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Cardiovascular > Heart Sounds > Flashcards

Heart Sounds Flashcards

1
Q

what valves are open and closed during systole?

A

Mitral & Tricuspid (A-V) valves close

Aortic & Pulmonic valves open

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2
Q

what valves are open and closed during diastole?

A

Mitral & Tricuspid (A-V) valves open

Aortic & Pulmonic valves close

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3
Q

heart sounds are created by what two things?

A

the changing of intracardiac pressure
closing of heart valves

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4
Q

which part of the stethoscope can you hear low pitched sounds better?
what conditions/sounds could be heard?

A

bell - S3, S4, mitral stenosis
diaphragm - high pitched sounds - S1, S2, AR, MR, pericardial friction rub

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5
Q

how should the pt be positioned during a PE in general?

A
  • Lying supine with their head at 30°
  • Listen over all precordial areas with diaphragm
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6
Q

what position and post can you listen to S3, S4, and MS better? using what part of the stethoscope?

A

Left lateral decubitus
With the bell at the MV post

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7
Q

if you hear something at the aortic post, what position should they be and have the pt do? why?

A
  • sit up, lean forward, and listen again with diaphragm after deep exhalation
  • Helps distinguish aortic murmurs, esp. AR
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8
Q

what position Decreases venous return, arterial BP and stroke volume

A

standing

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9
Q

standing position affects which valvular disorders (3) how?

A

Increases MVP
increases outflow obstruction of HCM
decreases intensity of AS murmur

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10
Q

what position Increases venous return, LV volume, arterial BP?

A

squatting

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11
Q

squatting position affects which valvular disorders (3) how?

A

Decreases MVP
decreases obstruction of HCM
increases intensity of AS

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12
Q

which position is the same as standing? what does it do?

A

valsalva
increases intrathoracic pressure, leading to a reduction in preload to the heart

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13
Q

Produced by closure of the mitral valve
Marks the beginning of systole
what is this heart sound?

A

S1

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14
Q

Produced by closure of the aortic valve
Marks the end of systole and beginning of diastole
what is this heart sound?

A

S2

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15
Q

Result of opening of AV (dilated aorta, AS, or bicuspid AV) or PV (dilated pulmonary artery, pulm HTN, or pulmonic stenosis)
Immediately follows S1
what is this heart sound?

A

Ej (or Ec) - Ejection click

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16
Q

Caused by opening of MV, as in MS
Follows S2
what is this heart sound?

A

OS - opening snap

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17
Q

What abnormal heart sound
Occurs in early diastole
Dull, low pitched

A

S3 - “Kentucky” gallop

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18
Q

S3 - “Kentucky” gallop is best heard with (Bell/diaphragm) at where, with the pt in what position?

A

bell at apex
left lateral decubitus

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19
Q

S3 - “Kentucky” gallop is physiologic and pathologic in who? reason of pathology?

A
  1. Physiologic - kids, young adults, 3rd trimester of pregnancy
  2. Pathologic - older adults d/t change in ventricular compliance
    - Specifically decreased myocardial contractility, CHF, and volume overload of ventricle
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20
Q

what abnormal heart sound
Occurs in late diastole, immediately before S1
Marks atrial contraction
Dull, low pitch heard

A

S4 - “Tennessee” gallop

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21
Q

S4 - “Tennessee” gallop’s dull, low pitch is heard best with (diaphagram/bell) at where, in what position?

A

bell at apex
left lateral decubitus

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22
Q

why does S4 occur?

A
  1. result of change in ventricular compliance
    - D/t increased resistance to ventricular filling
  2. Caused by HTN heart disease, CAD, AS and cardiomyopathy
23
Q

where is S1 softer and louder than S2

A

Softer than at base
louder than at apex

24
Q

what conditions make S1 sound diminished (3)

A

first degree AVB
mitral regurg
reduced LV contractility

25
Q

when can variations in S1 be seen? (conditions)

A

S1 varies in a complete heart block and any irregular rhythm, such as A. Fib

26
Q

when/where can split S1 be normal? abnormal?

A
  1. normal - along left lower sternal border where TV component is heard
  2. Abnormal - RBBB and in PVCs
27
Q

where and how is S2 physiologic splitting best heard?

A
  1. 2nd and 3rd left intercostal space where pulmonic valve
  2. Accentuated by inspiration and disappears on expiration
28
Q

when is pathologic S2 splitting heard? causes?

A
  1. Persists thru the respiratory cycle
    - Delayed closure of the PV (PS, RBBB) or early closure of the AV (mitral regurg)
    - ASD or RV failure
29
Q

Murmurs are differentiated from extra heart sounds by their ____ ____

A

longer duration

30
Q

Describing a murmur should include the following points: (7)

A
  1. Timing
  2. Shape
  3. Location of maximum
  4. Radiation
  5. Intensity
  6. Pitch
  7. Quality
31
Q

murmur timing types

A
  1. Systolic
    - Midsystolic
    - pansystolic (holosystolic)
    - late systolic
  2. Diastolic
    - Early
    - mid-diastolic
    - late diastolic
  3. Continuous
    - Both systolic & diastolic components - PDA, pericardial friction rub, venous hum
32
Q

parts of murmur features

A
  1. Shape
    - Crescendo
    - Decrescendo
    - Crescendo-decrescendo
    - Plateau
  2. Location of Maximal Intensity - Where murmur originates
  3. Radiation - direction of blood flow and intensity of murmur
33
Q

features of murmur intensity

A
  1. Graded on a 6-point scale
  2. Influenced by thickness of chest wall and presence of intervening tissue
  3. Grades
    - I - very faint, have to “tune in” to catch
    - II - quiet, but can hear immediately with stethoscope
    - III - moderately loud
    - IV - loud, with palpable thrill
    - V - very loud with thrill; may be heard with stethoscope partly off chest
    - VI - very loud with thrill; may hear with stethoscope fully off chest
34
Q

features of pitch and quality murmurs

A
  1. Pitch - High, medium, or low
  2. Quality - Blowing, harsh, rumbling or musical
  3. Be mindful of positioning
  4. Comment on positioning and whether murmur changes with certain maneuvers or with respirations
35
Q

Pathologic
Arising from blood flow from a chamber of high pressure to one of low pressure through a valve that should be closed
what type of murmur
What conditions is it commonly heard?

A

Pansystolic (holosystolic)
Mitral regurgitation, tricuspid regurgitation, ventricular septal defect (VSD)

36
Q

Most common heart murmur
May be innocent, physiologic, or pathologic
what type of murmur

A

Midsystolic

37
Q

when is midsystolic murmur innocent?

A
  1. turbulent blood flow
  2. grade I-III murmur typically heard between 2nd - 4th L ICS w/ minimal radiation
  3. Disappears/decreases with sitting
  4. blowing, mid-systolic
  5. No other associated PE findings
38
Q

how is midsystolic physiologic

A
  1. Similar to innocent, but may have signs of an underlying cause
  2. Normal blood turbulence enhanced by conditions that increase blood flow
    - anemia, pregnancy, fever and hyperthyroidism
39
Q

when is midsystolic pathologic? (sound, condition)

A

Harsh, mid-systolic murmur
Aortic stenosis, HCM, pulmonic stenosis

40
Q

pathologic diastolic murmurs can be heard when? reasons?

A
  1. early or mid-late
    - Early decrescendo = regurgitation through incompetent semilunar valves, most often aortic regurg
    - Mid-late diastolic = stenosis of AV valve, MC mitral stenosis
41
Q

Produced by turbulence of blood flow in jugular veins
Common in kids
Characterized by a continuous murmur that is louder in diastole
Soft, low pitched
what type of murmur?

A

Venous hum

42
Q

Venous hum is best heard where?

A

above the medial third of the clavicles with radiation into the 1st and 2nd intercostal spaces

43
Q

A result of inflammation of the pericardium
what is this condition

A

pericardial friction rub

44
Q

what 3 components can a pericardial friction rub have?

A

Atrial systole (diastole)
ventricular systole
ventricular diastole

45
Q

what sound does a pericardial friction rub produce? describe features of this murmur

A
  1. High pitched, scratching/scraping noise
    - Similar to rubbing the back of your stethoscope
  2. Increases when leaned forward, exhales, and holds their breath
  3. Location varies
  4. Radiation is not typical
46
Q

Congenital abnormality resulting in a channel between the aorta and pulmonary artery

A

patent ductus arteriosus

47
Q
  1. Loudest in systole and fades in diastole
  2. Best heard at left 2nd intercostal space, radiating to left clavicle
  3. Harsh, machinery-like, medium pitched
  4. Typically associated with a thrill
    what condition/murmur?
A

Patent Ductus Arteriosus

48
Q

Transthoracic (TTE) 2D echocardiogram w/Doppler imaging gives info about what? it gives images of what?

A
  1. size of all 4 chambers
  2. regional and global systolic function
  3. chamber wall thickness
  4. Provides excellent images of valve motion, intracardiac masses, cardiac abnormalities / anomalies, and pericardial fluid

Non-invasive and requires no radiation or prep!

49
Q

provides color flow, gives a visual image of blood flow velocities superimposed over anatomic 2D images
what is this diagnostic method?

A

doppler

50
Q

Allows viewer to see turbulence from valvular stenosis or regurgitation
Also picks up any intracardiac defects
what diagnostic method?

A

Doppler

51
Q

how to improve visualization of wall motion with doppler?

A

add contrast agents

52
Q

another option that is used if surface sound transmission is poor for a TTE
what is this diagnostic method?

A

Transesophageal echocardiography (TEE) with Doppler ultrasound

53
Q

benefits of TEE vs TTE

A
  1. better view of posterior heart structures, esp atria, atrial appendage, and A-V valves
    - Better than a TTE for dx LAA thrombus
  2. Prosthetic heart valves and intracardiac masses difficult to see on TTE
  3. helps define septal defects or a PFO
  4. detects aortic dissection and severe atherosclerosis of the ascending aorta
54
Q

Cons of TEE

A
  1. NPO for 6-8 hrs prior
  2. risks include:
    - Aspiration
    - Throat irritation
    - Esophageal perforation
  3. IV sedation and a local anesthetic to reduce gag reflex
  4. has to be monitored during procedure (O2, HR, BP)
  5. Signed consent required

Cardiovascular (24 decks)

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