Clinical Heart Sounds

Question 1

Aortic area auscultation

Answer 1

Second ICS on RSB

Question 2

Pulmonic area auscultation

Answer 2

Second ICS on LSB

Question 3

Erb’s point auscultation

Answer 3

Third ICS on LSB

Question 4

Tricuspid area auscultation

Answer 4

Fourth ICS on LSB

Question 5

Mitral area auscultation

Answer 5

Fifth ICS at left clavicular line.

Question 6

Atrial systole on ECG

Atrial diastole on ECG

Answer 6

P wave

PR interval

Question 7

Ventricular systole on ECG
Late ventricular systole on ECG
Ventricular diasystole on ECG

Answer 7

QRS complex
ST segment
T wave

Question 8

S1 is from:

Answer 8

Closure of the AV valves

Question 9

S2 is from:

Answer 9

Closure of the semilunar valves

Question 10

S3 is from:

Answer 10

Occurs from filling of the relaxed and empty ventricle.

Normal in kids.

Question 11

S4 is from:

Answer 11

Atrial filling from high pressure from SVC/IVC.

Occurs prior to S1.

Question 12

Grading of murmurs

Answer 12

1 - soft murmur in quiet surroundings
2 - soft murmur in loud surroundings
3 - prominent murmur
4 - loud murmur w/ thrill
5 - loud murmur heard with edge of steth tilted against the chest and thrill
6 - loud murmur heard without steth

Question 13

Pathological murmurs

Answer 13

Grade >/ 3
Diastolic murmurs
Gallops
Rubs
Blowing

Question 14

Innocent murmurs

Answer 14

Grade /< 2

Softer intensity when pt. is sitting compared to standing.

Question 15

During ventricular systole, what is the status of the valves?

Answer 15

Aortic and pulmonic valves are open.

AV valves are closed.

Question 16

During atrial systole, what is the status of the valves?

Answer 16

AV valves open.

Aortic and pulmonic valves are closed.

Question 17

Preload affect on aortic murmur in HOCM

Answer 17

Increase in preload improves aortic murmur by pushing septum away from aortic tract allowing easier passage of blood.
Decrease causes a worsening.

Question 18

Mitral valve prolapse

MVP

Answer 18

MV leaflets prolapse into the left atria under normal pressure and BF.

Question 19

Increase in preload causes what in MVP?

Answer 19

Improves the mid-systolic click heard w/ MVP by allowing the leaflets to return to normal orientation.

Question 20

Generally, increased afterload has what affect on murmurs?

Answer 20

Increased afterload is louder and decreased afterload is softer.

Question 21

Afterload

Answer 21

Pressure ventricles have to generate to move blood into the arterial system (PVR).

Question 22

Afterload affects on murmurs:

Answer 22

Increased afterload is a softer murmur.

Decreased afterload is a louder murmur.

Question 23

Aortic stenosis murmur

Answer 23

Crescendo-decrescendo murmur.

Calcified aortic valve and radiates to the carotids.

Question 24

Mitral regurgitation murmur (4)

Answer 24

Blowing murmur.
Radiates to the axilla.
Holosystolic murmur.
Heard best at apex.

Question 25

Tricuspid regurgitation murmur

Answer 25

Holosystolic murmur.

Hx of IVDA.

Question 26

Aortic regurgitation murmur

Answer 26

Early blowing murmur.
Found commonly in CT disorders.
Can have femoral bruits and a water-hammer pulse.

Question 27

Mitral stenosis murmur

Answer 27

Opening snap.
History of rheumatic fever.
“OS is MS”

Question 28

HOCM

Answer 28

Hypertrophic cardiomyopathy

Family hx of sudden cardiac death at young age.

Question 29

MVP murmur

Answer 29

Midsystolic click.
Often younger women with psychiatric disease.
“Myxomatous valvular disease” is in the stem.