Cardiac Auscultation Flashcards
cardiac auscultation is a quick, inexpensive method to detect and tract the ____ of ______ heart disease
progression
valvular
first sound (S1):
represents
composed of what sounds (which comes first)
represents atrioventricular valve closure
composed of M1 and T1 sounds where M1 normally precedes T1 slightly when normal conduction through bundle branches occur
When may T1 precede M1 in S1
with left bundle branch block (LBBB)
second sound (S2) (caused by, divided into)
caused by semilunar valve closure
divided into A2 (normally first) and P2
a very wide split of A2 and P2 may result from (4)
BBB (bundle branch block)
AV/PV stenosis
Atrial septal defect (ASD)
if one side of heart has more volume
mitral/tricuspid valve closure =
S1
aortic and pulmonic valve closure =
S2
why do sounds of S2 separate a bit during inspiration
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)
S3 caused by
the increased volume of blood in the ventricle when the MV opens (early filling of ventricles)
not caused by valves
S3 heard in what cases
normal in young, athletes, pregnancy
if not = may signify CHF
CHF
congestive heart failure
S4 is a ______ heart sound
presystolic (very end of diastole)
what does S4 represent if heard
blood being forced into a very stiff ventricle from the atria
valvular stenosis (what, when)
valvular stenosis is a narrowing of the laves resulting in increased flow velocities
occurs during antegrade flow through a valves
valvular regurgitation (what, when)
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)
clicks are sound usually produced during
valve opening
clicks may be caused by (2)
valvular stenosis
mitral valve prolapse (MVP)
MVP = ______ ____ murmur
mid-systolic click
MVP is what
mitral valve prolapse
when MV bows backward into LA during mid-systole
pericardial rub (what/sounds like)
beating of the heart against inflamed pericardium without fluid between the layers
sounds like sandpaper
knock (what, caused by)
beating of heart against hardened pericardium with fluid between the layers
pericardium is a hard shell from pericarditis
muffled heart sounds happen in the presence of
pericardial effusion (fluid dampens sound)
pericarditis may also result in a split between (and what is it called)
S1 and S2
paradoxical splitting
what increases sound intensity in a patient with muffled heart sounds
Valsalva maneuver
murmurs are sounds produced by ____ rather than ___
turbulent flow
valves
VSD
ventricular septal defect
PDA
patent ductus arteriosus
murmurs caused by (4)
turbulence
high flow rate
forward flow= stenosis
backward flow = regurgitant valves
6 factors for assessment and description of murmurs
SCRIPT
site
character
radiation
intensity
pitch
timing
site
location
where is the aortic valve heard
RUSB right upper sternal border
where is the tricuspid valve heard
left lower sternal border
where is the pulmonic valve heard
LUSB
character
characteristics: blowing, cres/decrescendo, soft, harsh, rumbling, etc
tend to match Doppler flow profiles
where is the mitral valve heard
apex
crescendo vs decrescendo meaning
increasing intensity
vs
decreasing intensity
radiation
certain murmurs may be said to radiate to other areas
aortic stenosis murmur radiates to
carotid arteries
mitral regurgitation murmur radiates to
LT axilla
intensity (6 grades)
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
pitch
high difference in pressure = high pitch
subtle difference in pressure = low pitch
timing
occur during systole/diastole/both
holo/pan
t=throughout
ex. holosystolic/pansystolic murmur occurs throughout systole
continuous timing
occurs in systole and diastole
AV/PV stenotic murmurs using script (s already figured out)
character: harsh
radiation: Ao = carotids
intensity: varies
pitch: high
timing: systolic
AV/PV closing sound may be muted or absent when valve is _____, and the murmur may start with an opening ____
thickened
snap
MV/TV stenotic murmurs using script (s already figured out)
character: rumbling, decrescendo
radiation: very little
Intensity: varies
Pitch: low
timing: diastolic
AV/PV regurgitant murmurs using script (s already figured out)
character: blowing decrescendo
radiation: none
intensity: varies
pitch: doesn’t say?
timing: diastolic
MV/TV regurgitant murmurs using script (s already figured out)
character: rumbling, decrescendo
radiation: MV -> Lt axilla
intensity: loud
pitch: low
timing: holo/pan systolic
continuous murmurs occur when there is a ____ between an area that always maintains a ______ (and example)
connection
pressure gradient
PDA
patent ductus arteriosus
shunt from desc aorta -> PA
grade III systolic murmur, LLSB
tricuspid regurgitation
grade IV holosystolic murmur, heard best as apex, radiating to axillary line
mitral regurgitation
crescendo/decrescendo systolic murmur, right intercostal border
aortic stenosis
mid systolic click/murmur at apex
mitral valve prolapse
