CV Flashcards
four key areas and levels for auscultation of cardiac areas
aortic 2nd intercostal space Right sternal boarder RSB
pulmonic 2nd ICS, LSB
tricuspid- 4th and 5th ICS, LSB
Mitral apex - 5th ICS MCL
others needed
second pulmonic 3rd ICS, LSB
pathologic splitting of S2 is due to what
delayed closure of pulmonic valve
- WIDE increase in usual splitting during inspiration
- FIXED splitting does not vary with respiration eg. atrial septal defect, right ventricular failure
- A2 follows P2 then PARADOXAL splitting during expiration and gone during inspiration eg left bundle branch
what is S3 from
sound created in early diastole by passive, rapid filling of the ventricle with blood from atria
blood filling chamber that is already volume overload causing rapid distension of the ventricular wals leading to vibration
S1+S2+S3= ventricular gallop rhythm
children, healthy young adults and pregnant women normal
over 40 heart failure, anemia, volume overload of ventricle, decreased myocardial contractility
what cause S4
low pitched sound created by second phase of ventricular filling in diastole, as the atria contract and eject blood into the ventricles during atrial kick
caused by rush of blood causing vibration of valves, papillary muscles, and ventricular walls
S1+S2+S4= atrial gallop rhythm
heard best with bell at apex
normal in trained athletes and some older individuals
pathologic S4 over age 40 due to resistance of ventricular filling stiffness of heart muscle, HTN, CAD, AS
murmur
prolonged heard sound made by blood rushing through:
narrowed valve
leaking valve
wall between chambers
think turbulent flow
graduations of murmurs-each grade
1/6 barely audible in quiet room
2/6 quiet but clearly audible
3/6 moderately loud
4/6 loud, associated with THRILL (palpable murmur)
5/6 very loud, heard with stethoscope partially off chest: obvious THRILL
6/6 very loud, heard with stethescope entirely off the chest, obvious THRILL
midsystolic murmur type and cause
usually crescendo-decrescendo
usually due to obstructed flow across semilunar valves or atrial septal defect
narrowed valve
heard best at base along right and left sternal boarders
pansystolic (holosystolic) murmur
usually plateau
usually regurgitation across AV valves or ventricular septal defect
late systolic murmur
typical of mitral prolapse
crescendo-decrescendo systolic murmur
high pressure to high pressure
ex. aortic stenosis
systolic murmur: innocent systolic murmur
common in children and young adults physiologic in pregnancy, anemia, fever, hyperthyroidism (increased flow across valve) grade less than or equal to 2 intensity softer when sitting short systolic duration minimal radiation musical/vibratory quality
midsystolic murmur: atrial septal defect ASD
congenital anomaly resulting in left-to-right shunting of blood (LA->Ra), RV enlargement and increase in flow through pulmonic valve
midsystolic murmur 2nd ICS
wide fixed splitting of S2
pansystolic (or holosystolic) murmur
high pressure to low pressure
ex. mitral/tricuspid regurgitation
pressure in left and right ventricles is significantly higher than in the atria
probably an associated thrill
Diastolic murmurs
early
mid
late diastolic (presystolic)
early- usually decrescendo, usually from regurgitant flow across leaking semilunar valve (aortic or pulmonic) Mid- from turbulent flow across AV valves Late diastolic (presystolic)- usually up to S1
aortic regurgitation
leaking aortic valve
heard best at apex
opening snap and diastolic rumble
mitral stenosis
narrowed valve obstructs flow from the LA to LV
continuous vs “to and fro” murmurs
patent ductus arteriosus (machinery like)
failure of channel between aorta and pulmonary artery to close after birth
to and fro
aortic stenosis/regurgitation
severe aortic regurgitation
systolic-diastolic murmur
aortic stenosis with aortic regurgitation
obstruction to outflow due to narrowed valve and failure of complete closure
effects of standing or strain phase of valsalva
decreased left ventricular volume from decreased venous return to heart
decreases vascular tone decrease BP and PVR
most murmurs decrease except HCM INCREASES
squatting or release phase of valsalva
increased left ventricular volume from increased venous return to heart
increases vascular tone increases BP and PRV
systolic clicks
mitral valve prolapse
ballooning of mitral leaflets into the left atrium during systole
usually benign
what is a lift or a heave
vigorous cardiac impulse that can be seen/felt through the chest wall
abnormal abdominal aorta for adults older than 50
abnormal > 3 cm
