+ abnormal connections (VSD, Patent ductus arterioles)

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19
Q

if a patient had a Patent ductus arterioles, what kind of signal does it often produce w/ cardiac auscultation?

A

continous signal

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20
Q

why might we not hear a murmur if a patient has an abnormality that would normally cause one?

A

the flow isnt turbulent enough

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21
Q

does MV prolapse cause a murmur

A

yes

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22
Q

w/ stenosis, how might the opening of a valve sound

A

like a click or snapping during opening

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23
Q

are the opening of valves normally silent

A

yes

24
Q

why do valves w/ regurg produce murmurs?

what type of sound would be typically hear w/ regurg

A

because theres turbulent flow when the valve should be closed

-spraying

25
Q

what are the 6 factors we used to assess and describe murmurs

A
  1. which phase
  2. which portion of the phase
  3. location where the murmur is best heard
  4. radiation?… if yes, to where
  5. quality/shape of murmur
  6. intensity of murmur
26
Q

In which intercostal space is the AO valve best heard

A

2-3rd right intercostal space

27
Q

Which intercostal space is considered to be the pulmonic area

A

2-3rd left intercostal space

28
Q

In which intercostal space is the TV valve best heard

A

L lower sternal border (approximately 5th intercostal space)

29
Q

In which area is the MV valve best heard

A

Apex (approximately the 5th intercostal space on the L near the auxilia)

30
Q

Where are common areas of radiation

A

Carotid or apex

31
Q

What’s the purpose of describing the quality of a murmur

A

Helpful to relate doppler qualities to the quality of the murmur heard w/ auscultation

32
Q

What is crescendo and decrescendo?

A

Crescendo: an increased pitch

Decrescendo: decreased pith

33
Q

Is pitch often related to velocity

A

Yes

34
Q

What does a decrescendo waveform look like

A

Will have a downward slop

35
Q

What does a crescendo and decrescendo waveform look like

A

Will have an arch appearance (equal on both sides)

36
Q

What type of murmur does a stenotic SV valve create

A

Crescendo/decrescendo

37
Q

What type of murmur does a stenotic MV/TV valve create

A

Diastolic rumble (lower pitch)

38
Q

What terms describe the phase or duration in which regurgitation would be heard

A

Holophasic and panphasic

39
Q

List the intensities of murmurs and clicks and describe them

A

I: lowest intensity (barely audible)

II: Low intensity

III: Medium intensity (no palpable thrill)

IV: Medium intensity (w/ palpable thrill)… often heard w/ skinny old patients

V: Loud intensity (palpable thrill)

VI: loudest (w/ palpable thrill), heard w/ a stethoscope above the cest

40
Q

Describe the quality of stenotic murmurs for the AV/PV

A
  • harsh murmur
  • radiation
  • closing sound may be muted or absent when valve is thickened
41
Q

Where do AO stenotic murmurs usually radiate to

A

Carotid

42
Q

Describe the quality of stenotic murmurs for the MV/TV

During what phase will they be heard?

A

-heard during diastole… starts w/ and opening snap

  • Mv will be heard at the Apex
  • low rumbling quality, usually decrescendo
  • little radiation w/ stenotic murmurs
43
Q

Describe the quality of regurg. murmurs for the AV/PV

During what phase will they be heard?

A
  • heard during diastole

- has a blowing or decrescendo sound

44
Q

Describe the quality of regurg. murmurs for the MV

During what phase will it be heard?

A
  • will occur during systole and be pan or holosytolic
  • MV heard at apex w/ radiation to L axilla
  • usually loud
45
Q

Describe the quality of regurg. murmurs for the TV

During what phase will it be heard?

A
  • will occur during systole and be pan or holosytolic

- heard at the left sternal border

46
Q

what is a rub murmur and what causes it

A
  • beating of the heart against inflamed pericardium (pericarditis) w/o fluid b/w the layers
  • cause by tiny crystals in the pericardium
47
Q

what is a knocking murmur and what causes it

A

-beating of the heart against hardened pericardium w/ fluid b/w the layers
pericardium is hard from pericarditis

48
Q

what causes muffled heart sounds

A

-presence of pericardial effusion… fluid dampens the sound

49
Q

how can heart changes w. respiration or provocative maneuvers effect heart sounds/murmurs

A
  • Inspiration can cause an : S1-S2 split, paradoxical splitting
  • Valsalva increases the intensity of heart sounds.
50
Q

describe systolic murmurs in general. are they usually pathological?
If they are pathological what could they be caused by

A

-not usually pathological, can be due to anxiety, nerves…. can be functional

-if pathological they can be:
AS, PS, MR, TR

51
Q

describe diasystolic murmurs in general. are they usually pathological?
If they are pathological what could they be caused by

A

-usually pathological

-if pathological they can be:
AR, PR, MS, TS

52
Q

what is a phonocardiogram

is it used often

A
  • graphic display of heart sounds and murmurs by placing a microphone on the chest
  • not used b/c echo is so good
53
Q

Is any type of pathological regurgitation (AR PR MR TR) always panphasic?

A

Yes

54
Q

Why is IVRT prolonged w/ MS?

A

The valve is thick and it takes longer for it to move and open which prolongs the IVRT

55
Q

Will any type of stenotic murmur be heard during IVRT AND IVCT?

A

No

Echo 1 (17 decks)

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