Heart sounds

Question 1

S1

Answer 1

• normal heart sound
• due to closure of the mitral and tricuspid valves (AV valves)

Question 2

S2

Answer 2

• normal heart sound
• due to closure of the aorta and pulmonic valve (semilunar valves)

Question 3

S3

Answer 3

• heard just after S2, in diastole when the heart is rapidly filling.
• Considered normal in children and young adults, and during pregnancy.
• It is produced by rapid filling and expansion of the ventricles.
• In adults it is a key diagnostic sound for CHF. (may be heard best with the bell at the apex of the heart).*Sounds like “SLOSH’-ing – in” 0r “KEN’-tuck-y”
• fluid overload
• hallmark sign of CHF, (have this sound and BL edema)
• pregnancy: excess fluid circulating in the body

Question 4

S4

Answer 4

• this sound occurs just prior to S1 and is produced by the sound of blood being forced into a stiff or hypertrophic ventricle.
• Not normal and is associated with resistance to ventricular filling. (may be heard best with the bell at the apex of the heart)
• never normal
• less compliance and makes sound because ventricle is not expanding
• MI - tissue death causing scar tissue can be a result

Question 5

Heart murmur

Answer 5

• extra sounds during the cardiac cycle, heard as a whooshing or swishing made by turbulent blood flow as blood flows past a site of stenosis or regurgitation at the valve. - Named by location, timing, intensity, pitch. Know that these are abnormal.

Question 6

Pericardial friction rub

Answer 6

• fluid changes or inflammation in the pericardial sac impair filling of the ventricles.
• During filling, the ventricles will “rub” against the sac, making a leathery, squeaky door sound.

Question 7

Splitting sound

Answer 7

occurs when the 2 valves are not closing with synchronized timing

Question 8

Anterior auscultation points of the lungs

Answer 8

• About 8 with the first two above the clavicle
• the last two around moving laterally

Question 9

Posterior auscultation points of the lungs

Answer 9

• about 10
• first 4 are above/around spine of scapula
• upper lobe ends around T4 posteriorly (spine of scapula)

Question 10

Bronchial (A)

Answer 10

• normal sound
• loud and high pitched. Inspiration and expiration times are usually equal and loud
• usually higher

Question 11

Bronchovesicular (B)

Answer 11

• normal sound
• Heard close to the sternum, combination of bronchial and vesicular sounds.
• Usually inspiration and expiration times are equal but softer than bronchial or tracheal sounds

Question 12

Vesicular (lung periphery) (C)

Answer 12

• normal
• soft, low pitched (gently rustling sound).
• Inspiration time is longer than expiration time and quieter than tracheal and bronchial
  sounds
• exhale is shorter
• heard more lateral/inferior

Question 13

what happens if you hear a breath sound where you shouldn’t (bronchial lower down)

Answer 13

• indicate pathology

Question 14

Crackles (rales)

Answer 14

• soft, bubbling like air flow through fluid.
• Or crackling sounding, like a collapsed airway popping open as you inspire.
• Crackle that clear (disappear or lessen) with cough, indicate that mucous is mobile or alveoli are able to open with forceful air exchange

Question 15

Wheezes (rhonchi)

Answer 15

• over airways that are constricted,
• usually louder on expiration but can be heard during both phases.
• High pitched continuous sound

Question 16

Stridor

Answer 16

• very high pitched, minimal air exchange. Usually hear without stethoscope, a medical emergency

Question 17

pleural friction rub.

Answer 17

Leathery sound that is caused by the pleural layer rubbing together during inspiration/expiration. Similar to pericardial friction rub.

Question 18

Tracheal (A)

Answer 18

• typically loud and harsh. Inspiration and expiration times are usually equal and loud