Cardiac Auscultation

Question 1

cardiac auscultation is a quick, inexpensive method to detect and tract the ____ of ______ heart disease

Answer 1

progression
valvular

Question 2

first sound (S1):
represents
composed of what sounds (which comes first)

Answer 2

represents atrioventricular valve closure
composed of M1 and T1 sounds where M1 normally precedes T1 slightly when normal conduction through bundle branches occur

Question 3

When may T1 precede M1 in S1

Answer 3

with left bundle branch block (LBBB)

Question 4

second sound (S2) (caused by, divided into)

Answer 4

caused by semilunar valve closure
divided into A2 (normally first) and P2

Question 5

a very wide split of A2 and P2 may result from (4)

Answer 5

BBB (bundle branch block)
AV/PV stenosis
Atrial septal defect (ASD)
if one side of heart has more volume

Question 6

mitral/tricuspid valve closure =

Answer 6

S1

Question 7

aortic and pulmonic valve closure =

Answer 7

S2

Question 8

why do sounds of S2 separate a bit during inspiration

Answer 8

chest cavity expands = pressure decreases = more blood enters RA = higher volume of blood going from RA to RV ( takes slightly longer for PV to close than AV)

Question 9

S3 caused by

Answer 9

the increased volume of blood in the ventricle when the MV opens (early filling of ventricles)

not caused by valves

Question 10

S3 heard in what cases

Answer 10

normal in young, athletes, pregnancy

if not = may signify CHF

Question 11

CHF

Answer 11

congestive heart failure

Question 12

S4 is a ______ heart sound

Answer 12

presystolic (very end of diastole)

Question 13

what does S4 represent if heard

Answer 13

blood being forced into a very stiff ventricle from the atria

Question 14

valvular stenosis (what, when)

Answer 14

valvular stenosis is a narrowing of the laves resulting in increased flow velocities
occurs during antegrade flow through a valves

Question 15

valvular regurgitation (what, when)

Answer 15

occurs when a valve cannot coapt, or close correctly resulting in leakage (backward flow) through the valve

occurs during the timeframe the valve should normally be closed (and/or isovolumic times)

Question 16

clicks are sound usually produced during

Answer 16

valve opening

Question 17

clicks may be caused by (2)

Answer 17

valvular stenosis
mitral valve prolapse (MVP)

Question 18

MVP = ______ ____ murmur

Answer 18

mid-systolic click

Question 19

MVP is what

Answer 19

mitral valve prolapse
when MV bows backward into LA during mid-systole

Question 20

pericardial rub (what/sounds like)

Answer 20

beating of the heart against inflamed pericardium without fluid between the layers
sounds like sandpaper

Question 21

knock (what, caused by)

Answer 21

beating of heart against hardened pericardium with fluid between the layers

pericardium is a hard shell from pericarditis

Question 22

muffled heart sounds happen in the presence of

Answer 22

pericardial effusion (fluid dampens sound)

Question 23

pericarditis may also result in a split between (and what is it called)

Answer 23

S1 and S2
paradoxical splitting

Question 24

what increases sound intensity in a patient with muffled heart sounds

Answer 24

Valsalva maneuver

Question 25

murmurs are sounds produced by ____ rather than ___

Answer 25

turbulent flow valves

Question 26

VSD

Answer 26

ventricular septal defect

Question 27

PDA

Answer 27

patent ductus arteriosus

Question 28

murmurs caused by (4)

Answer 28

turbulence high flow rate forward flow= stenosis backward flow = regurgitant valves

Question 29

6 factors for assessment and description of murmurs

Answer 29

SCRIPT site character radiation intensity pitch timing

Question 30

site

Answer 30

location

Question 31

where is the aortic valve heard

Answer 31

RUSB right upper sternal border

Question 32

where is the tricuspid valve heard

Answer 32

left lower sternal border

Question 33

where is the pulmonic valve heard

Answer 33

LUSB

Question 34

character

Answer 34

characteristics: blowing, cres/decrescendo, soft, harsh, rumbling, etc tend to match Doppler flow profiles

Question 34

where is the mitral valve heard

Answer 34

apex

Question 35

crescendo vs decrescendo meaning

Answer 35

increasing intensity vs decreasing intensity

Question 36

radiation

Answer 36

certain murmurs may be said to radiate to other areas

Question 37

aortic stenosis murmur radiates to

Answer 37

carotid arteries

Question 38

mitral regurgitation murmur radiates to

Answer 38

LT axilla

Question 39

intensity (6 grades)

Answer 39

grade 1 - difficult to hear grade 2 - quiet grade 3 - easy to hear grade 4 - easy to hear + palpable thrill grade 5 - can hear with stethoscope barely touching chest grade 6 - can hear with stethoscope off chest

Question 40

pitch

Answer 40

high difference in pressure = high pitch subtle difference in pressure = low pitch

Question 41

timing

Answer 41

occur during systole/diastole/both

Question 42

holo/pan

Answer 42

t=throughout ex. holosystolic/pansystolic murmur occurs throughout systole

Question 43

continuous timing

Answer 43

occurs in systole and diastole

Question 44

AV/PV stenotic murmurs using script (s already figured out)

Answer 44

character: harsh radiation: Ao = carotids intensity: varies pitch: high timing: systolic

Question 45

AV/PV closing sound may be muted or absent when valve is _____, and the murmur may start with an opening ____

Answer 45

thickened snap

Question 46

MV/TV stenotic murmurs using script (s already figured out)

Answer 46

character: rumbling, decrescendo radiation: very little Intensity: varies Pitch: low timing: diastolic

Question 47

AV/PV regurgitant murmurs using script (s already figured out)

Answer 47

character: blowing decrescendo radiation: none intensity: varies pitch: doesn't say? timing: diastolic

Question 48

MV/TV regurgitant murmurs using script (s already figured out)

Answer 48

character: rumbling, decrescendo radiation: MV -> Lt axilla intensity: loud pitch: low timing: holo/pan systolic

Question 49

continuous murmurs occur when there is a ____ between an area that always maintains a ______ (and example)

Answer 49

connection pressure gradient PDA

Question 50

patent ductus arteriosus

Answer 50

shunt from desc aorta -> PA

Question 51

grade III systolic murmur, LLSB

Answer 51

tricuspid regurgitation

Question 52

grade IV holosystolic murmur, heard best as apex, radiating to axillary line

Answer 52

mitral regurgitation

Question 53

crescendo/decrescendo systolic murmur, right intercostal border

Answer 53

aortic stenosis

Question 54

mid systolic click/murmur at apex

Answer 54

mitral valve prolapse