Heart sounds Flashcards
S3 heart sound
From rapid ventricular filling (dilated cardiomyopathy)
Normal in children and pregnant women
Normal split S2 (inspiration)
Decreaed intrathoracic pressure
Incresed Right ventricular filling
Pulmonary valve colsure is delayed
S4
S4 heart sound
Hypertrophic cardiomyopathy
Wide S2 splitting
Pulmonic stenosis
Right bundle branch block
Fixed S2 splitting
Atrial septal defect
Heard as flow murmur in Pulmonic area
Heard as diasolic rumble in Tricuspid area
Paradoxical S2 splitting
Aortic stenosis
Left bundle branch block
Bedside maneuvers on murmurs
Inspiration:
Expiration:
Inspiration: intensifies right heart sounds
Expiration: intesnsifies left heart sounds
Bedside maneuvers on murmurs
Hand grip
Intensifies:
Mitrial regurgiation
Ventricular septal defect systolic murmurs
Bedside maneuvers on murmurs:
Valsalva maneuver
Intensifies:
Mitral valve prolapse
Hypertrophic cardiomyopathy
Rappid squatting
Decrease mitral valve prolapse murmur
Decrease: hypertrophic cardiomyopathy murmur
Pansystolic/Holosystolic murmur
Mitral regurgitation
- Ischemic heart disease, LV dilation, rheumatic fever
- Enhanced by squatting, expiration
Tricuspid regurgitation
- RV diliation, endocarditis
- Enhacned by inspiration
Crescendo-decresecndo systolic murmur following ejection click
Aortic stenosis
- Age releated calcific aortic stenosis or bicuspid aortic valve
(pulses week compared to heart sounds)
Holosystolic, harsh-sounding murmur in tricuspid area
Ventricular septal defect
Late systolic crescendo murmur with midsystolic click
Mitral valve prolapse
- Rheumatic fever, chordae rupture
- Enhanced by standing, valsalva maneuvers
- Predispoase to infective endocardidits
High-pitched “blowing” diasolic murmur
Aortic regurgitation
- Aortic root dilation, bicuspid aortic valve, rheumatic fever
Bounding pulses (increased pulse pressure)
Head bobbing
