Cardiac Cycle And Sounds Flashcards
When would S4 be heard in relation to the other heart sounds?
Just before S1
When would an S3 be heard in relation to the other heart sounds?
Just after S2
What might cause an abnormally loud S1?
Vigorous ventricular contraction
Delayed closure of mitral valve (mitral valve prolapse, mitral stenosis, left atrial myxoma)
What might cause an abnormally soft S1?
Weak ventricular contraction
Early closure of MV (long PR interval, acute endocarditis)
What might cause S1 splitting?
Delay in closure of TV - d/t right BBB, LV ectopic beats or paced beats
There may be physiologic splitting of S2. This would be heard over ____ or _____ ICS at left sternum.
If heard any lower, it could indicate _______.
If heard any higher, it could indicate _______.
2; 3rd
COPD
Obesity
Wide physiologic split of S2
RBBB
Wide fixed split of S2
Atrial septal defect with regular rhythm
Paradoxic splitting (reversed splitting) of S2
A2 and P2 meld during inspriation, often in elderly with aortic flow murmurs
Conditions commonly associated with S3
CHF, regurg, L-R shunts
[in CHF S3 suggests decreased EF]
Conditions commonly associated with S4
HTN
Ischemic cardiomyopathy
Hypertrophic cardiomyopathy
Aortic stenosis
Small, non-tender erythematous or hemorrhagic lesion on palms or soles of feet indicative of endocarditis
Janeway lesions
Tender, raised, red lesions on hands or feet potentially indicative of endocarditis
Osler’s nodes
What part of the physical exam is the most accurate estimate of RA pressure, volume status, and cardiac function?
Jugular venous pressure
Normal JVP
3-4 cm above the angle
