Cardiopulmonary Auscultation

Question 1

Normal Lung Sounds (3)

Answer 1

Vesicular: Low pitch, soft intensity, peripheral lung area.
Bronchovesicular: moderate pitch and intensity, around upper part of sternum, between scapula.
Tracheal: High pitch, loud intensity, over trachea.
First sign of disease is if you can’t identify normal lung sounds.

Question 2

Abnormal Lung Sounds - Wheezes and Stridor

Answer 2

Wheezes: rapid airflow through obstructed airway. High pitch, usually expiratory.
Stridor: Rapid airflow through obstructed upper airway. High pitch, monophonic.
Bronchospasm, mucosal edema, inflammation, tumors, foreign bodies and pulmonary edema.

Question 3

Abnormal Lung Sounds - Crackles

Answer 3

Airflow moves secretion or fluid or collapsed airways popping open during inspiration.
Coarse: Fluid. Inspiration and expiration. Severe pneumonia, bronchitis.
Fine: Airways opening, late inspiration. Atelectasis, fibrosis, pulmonary edema.

Question 4

Abnormal Lung Sounds - Pleural Friction Rub

Answer 4

Creaking or grating sound. Pleural space inflamed (pleurisy). Both inspiration and expiration.

Question 5

Cardiac Auscultation - Identification

Answer 5

Physiological heart sounds (S1-S2)
Heart frequency, intensity, rhythm.
Heart murmurs.
Many Things Are Possible: mitric, tricuspid, aortic, pulmonary.

Question 6

Normal Cardiac Sounds (2)

Answer 6

S1: Lub, closure of AV valves, at beginning of systole, single sound.
S2: Dub, closure of SL valves at the end of systole. Split sound because aortic closes before pulmonary.

Question 7

S2 - Split Sound

Answer 7

Expiration: pulmonary just after aortic.
Inspiration: Pulmonary even more delayed due to respiratory pump:
↓ intrapulmonary pressure → ↑ vasodilation → ↑ venous return.
↑ Abdominal pressure → Helps blood pump to inferior vena cava → ↑ venous return → ↑ R. ventricle preload → intraventricular septum deviates to the left and decreases LV chamber → Aortic valve closes first due to decreased volume (faster contraction).

Question 8

Abnormal Cardiac Sounds (2)

Answer 8

S3: Dilated cardiomyopathy. Hearing blood hitting the dilated wall in early diastole. Rapid ventricular filling.
S4: Cardiac hypertrophy, ↑ afterload. Forced atrial contraction + decreased ventricular compliance, late diastole.

Question 9

Cardiac Murmurs - Aortic Stenosis

Answer 9

Heard during expiration only, aortic closure delayed, heard after pulmonary, reversed splitting.
During inspiration pulmonary valve also delayed so the sounds are simultaneous.

Question 10

Cardiac Murmurs - Atrial Septal Defect

Answer 10

Left and right atrial communication, pressure difference in expiration and inspiration evens out. RV volume overload, delayed pulmonary closure in both inspiration and expiration.

Question 11

Cardiac Murmurs - Pulmonary Hypertension

Answer 11

Narrowed pulmonary arteries, dilated RV. Prolonged right ventricular systole (RV afterload). Almost the same in inspiration and expiration. Closed fixed splitting.