Harvey Lab, stasio Flashcards
Where is S1 loudest? S2?
S1- apex
S2- base
how does inspiration cause split S2
increased blood volume in R ventricle
S3 is best heard where
apex with patient lying no the L side
blood hitting non-compliant ventricle
what causes the S4 sound
vibrations of L ventricle, mitral valve and L ventricular outlow as result of atrial contraction
Waht is best position to hear S4
L lateral decubitus at apex
17 y.o has S2 split and an S3 heart sound. rest of exam unremarkable.. should you be worried?
children and young adults have physiologic filling sounds (S3)
48 y.o obese man with HTN, HLD, has S4 at mitral post, and left carotid bruit. reason for murmur?
ASHD, noncompliant ventricle.
56 y.o with crushing chest pain, dyspnea and diaphoresis. Hx ASHD and angina
dec carotid and peripheral pulses, inspiratory crackles or rales b/l
S3 and S4 present
Dx?
anterior wall MI, S3 indicating significant LV dysfunction
crackles in lungs reflecting acute pulmonary congestion
When is an aortic ejection click heard
onset of LV ejection
When is a pulmonic ejection click heard
onset of RV ejection
When do you hear a mid systolic click? where do you hear it?
mitral valve prolapse
heard at apex in mid or late systole
What are the sounds from pericarditis
triphasic scratchy, grating, rasping or squeking
causes of pericarditis
infectious, MI, cardiac surgery, uremia, metastatic Ca, TB
38 y/o male had recent upper viral infection, leaning forward relieves chest pain
pleural rub with inspiration, normal vesicular breath sounds
has 3 component pericardial firciton rub early and late diastole and mid systolic
acute viral pericarditis
how do you describe a heart murmur
timing, location, radiation, shape, intensity, pitch, quality
where does mitral regurg usually radiate?
aortic stenosis?
mitral regurg- axilla
aortic stenosis- up the neck
which systolic murmur has diamond shape
aortic stenosis
which systolic murmur has a holosystolic high pitch blowing sound
mitral regurg
what are descriptions of “quality”of a murmur
harsh, blowing, rumbling or musical
upon standing or strain phase valsalva what murmurs increase in sound
mitral valve prolapse
HOCM
What is effect of standing or valsalva on blood flow in heart
decreased left ventricular volume from dec VR
decreased arterial BP
what murmurs get louder with squatting or release of valsalva
aortic stenosis
Do you use bell or diaphragm to listen to diastolic events at apex
bell
mid systolic click with high frequency 3/6 late systolic crescendo murmur
standing makes murmur louder
mitral valve prolapse
high frequency grade 2/6 holosystolic murmur radiating to axilla
S1 obscured by murmur
Dx?
mitral regurg
36 y.o male. PMI 6th ICS lateral. carotid pulse bisferiens with brisk upstroke and peripheral pulses bounding Aortic post: S1 with ejection sound short grade 2/6 early systolic murmur S2 has high frequency 2/6 mitral post: austin flint murmur
severe congenital aortic regurg
What is an austin flint murmur
premature closure mitral valve
18 y.o with syncope episodes while exercising, hypokinetic pulses, PMI infralaterally with heave
Aortic post: S1 with ejection sound, 3/6 systolic murmur ends before S2
Mitral post: S4 and 1/6 blowing systolic murmur
severe aortic stenosis probably from bicuspid valve
S4 indicates obstruction is severe
10 y.o small stature, sports PE
Pumonary post: 1/6 early systolic murmur
tircuspid post: 3/6 high frequencys holosystolic murmur
mitral post: 2/6 transmitted from tricuspid valve
ventricular septal defect
30 y.o female with bounding carotid and peripheral pulses
PMI 6th ICS MCL
pulmonic post: high freq 3/6 continuous systolic and diastolic peaks at S2
machine or to and from murmur
mitral post: S3 with short 2/6 diastolic murmur
patent ductus arteriosus
