CVS 2 Flashcards
Loud S1 (3)
Short PR-interval
Mild mitral stenosis
Hyperdynamic states
Soft S1
Long PR-interval Severe mitral stenosis LBBB COPD Obesity Pericardial effusion
Variable S1
AV dissociation
Atrial fibrillation
Large pericardial effusion
Severe LV dysfunction
During expiration S2 is
single
During inspiration: S2 is
split
Pathologic split: occurs during
expiration
Wide S2 split:
RBBB, Pulmonic stenosis
Mitral regurgitation
Fixed splitting:
ASD
RV failure
Pulmonary HTN
Paradoxical S2 split:
LBBB, Aortic stenosis
Single S2
Severe aortic stenosis/ aortic regurgitation
Loud A2
Systemic HTN
Dilated aortic root
Soft or Absent A2
Calcified aortic stenosis
Loud P2
Pulmonary HTN
ASD
Soft or Absent P2
Pulmonic stenosis
COPD, aging
S3
LVF (apex)
Volume overloading: MR/TR
Decreased myocardial contractility
S4
never present in atrial fibrillation
L-sided S4: apex
Systemic HTN, aortic stenosis, hypertrophic cardiomyopathy
Ongoing myocardial ischemia
Aging
R-sided S4: LSB
Pulmonary HTN, pulmonic stenosis
Systolic
Systolic: starts after S1 and ends before S2
‘Flow’ murmurs: Hyperdynamic states, anemia
Aortic/ pulmonic stenosis
Aortic outflow tract obstruction: HOCM
Mitral/ tricuspid regurgitation
VSD
Grade 1 -6
Grade 1: Barely audible
Grade 2: Soft but easily heard
Grade 3: Loud
Grade 4: Loud + palpable thrill**
Grade 5: Loud with minimal contact between stethoscope and chest + thrill**
Grade 6: Loud with no contact between stethoscope and chest + thrill**
Squatting/ Valsalva: Release
HOCM
↓ Intensity of murmur
Aortic Stenosis
↑Intensity of murmur
MVP
↓ valve prolapse
CV EFFECT:
↑LVEDV
(from ↑ venous return)
↑SV
Standing/ Valsalva: Strain
HOCM
↑Intensity of murmur
AS
↓ Intensity of murmur
MVP
↑valve prolapse
Aortic Stenosis
ejection click w/crescendo- decrescendo paradoxical split LV>>>>aortic pressure radiate to neck/carotid SYNCOPE ANGINA DYSPNEA ON EXERTION Calcifications in >60 yo or on young w/ bicupisid aortic valve palsus parvus et tardus
Mitral regurgitation
high pitched blowing post MI, MVP, LV dialation holo/pansystolic radiates to axilia wide split hyperdamic conditions
MVP
non ejection click midstystolic click w/ late systolic murmur
b/c chordinae tensing
predipose to infective endocarditis
common in rhematic fever, marfan/ehlers danos pts
s/s: chest pain, anxious, dizziness
AR
autin flint murmur hears at erbs point high pitched blowing head bobbing - severe due to bicupsid aortic valve or endocarditis bounding carotid pulse quincke pulse heard best at left sternal border
MS
NO S3/S4 sound LA>>>LV pressure OS w/ mid diasystolic rumble a-fib common s/s: hempotysis, hoarseness (ortner)
Decrescendo-Crescendo
Diastolic (presystolic accentuation)
MS
Decrescendo
Diastolic:
AR
Crescendo-Decrescendo
Systolic:
AS, flow murmurs
Uniform (plateau): holosystolic
Systolic:
MR
Musical, vibratory
Common in 80% of children
innocent murmur
PDA
machine-like
Increases with valsalva strain/standing;
decreases with squatting
S4
Hypertrophic cardiomyopathy
