Clinical Heart Sounds Flashcards
Aortic area auscultation
Second ICS on RSB
Pulmonic area auscultation
Second ICS on LSB
Erb’s point auscultation
Third ICS on LSB
Tricuspid area auscultation
Fourth ICS on LSB
Mitral area auscultation
Fifth ICS at left clavicular line.
Atrial systole on ECG
Atrial diastole on ECG
P wave
PR interval
Ventricular systole on ECG
Late ventricular systole on ECG
Ventricular diasystole on ECG
QRS complex
ST segment
T wave
S1 is from:
Closure of the AV valves
S2 is from:
Closure of the semilunar valves
S3 is from:
Occurs from filling of the relaxed and empty ventricle.
Normal in kids.
S4 is from:
Atrial filling from high pressure from SVC/IVC.
Occurs prior to S1.
Grading of murmurs
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
Pathological murmurs
Grade >/ 3 Diastolic murmurs Gallops Rubs Blowing
Innocent murmurs
Grade /< 2
Softer intensity when pt. is sitting compared to standing.
During ventricular systole, what is the status of the valves?
Aortic and pulmonic valves are open.
AV valves are closed.
During atrial systole, what is the status of the valves?
AV valves open.
Aortic and pulmonic valves are closed.
Preload affect on aortic murmur in HOCM
Increase in preload improves aortic murmur by pushing septum away from aortic tract allowing easier passage of blood.
Decrease causes a worsening.
Mitral valve prolapse
MVP
MV leaflets prolapse into the left atria under normal pressure and BF.
Increase in preload causes what in MVP?
Improves the mid-systolic click heard w/ MVP by allowing the leaflets to return to normal orientation.
Generally, increased afterload has what affect on murmurs?
Increased afterload is louder and decreased afterload is softer.
Afterload
Pressure ventricles have to generate to move blood into the arterial system (PVR).
Afterload affects on murmurs:
Increased afterload is a softer murmur.
Decreased afterload is a louder murmur.
Aortic stenosis murmur
Crescendo-decrescendo murmur.
Calcified aortic valve and radiates to the carotids.
Mitral regurgitation murmur (4)
Blowing murmur.
Radiates to the axilla.
Holosystolic murmur.
Heard best at apex.
Tricuspid regurgitation murmur
Holosystolic murmur.
Hx of IVDA.
Aortic regurgitation murmur
Early blowing murmur.
Found commonly in CT disorders.
Can have femoral bruits and a water-hammer pulse.
Mitral stenosis murmur
Opening snap.
History of rheumatic fever.
“OS is MS”
HOCM
Hypertrophic cardiomyopathy
Family hx of sudden cardiac death at young age.
MVP murmur
Midsystolic click.
Often younger women with psychiatric disease.
“Myxomatous valvular disease” is in the stem.