Cardiac Auscultation Flashcards
what does splitting of s1 tell you?
RBBB or ASD without Eisenmenger’s physiology
what causes reversed splitting?
LBBB or aortic stenosis
where is splitting of S2 heard the best?
LUSB
what causes normal splitting of S2 during inspiration?
increased systemic venous return, increased pulmonary vascular bed capacitance, decreased pulmonary venous impedence
what causes wide physiological splitting during expiration
RBBB, pulmonic stenosis, pulmonic hypertension, ASD
what causes narrow splitting?
tricuspid regurgitation - early P2 pulmonary hypertension - early P2 aortic stenosis - late A2 peripheral vascular shunt - late A2 PDA - late A2
what does 24 suggest?
hypertensive heart disease, hypertrophic cardiomyopathy or acute MI
what does the opening snap tell you?
rheumatic or congential valvular disease
mitral stenosis
what abnormality does S3 suggest?
CHF with increased L heart pressure
AV valve regurgitation
where do you hear aortic ejection sounds?
base –> apex
what do you hear with mitral valve prolapse?
midsystolic click at apex or LLSB
occurs earlier with decreased preload (standing)
occurs later with increased preload (squatting)
what causes valvular clicks?
congenitally deformed or bicuspid valves due to tensing of deformed valve leaflets
what causes diastolic murmurs?
turbulent anterograde flow across mitral or tricuspid
retrograde across aortic or pulmonic valves
*pathologic
what are symptoms of mitral stenosis?
first left then right sided heart failure
what causes systolic ejection murmurs?
turbulent flow across aortic or pumonic tracts. they are separated from S1 by isovolumic contraction
what is an austin flint murmur
physiologic impingement of mitral valve, diastolic excursion by severe aortic regurgitation
physical findings of mitral stenosis?
loud s1, OS, diastolic rumble (left lateral decubitus position)
what are symptoms of left sided heart failure?
exertional dyspnea, orthopnea, paroxysmal nocturnal dyspnea
what causes continuous murmur?
PDA or benign cervical venous hum (children, pregnant women, ends with compressing of JVP) or mammary souffle (terminated by pressing diaphragm against chest wall)
how do you diagnose hypertrophic obstructive cardiomyopathy?
thick septum causes abnormal motion of anterior mitral valve
late peaking SEM at LLSB
S4
pansystolic murmur regurgitation –> abnormal coaption
what is a diastolic rumble?
anterograde flow across stenotic mitral or tricuspid valve best heard at LLSB and apex, beginning immediately after S2 until S1
what are physical findings of mitral regurgitation?
holosystolic murmur at apex
accentuated murmur with fist clenching
how do you diagnose an ASD?
L–>R flow increased anterograde flow across tricuspid and pulmonic valves, early peaking SEM at LUSB
diastolic flow murmur across tricuspid if shunt is large
wide fixed splitting of S2 –> increased forward SV across pulmonic valve and decreased impedence in pulmonary vascular bed
rule out pulmonary hypertension
what are physical findings associated with aortic regurgitation?
wide pulse pressure
bounding pulses
early diastolic decrescendo murmur
what are causes of aortic stenosis?
degenerative calcific
congenital
rheumatic
what are causes of mitral regurgitation
acute: endocarditis, ruptured chordae, papillary muslce, dysfunction
chronic: rheumatic, mitral prolapse, calcified annulus, LV dilation
what are causes of aortic regurgitation?
congenital, endocarditis, rheumatic, aortic root dilation
what are physical findings associated with aortic stenosis?
SEM at RUSB
carotids: delayed upstroke and decreased volume
palpation: suprasternal thrill
soft A2
what are symptoms of rights sided heart failure?
peripheral edema, abdominal bloating, right upper quadrant tenderness (hepatic enlargement)
what are symptoms of mitral regurgitation?
acute: pulmonary edema
chronic: symptoms of left heart failure and low CO (fatigue)
how do you diagnose an innocent murmur?
cresc-decres
grade <3
ends before S2 with normal splitting of S2
absence of systolic or diastolic ejection sounds
absence of conditions like anemia, thyrotoxicosis
exclude: aortic/pulmonic stenosis, high flow states like ASD
what causes holo or pansystolic murmurs
mitral or tricuspid regurgitation
VSD
increased intensity with severity
described as blowing
