Cardio Exam Module Flashcards
What are the “big 12” heart sounds?
2nd sound splitting; 3rd sound; 4th sound; systolic click; innocent murmur; mitral regurgitation; aortic stenosis; aortic regurgitation; mitral stenosis; continuous murmur; tricuspid regurgitation; pericardial rub
What are the most important heard sounds?
3rd sound and 4th sound, since they represent ventricular functions (they’re called “filling sounds”)
What are the 5 fingers of the “5 finger approach”?
- the appearance of the patient; 2. assessing the carotid arterial pulse; 3. the venous pulse; 4. chest wall movement (precordial movement); 5. auscultation
What does S1 represent?
When the pressure in the left ventricle rises above the pressure in the left atrium and mitral valve closes; sounds occurs at the beginning of the carotid impulse
Where is S1 loudest?
at the apex
What does S2 represent?
When the pressure in the left ventricle falls below that of the aorta and the aortic valve closes; sound occurs at the end of the carotid impulse
Where is S2 loudest?
at the base
What do you hear on heart auscultation?
valves closing - valves opening typically doesn’t make an audible sound!
What should the bell of the stethoscope be used for?
Low frequency sounds
What can an abnormally loud aortic closure mean?
Hypertension
Where is the best place to hear S2 splitting?
left sternal edge
When might you hear S2 splitting?
- pathology, like atrial septal defects with permanent splitting; 2. children may have persistent splitting when supine, but it disappears when they sit or stand; 3. splitting may occur during inspiration
What can be heard at the upper right sternal edge?
S1 and S2
What is S1 splitting due to?
Normal variation - typically due to small differences in mitral/tricuspid closing; limited diagnostic value
Where/how should you listen for 3rd heart sound?
With bell of the stethoscope at the apex. Right sided 3rd heart sounds may be heard at the tricuspid area and may augment with inspiration. Sometimes patient should be in the left lateral decubitus position
What is a third heart sound? What does it represent?
Early diastolic, low frequency filling heart sound. Related to acceleration and deceleration of blood during passive filling of the ventricle. May be normal in children and young adults. May be pathologic in adults - heart failure (less compliant ventricle).
Where/how should you listen for 4th heart sound?
With bell of the stethoscope at the apex. Sometimes patient should be in the left lateral decubitus position
What causes 4th heart sound?
Occurs during late diastole when atrial contraction causes rapid blood flow into the ventricle. If the ventricle is less compliant than normal, then the blood decelerates and causes low frequency sound.
How can you tell 4th heart sound from S1 splitting?
- Listen at apex; put patient in left lateral decubitus position; identify the LV impulse; if the impulse is presystolic, then it is the fourth sound; 2. put bell over apical impulse - use light pressure for 4th sound and firm pressure for S1
What is a systolic click?
A sharp, high frequency sound that is best heard at the apex. There may be one, or there may be multiple heard during systole. It is caused by abrupt tensing of prolapsed mitral valve.
How should murmur be described?
location, timing, contour, frequency
Where should you listen for murmur?
2nd left intercostal space (pulmonary valve)
How can you describe an innocent murmur heard at the upper left sternal edge?
Systolic, short, early peaking, crescendo-decrescendo, mid frequency; the result of turbulent flow. May be associated with splitting of the second sound.
Where can you hear mitral regurgitation?
Mitral area; blood flows from LV to LA - radiates to axilla ; all of systole
What are the characteristics of mid-late systolic murmur?
Likely due to mitral valve prolapse; Early systole is silent; clicks introduce the murmur; crescendos into S2; high frequency
What is holosystolic mitral regurgitation?
Rheumatic
What is crescendo-decrescendo mid systolic murmur?
Papillary dysfunction
Where is the best location to hear aortic stenosis?
Upper right sternal edge - aortic area; may also palpate a thrill; crescendo-decrescendo in systole - all of systole
How can you tell the difference between aortic stenosis and aortic sclerosis?
Both are heard in the upper right sternal edge and are systolic crescendo-decrescendo; sclerosis is short and early-peaking (as opposed to long and late-peaking)
Where is aortic regurgitation best heard?
Lower left sternal edge (direction of diastolic flow)
What is mitral stenosis and where is it heard?
Apex or mitral area with bell; narrowing of mitral valve; diastolic murmur; feel right ventricular impulse at right sternal edge; low frequency
What is a continuous murmur?
systolic and diastolic component; represents patent ductus arteriosus; due to turbulent flow originating in blood vessels; high frequency
What are some causes of continuous murmur?
venous hum - heard in children in clavicular area; shunts from high to low vessels - patients with patent ductus arteriosus; obstruction - patients with critical stenosis and insufficient circulation
What is tricuspid regurgitation?
Often occurs with other heart disease; whole of systolic, plateau-shaped; high frequency
When is tricuspid regurgitation augmented?
Inspiration
What is pericardial rub?
when heart moves inside pericardial sac due to inflammation of the sac; high pitch and scratchy - may vary in intensity
How is pericardial rub best heard?
With diaphragm of the stethoscope; patient should be leaning forward; best heard at end of expiration; typically best heard between lower left sternal edge and apex
What are the components of pericardial rub?
3 classic components: systolic, early diastolic, presystolic (late diastolic); must have 2 components to dx - otherwise too difficult to differentiate from scratchy murmur
