Chapter 2 Lilly Flashcards
What 3 factors determine the intensity of S1
- distance separating hte leaflets of the open valves at the onset of ventricular contraction
- mobilty of hte mitral and tricuspid leaflets
- rate of rise of ventricular pressure
What would be 3 causes of accentuated S1?
- Shortened PR interval
- mild mitral stenosis
- high cardiac output states or tachycardia (like exercise)
What would be 4 causes of diminished S1?
- lengthened PR interval (like an AV nodal block)
- Mitral regurgitation
- severe mitral stenosis
- stiff left ventricle (i.e left ventricular hypertrophy)
What are the two components of the second heart sound
closure of aortic valve (A2) and closure of pulmonic (P2)
dscribe physiologic splitting
- idea that S2 varies with respiratory cycle
- normally fused as one sound during expiration but are audibly separated during inspiration
what is effect of inspiration on the P2 sound? A2 sound?
- inspiration is going to delay the P2 sound by delaying the pulmonary valve closure
- inspiration is going to cause the aortic valcve to close earlier than it would during expiration
What are the three types of abnromal splitting patterns of S2?
- Widened splitting (increase in time interval between A2 and P2)
- Fixed splitting (abnormally widened interval of A2 and P2 that is FIXED throughout the whole respiratory cycle)
- Paradoxical splitting (A2/P2 are the same sound on inspiration, A2 and P2 are split on expiration, but P2 precedes A2)
What is an ejection click? what do they indicate?
abnormal early systolic sounds occurring shortly after S1
- indicates aortic/pulmonary valve stenosis or dilatation of pulmonary artery/aorta
Name the 4 extra diastolic heart sounds
- opening snap (OS)
- third heart sound (S3)
- Fourth heart sound (S4) aka ATRIAL GALLOP
- pericardial knock
Define murmur
sound generated by turbulent blood flow
How to characterize murmurs (7 ways)
- timing
- intensity
- pitch
- shape
- location
- radiation
- response to maneuvers
Give intensity characterization for systolic murmurs
6 grades
1/6– barely audible
2/6 – faint but immediately audible
3/6 – easily heart
4/6 – easily heart and associated with a palpable thrill
5/6 – very loud; heard with the stethoscope lightly on the chest
grade 6/6 – audible without stethoscope directly on chest wall
give intensity characterization of diastolic murmurs
4 grades
1/4 – barely audible
2/4 – faint but immediately audible
3/4– easily heard
4/4 – very loud
