Cardiac Auscultation and Cardiac Heart Sounds Flashcards
1
Q
_______is the small rise in right atrial pressure due to right atrial contraction
A
a wave
2
Q
__________is the small rise in right atrial pressure as the tricuspid valve closes and bridges toward the right atrium
A
c wave
3
Q
__________is the rise in right atrial pressure during ventricular systole when the tricuspid valve is closed (supposedly)
A
v wave
4
Q
what is normal S2 splitting defined as
A
normal physiologic splitting of S2 means that 2 distinct components of S2 can be heard during inspiration but not during expiration
5
Q
where is normal S2 splitting best heard at
A
3LSB
6
Q
what population is S3 heart sounds normal in
A
children and young adults
7
Q
what are some of the most common causes of paradoxical splitting of the 2nd heart sound
A
left bundle branch block left ventricular outflow obstruction right ventricular pacemaker right ventricular ectopic beats systemic hypertension (rarely)
8
Q
fixed splitting of the second heart sound is the ausculatory hallmakr of
A
atrial septal defect (ASD)
9
Q
a fixed splitting of S2 and a mid systolic murmur is extremely indicative of
A
atrial septal defects
10
Q
S3 heart sounds are normal in
A
children and young adutls
11
Q
what is the cause of S3 heart sounds
A
tensing of the chordae tendinae and or sudden limitation of longitudinal ventricular expansion during early rapid ventricular filling
12
Q
when is the third heart sound heard
A
early to mid diastole
13
Q
what is the frequency of the third heart sound
A
low (a dull thud)
14
Q
where is the third heart sound heard best
A
apex (left) lower Left Sternal border
15
Q
which heart sound if found is rarely normal
A
S4
16
Q
what is S4 heart sound caused by
A
atrium vigorously contracting against a stiffened ventricle (results from reduced ventricular compliance)
17
Q
when is the S4 heared
A
late diastole (presystole)
18
Q
what is the frequency of S4
A
low
19
Q
where is the S4 heart sound best heard
A
apex (L), lower LSB/Xiphoid right
20
Q
all ______increase in intensity (loudness) during inspiration except the pulmonic ejection click
A
right sided
21
Q
squatting to standing does what to venous return
A
decreases venous return
22
Q
squatting to standing does what to ventricular preload
A
decreases
23
Q
squatting to standing does what to systemic vascular resistance
A
decreases
24
Q
standing to squatting does what to venous return, preload and systemic vascular resistance
A
increases!
25
passive elevation of the legs does what to venous return
increases venous return
26
what does the valsalva maneuver do to venous return
decreases (also decreases ventricular preload)
27
what does the muller maneuver do to venous return and threfore preload
increases venous return and preload
28
what does PVC's do to preload
increases preload (post ectopic beat)
29
what does isometric exercise do to CO, heart rate, etc
```
increases systemic resistance
increases pressure
increases heart rate
increases CO
increases left ventricular filling pressure
increases left ventricular olume
```
30
what does amyl nitraite do
potent vasodilator and within first 30 seconds decreases systemic arteiral resisant and after 30-60 seconds it increases heart rate and CO
31
when should vasopressors be avoided
in CHF or HTN pts
32
action of methoxamine and phenylephrine
decrease hrrt rate and cardiac output
33
no palpable thirll
grades 1-3
34
palpable thrill
grades 4-6
35
what murmur begins with or after S1 and ends before S2
systolic murmur
36
what murmur begins with or after S2 and ends before the next S1
diastolic
37
what murmur begins in systole and continues without interruption through S2 into all or part of diastole
continuous
38
a valve that does not open properly will cause a murmur of
stenosis
39
a valve that does not close properly will cause a murmur of
regurgitation or insufficiency
40
the aortic and pulmonic valve is __during systole and ______-during diastole
open during systole and closed during diastole
41
the mitral and tricuspid valves are _______-during systole and ______-during diastole
closed, open
42
aortic/pulmonic systolic murmur is
stenosis
43
aortic/pulmonic diastolic murmur is
regurgitation
44
mitral or triscupid diastolic murmur is murmur of
stenosis
45
mitral or tricuspid systolid murmur is a murmur of
regurgitation
46
what are some potential causes of systolic murmurs
outflow obstruction of either ventricle, insufficiency of either at AV valve, VSD, aortic sclerosis, ventricular ejection in high flow states
47
mitral valve prolapse causes
mid systolic click, late systolic murmur
48
acute mitral regurgitation mummur
early systolic decrescendo murmur
49
chronic mitral regurgitatiom murmur
classic holosystolic murmur
50
characteristics of chronic mitral regirgitation
doesn't get louder during inspiration
best heard at the cardiac apex, and sometimes radiating to the left axilla and gets louder during isometric handgrip, sudden squatting or vasppressor administration
51
where is a chronic mitral regirgitation heard best
cardiac apex sometimes radiating to the left axilla
52
does chronic mitral regurgiattion get louder during inspirtaion
no
53
what can you do to make a chronic mitral regirgitation murmur get louder
isometric handgrip
sudden squatting
vasopressor administration
54
acute mitral regirgitation is a
early systolic descrecendo murmur
55
mitral valve prolapse is a
mid systolic click late systolic murmur
56
squatting makes mitral valve prolapse click _______and murmur _____
later, shorter and often softer
57
standing or valsalva maneuver makes mitral valve prolaspe click __________ and murmur ____-
click earlier and murmur longer and often louder
58
carvallos sign
murmur gets louder during inspiration
59
what is the classic triad for severe tricuspid regurgitation
carvallos sign
pulsatile JVD
pulsatile liver
60
tricupid regurgitation characteristics
holosystolic murmur
| louder during inspiration
61
where is VSD best heard
lower left sternal border (LSD)
62
does a VSD get louder during inspiration
NO
63
systolic ejection murmurs
crescendo-decrecendo murmur
64
what is the ausculatory hallmark for bicupid aortic valve (aortic stenosis murmur)
aortic ejection click
65
what are the two acquired ways to aortic stenosis
crescendo-descrendo murmur
66
where is aortic stenosis murmur heard best
2rSB radiating to the carotids
67
how do you determine if a aortic stenosis murmur is severe
if it peaks early in systole it is NOT severe
68
pulsus parvus et tardus is
diminished or delayed carotid upstroke
69
aortic stenosis may have
paradoxical splitting of the 2nd heart sound
| diminished or absent A2 and aortic ejection sound (most common in congenital AS)
70
characteristics of hypertrophic cardiomyopathy murmur
gets louder during valsalva maneuver, standing or amylnitrate and gets softer with isometric handgrip and squatting
71
characteristics of aortic stenosis murmur
gets louder during sqatting and amylnitrate inhlation
| gets softer with tanding, valsalva and isometric hand grip
72
pulmonic stenosis murmur
crescendo-decrescendo murmur that increases during insiration
73
where is a pulmonic stenosis murmur best heared
2 LSB
74
does the pulmonic stenosis murmur radiate to the carotids
NOT
75
if ejection click is present in pulmonic stenosis it gets _____--during inspiration
softer
76
potential causes of diastolic murmurs
insufficiency of either ventricular outflow valve (AR) and (PR) or stenosis of MS or TS valves
77
primary murmur of aortic insufficeincy
early diastolic
decrescendo
high pitched
blowing
78
when is a primary murmur of aortic insufficiency heard
best with diaphragm of stethoscope at 3L or RSB with patient leaning forward during help deep, end exhalation
79
patients with aortic insufficiency may also have
systolic ejection murmur and austin filint murmur
80
what is an austin flint murmur
diastolic rumble best heard with the bell of stethoscope at the apex
81
what is duroziez sign
systolic murmur over femoral artery when stethoscope is compressed proximally, and a diastolic murmur over femoral artery when stethoscope is compressed distally
82
what is the most predictive sign of severe aortic insufficienc
duroziez sing
83
signs associated with high stroke volume
```
wide pulse pressure
quinke's pulse (
hill sign
corrigan pulse
traube sign
mueller sign
```
84
what is hill sign
popliteal systolic blood pressure exceeds brachail systolic blood pressure by greater than 60 mmHg
85
what is quincke's pulse
phasic blanching of the nail bed
86
what is mueller sign
pulsating uvula
87
what is traube sign
pistol shot sound over femoral artery
88
what is corrigan (water-hammer) pulse
palpable abrubt upstroke and rapid fall in arterial pulsation
89
what is the murmur called that is due to pulmonary hypertensiion
graham steel murmur
90
characteristics of graham steell murmur
```
early diastolic
begins with a loud pulmonic component of S2
decresendo
high pitched
blowing
gets louder during inspirtion
```
91
where is the graham steel murmur heard best
diaphragm of stehoscope
| 2nd-4th ICS, LSB
92
what does the murmur that is caused by pulmonic insufficiency due to defomity of the pulmonic valve sound like
```
mid diastolic
begins after pulmonic component of S2
crescendo-decrescendo
low pitch
louder during insiration
```
93
where are diastolic murmurs best heard
bell of stethoscope at 3rd to 4th ICS, LSB
94
mitral stenosis is almost always a sequela of
rheumatic fever
95
mitral stenosis murmur
mid diastolic murmur, low pitched rumble
96
where is the mitral stenosis murmur best head
when patient is in the left lateral recumbent position with the bell of the stethoscope at the cardiac apex
97
what are some of the associated findings of mitral stenosis
opening snap (high pitched sound that occurs after s2 early in diastole), loud s1
98
the ___murmur sounds just like mitral stenosis except
tricuspid
| gets louder during inspiration and best heard at lower sternal border
99
what are potential causes of continuous murmurs
```
PDA
cervical venous hum
hepatic venous hum
arteriovenous connections
ruptured aneurysm of sinus valsalva
```
100
what is becks triad
hypotension
jugular venous distension
muffled or distant heart sounds
101
becks triad is indicative of
pericardial tamponade
102
what is exaggerated pulsus paradoxus
exaggeration of the normal decline in systolic arterial pressure during inspiration
103
what is kussmaul sign
increase in jugular venous pressure (distention) during inspiration (normally, JVP decreases during inspiration
104
a pericardial friction rub is an ausculatory hallmark of
acute pericarditis
105
scratch sound at lower left sternal border
pericardial friction rub
106
pericardial friction rub is best heard
lower left SB, when patient is at full exhalation
