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Fall 2014 - HP1 Cardio > Cardiac Auscultation > Flashcards

Cardiac Auscultation Flashcards

1
Q

S1

A
  • closure of mitral and tricuspid valves produce S1

- left ventricle starts to contract so mitral valve snaps shut

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2
Q

S2

A
  • aortic and pulmonic valve closure produces S2
  • end of systole
  • ventricular pressure falls below aortic pressure so aortic valve shuts
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3
Q

S2 Splitting

A
  • right side events happen slightly later than left events
  • first (A2) sound is from left side aortic valve closure
  • second (P2) sound is from right side pulmonic valve closure
  • at end of inspiration, A2 and P2 separate slightly
  • during expiration, A2 and P2 fuse into single sound
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4
Q

S3

A
  • occurs just after S2
  • usually heard best by the PMI
  • Kentucky
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5
Q

S4

A
  • occurs just before S1
  • usually heard best at PMI in left lateral decubitus position
  • Tennessee
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6
Q

Potential Causes of S3

A
  • can be normal or physiologic in people under age 40 and is common in 3rd tri of pregnancy
  • past 40, is almost always pathologic –> heart failure of volume overload
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7
Q

Potential Causes of S4

A
  • thought to be due to stiff myocardium w/ decreased compliance
  • may be normal in athletes and elderly
  • HTN
  • coronary artery dz
  • aortic stenosis
  • cardiomyopathy
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8
Q

When you are feeling the pulse, what are you hearing in the stethoscope simultaneously?

A

-feeling the pulse happens while you HEAR S1

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9
Q

How are murmurs distinguished from heart sounds?

A

longer duration

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10
Q

What are murmurs attributed to?

A
  • turbulent blood flow

- may be innocent/physiologic or pathologic

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11
Q

If you hear a murmur, what characteristics should be noted?

A
  • timing, shape
  • location of maximal intensity, radiation from this location
  • intensity, pitch, quality
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12
Q

Murmur Shape

A

-shape or configuration is determined by the murmur’s intensity over time

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13
Q

Crescendo Murmur

A

gets louder over time

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14
Q

Decrescendo Murmur

A

gets softer over time

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15
Q

Crescendo-Decrescendo Murmur

A

first rises in intensity (volume) then falls

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16
Q

Plateau Murmur

A

has same intensity throughout

17
Q

Midsystolic Murmur

A

-begins after S1 and stops before S2 WITH a gap between the murmur and heart sounds

18
Q

Pan/Holosystolic Murmur

A

-starts with S1 and stops at S2 w/o a gap between murmur and heart sounds

19
Q

Late Systolic Murmur

A

-starts in mid to late systole and persists to S2

20
Q

What is the most common kind of heart murmur?

A

midsystolic

21
Q

3 Types of Systolic Murmurs

A
  1. innocent: w/o any detectable physiologic abnormality (grade 1-3)
  2. physiologic: from physio changes in body metabolism (1-3)
  3. pathologic: arising from a structural abnormality in heart or great vessels (grade 3-6)
22
Q

Usual Shape of Systolic Murmurs

A

crescendo-decrescendo

23
Q

What causes pan/holosystolic murmurs?

A

-arise from blood flowing from a chamber with high pressure to chamber with lower pressure, through a valve that should be closed

24
Q

3 Examples of Pan/Holosystolic Murmurs

A
  • mitral valve regurgitation
  • tricuspid valve regurgitation
  • ventricular septal defect
25
Q

What usually causes systolic clicks?

A

mitral valve prolapse

26
Q

When do systolic clicks usually occur?

A

mid to late systole

27
Q

Where are systolic clicks best heard?

A

-with diaphragm between left lower sternal border and PMI

28
Q

How do squatting and standing affect the click?

A
  • squatting delays the click closer to S2

- standing moves it closer to S1

29
Q

What do diastolic murmurs indicate?

A

-almost always indicative of disease

30
Q

2 Main Types of Diastolic Murmurs

A
  • aortic regurgitation: heard best @ base w/ pt sitting forward; suggests more severe dz if S3 or S4 present
  • mitral stenosis: low pitched and located near PMI; may be easier to hear in left lateral position
31
Q

Venous Hum

A
  • benign
  • caused by turbulent flow in jugular veins
  • common in young kids
  • disappears w/ compression of jugular vein
32
Q

Patent Ductus Arteriosus

A
  • congenital patent opening between aorta and pulmonary artery
  • often not heard until child 7-10 days old
  • may not show up until child is grown and could surface in a year or so
33
Q

Pericardial Friction Rubs

A
  • usually heard best in second pulmonic area (Erb’s point)
  • may be described as crunchy or squeaky
  • look for underlying causes: trauma, illness, tumor

Fall 2014 - HP1 Cardio (5 decks)

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