Harvey Booklet Flashcards
What does the first heart sound herald?
The beginning of systole
What causes the first heart sound?
The closure of the mitral and tricuspid valves
What does the second heart sound herald?
The end of systole and the start of diastole
What causes the second heart sound?
The closure of the aortic and pulmonary valves
Do systolic murmurs coincide with the carotid pulse?
Yes, systolic murmurs coincide with the carotid pulse
Do diastolic murmurs coincide with the carotid pulse?
No, diastolic murmurs do not coincide with the carotid pulse
What is splitting of the 2nd heart sound due to?
Decreased intrathoracic pressure during inspiration
What does the decreased intrathoraic pressure result in?
Increased venous return to the right side of the heart
What does the increased venous return to the right side of the heart result in?
Increased right ventricular volume, which prolongs the right ventricular ejection time
Which component of the 2nd heard sound during splitting is the loudest?
The aortic component
Where is splitting of the 2nd heart sound best heard?
2nd intercostal left sternal edge
What is the significance of the 2nd heart sound splitting on inspiration?
It is a normal finding
What is the 3rd heart sound?
An early diastolic low frequency filling sound
Low pitched early diastolic sound.
When does the 3rd heart sound occur?
Immediately after the 2nd heart sound
What is the 3rd heart sound related to?
The acceleration and deceleration of blood during the early passive filling of the ventricle
Coincides with the rapid ventricular filling immediately after opening of the atrioventricular valves.
Where is the 3rd heart sound best heard?
At the apex with the bell
What is the significance of S3 in a healthy child/young adult?
Normal finding
What is the significance of S3 in an older patient with known/suspected cardiac disease?
Usually pathological - commonly left ventricular systolic dysfunction
What is the 4th heart sound?
A late diastolic low frequency filling sound
What is the 4th heart sound due to?
The atrial contraction causing rapid blood flow into a less compliant (or stiff) ventricle
Forceful atrial contraction against a non-compliant/stiff ventricle
What are some of the causes of a less compliant ventricule?
Aortic stenosis
MI
Hypertension
What is the significance of a 4th heart sound?
ALWAYS pathological
Good indicator of the severity of hypertension or aortic stenosis
What are cardiac murmurs caused by?
Turbulent blood flow in the heart
What would a full description of any cardiac murmur include?
Intensity (grading) Radiation Character + pitch Timing Location
What is an innocent cardiac murmur?
A systolic flow murmur usually caused by a turbulence of blood in the RIGHT VENTRICULAR OUTFLOW TRACT
When is an innocent cardiac murmur usually loudest?
When the blood flow is hyper dynamic (pregnancy, anaemic, fever etc)
What are the characteristics of an innocent murmur?
Soft mid systolic Usually heard in the pulmonary area Localised to one auscultatory area NO radiation NO other cardiac abnormalities (no symptoms, clinical signs, etc)
What is a pathological cardiac murmur?
A murmur which is caused by a turbulence of blood flow due to a structural abnormality
Can be systolic or diastolic
What are the characteristics of pathological murmurs?
DIASTOLIC murmur are always pathological
EJECTION SYSTOLIC especially late peaking and PAN SYSTOLIC murmurs are often pathological
NOT LOCALISED - may be audible in more than one area
RADIATION - may radiate (e.g to the neck in aortic stenosis or to the axilla in mitral regurgitation)
ASSOCIATED ABNORMALITIES - murmurs with symptoms or other clinical signs (e.g. low volume pulse, thrills, palpable heaves etc)
When can S4 not occur?
When the heart is in AF
