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Cardiac auscultation > Cardiac Auscultation > Flashcards

Cardiac Auscultation Flashcards

1
Q

noise:
Early systolic ejection sound
early triplet
usually also w/ obstructive ESM

location:
2ICRS -RoS

maneuvers:
No change

A

noise:
Early systolic ejection sound
early triplet
usually also w/ obstructive ESM

ass. disease:
Bicuspid aortic valve

location:
2ICRS -RoS

maneuvers:
No change

EKG:
LVH

CXR:
possible calcified aorta

clinical/physiology:

  • asymptomatic early -congenital, predisposes to AI
  • murmur is obstructive
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2
Q

noise:
Mid systolic click
even triplet

location:
Left sternal border/apex

maneuvers:
i w i  SVR (hand grip) Earlier w/ d LVvol delay w/i  LV vol (squatting)

A

noise:
Mid systolic click
even triplet

ass. disease:
Mitral valve prolapse

location:
Left sternal border/apex

maneuvers:
i w i  SVR (hand grip) Earlier w/ d LVvol delay w/i  LV vol (squatting)

EKG:
-normal usually
if chronic= LA and LV enlargement
-can see abnl U wave if pap musc rupt

CXR:
usually normal

clinical/physiology:

  • women > men, 2/2 AMI -Marfan’s
  • if w/ MR: need abx ppx (ampicillin)
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3
Q

noise:
Early
Physiologic split S2

location:
2ICRS -LoS

maneuvers:
occurs with inspiration

A

noise:
Early
Physiologic split S2

ass. disease:
Normal

location:
2ICRS -LoS

maneuvers:
occurs with inspiration

EKG:
normal

CXR:
normal

clinical/physiology:
2/2 de intrathoracic pressure with increased ventricular >
i pulmonary flow

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4
Q

noise:
Early
Persistent split S2

location:
2ICRS -Los

maneuvers:

  • increases with inspiration, but never goes back to one heart sound
  • inspiration widens split
A

noise:
Early
Persistent split S2

ass. disease:
RBBB pulmonic stenosis

location:
2ICRS -Los

maneuvers:

  • increases with inspiration, but never goes back to one heart sound
  • inspiration widens split

EKG:
RBBB

CXR:

  • pulmonic stenosis—pulm artery dilation
  • Nl heart size/clear lungs

clinical/physiology:
-pHTN, i pulm pressures (CHF, COPD, OSA, MS)

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5
Q

noise:
Early
Fixed split S2

location:
-2ICRS -LoS

maneuvers:
-does NOT change with I/E

A

noise:
Early
Fixed split S2

ass. disease:
ASD
-w/ SEM

location:
-2ICRS -LoS

maneuvers:
-does NOT change with I/E

EKG:
-RA enlargement -R axis deviation

CXR:
-i pulm vasculature
Lg central pulm a (on L side above atrium)

clinical/physiology:
healthy young people

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6
Q

noise:
Early
Paradoxical slit S2

location:
-2ICRS -RoS

maneuvers:
no changes

A

noise:
Early
Paradoxical slit S2

ass. disease:
LBBB, transpacer HTN
Aortic Stenonsis

location:
-2ICRS -RoS

maneuvers:
no changes

EKG:
-LBBB

CXR:
-?calcifications

clinical/physiology:
caused by delay of aortic valve

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7
Q

noise:
Opening Snap
Sharp, crisp snap ~30-40msec -what-to-do

location:
apex

maneuvers:
Exercise cough

A

noise:
Opening Snap
Sharp, crisp snap ~30-40msec -what-to-do

ass. disease:
Early
Mitral stenosis

location:
apex

maneuvers:
Exercise cough

EKG:
?RVH, Afib, RAD

CXR:

  • RVH
  • double shadow enlarged atrium
  • prominent LA (can be isolated finding)
  • kerley B lines

clinical/physiology:

  • as MS worsens, gets closer to S2, and murmur starts
  • # 1cause: rheumatic fever +calcifc
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8
Q

noise:
S3
Wa’-ba-sha, low pitched thud
100-120msec

location:
Apex use bell

maneuvers:
Exercise

A

noise:
S3
Wa’-ba-sha, low pitched thud
100-120msec

ass. disease:
CHF-systolic dysf

location:
Apex use bell

maneuvers:
Exercise

EKG:
-may be normal -may have old MI (q-waves)

CXR:
-cardiomegaly -pulmonary edema/ cephalization

clinical/physiology:

  • nl in kids
  • due to rapid passive AV filling against floppy uncoordinated heart -systolic dysfunction, sloshy heart
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9
Q

noise:
S4
A stiff’’ heart

location:
Apex Use bell

maneuvers:
na

A

noise:
S4
A stiff’’ heart

ass. disease:
CHF-diastolic dysf

location:
Apex Use bell

maneuvers:
na

EKG:

  • ?1st degree AV block -MI
  • LVH, LAD

CXR:
-normal, no LVH

clinical/physiology:

  • non-compliant stiff heart, 2/2 atrial kick
  • diastolic dysfunction -concentric LVH
  • assoc w/HTN, HOCM, restrictive
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10
Q

noise:
Systolic ejection Non-obstructive

location:
-2ICRS RoS

maneuvers:

A

noise:
Systolic ejection Non-obstructive

ass. disease:
Innocent flow

location:
-2ICRS RoS

maneuvers:

EKG:

CXR:

clinical/physiology:

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11
Q

noise:
Systolic ejection-late peaking
Obstructive

location:
-L sternal border

maneuvers:
↑ w/ ↓ LV volume
valsalva
-↓ w/ ↑ LV volume
squatting
A

noise:
Systolic ejection-late peaking
Obstructive

ass. disease:
HOCM

location:
-L sternal border

maneuvers:
↑ w/ ↓ LV volume
valsalva
-↓ w/ ↑ LV volume
squatting

EKG:
LVH

CXR:
Normal?

clinical/physiology:
#1 cause of death for young, healthy athletes
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12
Q

noise:
*late peaking, harsh sounding
Crescendo-decrescendo

location:

  • L sterna border
  • radiates to carotids

maneuvers:
-↑ w/ ↑ LV volume –squat -↓ w/ ↓ LV volume-valsv

A

noise:
*late peaking, harsh sounding
Crescendo-decrescendo

ass. disease:
Aortic Stenosis
-diminished S2

location:

  • L sterna border
  • radiates to carotids

maneuvers:
-↑ w/ ↑ LV volume –squat -↓ w/ ↓ LV volume-valsv

EKG:
LVH
LA abnormality

CXR:
-rounding of ascending aorta (r-heart border) -no cardiomegaly

clinical/physiology:

  • bicuspid valve, rheumaticHD -sx: syncope, ang, SOB, CHF
  • Carotid:pulsus parvus et tardus
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13
Q

noise:
Hololsystolic
Differentiate HSM based on if they change with inspiration or not

location:
-apex

maneuvers:
-no change with inspiration
-↑w/ isometric hand grip -↓ w/ valsalva
(low LV vol)

A

noise:
Hololsystolic
Differentiate HSM based on if they change with inspiration or not

ass. disease:
VSD

location:
-apex

maneuvers:
-no change with inspiration
-↑w/ isometric hand grip -↓ w/ valsalva
(low LV vol)

EKG:
Biventricular enlargement

CXR:
-biventricular enlargement -enlarged pulm artery

clinical/physiology:

  • sx: CHF, growth failure, recurrent lower URI, SOB
  • smaller the defect, the louder the murmur
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14
Q

noise:

location:
-apex w/ radiation to L.axilla, radiates to back

maneuvers:
-↑ w/ ↑ LV volume –squat ↑ w/ ↑SVR
↓ w/ inspiration
↓ w/ PVCs

A

noise:

ass. disease:
Mitral Regurg/ Insufficiency

location:
-apex w/ radiation to L.axilla, radiates to back

maneuvers:
-↑ w/ ↑ LV volume –squat ↑ w/ ↑SVR
↓ w/ inspiration
↓ w/ PVCs

EKG:
LAE, LVH
If severe: RVH
-signs of inferior MI

CXR:
LA +LV dilation Calcified mitral valve Severe: RV dilation

clinical/physiology:
-acute sx: flash pulm edema, chronic: fatigue, weakness,DOE Severe: LV dsyfunc, PND, orthop
Can be 2/2 pap rupture, endocard, acute inferior MI, RhFev, marfans

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15
Q

noise:

location:
-apex w/ radiation to L.axilla, radiates to back

maneuvers:
-↑ w/ ↑ LV volume –squat ↑ w/ ↑SVR
↓ w/ inspiration
↓ w/ PVCs

A

noise:

ass. disease:
Tricuspid Insufficiency

location:
-apex w/ radiation to L.axilla, radiates to back

maneuvers:
-↑ w/ ↑ LV volume –squat ↑ w/ ↑SVR
↓ w/ inspiration
↓ w/ PVCs

EKG:
LAE, LVH
If severe: RVH
-signs of inferior MI

CXR:
LA +LV dilation Calcified mitral valve Severe: RV dilation

clinical/physiology:
-acute sx: flash pulm edema, chronic: fatigue, weakness,DOE Severe: LV dsyfunc, PND, orthop
Can be 2/2 pap rupture, endocard, acute inferior MI, RhFev, marfans

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16
Q

noise:
Late Systolic

location:
-apex

maneuvers:
Valsalva ↑ duration ↓ intensity
Squatting ↓ duration, ↑ intensity

A

noise:
Late Systolic

ass. disease:
Chronic MVP
PAP muscle dysfunction

location:
-apex

maneuvers:
Valsalva ↑ duration ↓ intensity
Squatting ↓ duration, ↑ intensity

EKG:
-? Inferior MI -chronic: LA/LV enlargement

CXR:
unsually normal unless LA/LV enlargement

clinical/physiology:
Ruptured chordate tendenae Papillary musc dysf 2/2 inferior MI

17
Q 
noise:
Early-short lived
Musical sounding (high pitched

location:
2ICRS RoS

maneuvers:
-↑w/ isometric hand grip (↑SVR-dopamine too) ↑w/ leaning forward

A 
noise:
Early-short lived
Musical sounding (high pitched

ass. disease:
Acute AI

location:
2ICRS RoS

maneuvers:
-↑w/ isometric hand grip (↑SVR-dopamine too) ↑w/ leaning forward

EKG:
Nothing

CXR:
prominent aortic knob Mediastinal widening

clinical/physiology:

  • can be associated with aortic dissection
  • SBE
  • Trauma
18
Q

noise:
Holodiastolic/
Early to late diastolic

location:
2ICRS RoS

maneuvers:
-↑w/ isometric hand grip (↑SVR-dopamine too) ↑w/ leaning forward

A

noise:
Holodiastolic/
Early to late diastolic

ass. disease:
Chronic AI AR

location:
2ICRS RoS

maneuvers:
-↑w/ isometric hand grip (↑SVR-dopamine too) ↑w/ leaning forward

EKG:
LUH

CXR:
Boot shaped heart with cephalization

clinical/physiology:

  • HTN, endocarditisy, ankylosing spondylitis, syph, ehlers danlos
    sx: wide pulse pressures, bobbing head, pistol shot sound over femoral pulse
19
Q

noise:
Midlate diastolic
Rumble w/ opening snap What-to doooooo

location:
apex

maneuvers:
↑ w/ valsalva (↓flow)
↓ w/ inspiration/squatting
-↑ w/ exercise cough

A

noise:
Midlate diastolic
Rumble w/ opening snap What-to doooooo

ass. disease:
Chronic Mitral Stenosis

location:
apex

maneuvers:
↑ w/ valsalva (↓flow)
↓ w/ inspiration/squatting
-↑ w/ exercise cough

EKG:

  • LAE
  • RVH (if pulm HTN) ?RAD
  • may have a-fib
  • NO lvh

CXR:
LAE w/ 4 sx: dbl atrial shadow, straight upper left heart border, elevated L- MS bronchus, clockwise rotation of cardiac silhouette

clinical/physiology:

  • as MS worsens, gets closer to S2, and murmur starts
  • # 1cause: rheumatic fever +calcifc
  • sx: DOE, orthopnea, PND, hoarsness, RHF if chronic Afib, can be kick dependent and ecompensate if in A-fib
20
Q

noise:
Pericardial friction Rub

location:
Same throughout

maneuvers:
Pain will decrease w/ leaning forward

A

noise:
Pericardial friction Rub

ass. disease:
Pericarditis, pericardial effusion

location:
Same throughout

maneuvers:
Pain will decrease w/ leaning forward

EKG:
-diffuse ST elevation PR depression

CXR:normal

clinical/physiology:
-pericarditis-post viral + viral endocarditis, uremia, SLE, acute MI, dressler’s
Sx: CP with positional relief

Cardiac auscultation (2 decks)

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