Heart sounds

Question 1

Early systolic ejection sound

heard where

Answer 1

Bicuspid aortic valve
-early triplet

+/- “has a systolic ejection murmur - obstructive”

2nd intercostal space - RIGHT

LVH?

rounded LV, normal or calcified aortiv

Question 2

Mid systolic click

heard where?

Answer 2

mitral valve prolapse
-even triplet

APEX, L sternal border

Question 3

Physiological Split S2

heard where?

Answer 3

normal
- S2 varies w/ inpiration

2nd intercostal space - LEFt

Question 4

Fixed split

heard where?

Answer 4

ASD

*W/ systolic ejection murmur - nonobstructive

2nd intercostal space - LEFT

RA R axis

pulm vascilature esp L

Question 5

Opening snap

heard where?

Answer 5

Early mitral stenosis
-backside triplet

APEX

LAH w/ double shadow

Question 6

S3

Heard Where?

Answer 6

CHF systolic dysfunction
-Slosh…. in.. ing; ends w/ a thud

APEX w/bell

q waves??

Question 7

S4

Heard where?

Answer 7

CHF diastolic dysfunction; 1st degree AV block; HOCM, wall motion defect; HTN

• late diastole . A .. Stiff……..heart
• intermittent vs early systolic
• watch for carotid pulse

APEX w/ bell

LVH

Question 8

Paradoxical split S2

heard where?

Answer 8

LBBB, Transducer, HTN, Aortic Stenosis?
-S2 split on expiration

2nd intercostal space RIGHT

LBBB-mtn sign

Question 9

Systolic ejection Murmur - nonobstructive

heard where?

Answer 9

innocent flow
- blowing

L sternal border, 2nd intercostal space RIGHT

pregnant, running, fever, pain, anemia, hyperthyroid

Question 10

Systolic Ejection Murmur - Obstructive

heard where?

Answer 10

HOCM

• increases w/ decreased LV volume - valsalva
• decreases w/ increased LV volume - squat

L Sternal border

Aortic stenosis

• decreases w/ decreased blood volume - valsalva
• increases w/ increased blood volume squatting

L sternal boder

LVH in both

Question 11

Hololsystolic Murmur

Heard Where?

Answer 11

VSD

• no change w/ inspiration; louder handgrip
• APEX
• LVH

Mitral insufficiency- rheumatic, pap rupture, acute inf MI

• decreases w/ inspiration
• Apex w/ radiation to L axilla
• LAH

Tricuspid insufficiency

• increases w/ inspiration
• Left Sternal border
• RAH

Question 12

Late Systolic Murmur

Answer 12

Chronic MVP; Papillary muscle Rupture; chordate tendonae tauma
- Obscurs S2*, space after S1

Apex or LLSB

-see posterior MI; a fib if pap muscle; acute HF SOB if trauma

Question 13

Early Short lived murmur

Answer 13

Acute AI - Aortic dissection
-musical w/ S2 heard; increases w/ grip

2nd intercostal space Right

NO LVH; normal/tachy
Mediastinum wide if dissection

Question 14

Holodiastolic

Answer 14

Chronic AI - HTN , endocarditis, ankylosing spondylitis, syphilus
- increases w/ grip

2nd intercostal space Right, L border

BOOT shape heart(LVH + ~LAH)
-wide pulse pressure*

Question 15

Mid -late diastolic murmur

Answer 15

Chronic mitral stenosis 2/2 rheumatic fever
- What …..to doooooooooo

Regular or irregular

W/ Opening Snap*

APEX

double atrial bubble CXR

LAH** - NO LVH if regular
afib* if irregular

Question 16

Pericardial Friction Rub

Answer 16

Pericarditis- Uremia, SLE, post viral, Acute MI, Dresslers

throughout the heart

effusion on CXR?
EKG: ST elevation throughout and PR depressiion*

Question 17

Systolic heart sounds(2)

Answer 17

Early systolic ejection sound

Mid systolic Click

Question 18

Splits (3)

Answer 18

physiological
pathological
fixed w/ nonobstructive SEM

Question 19

Diastolic heart sounds(3)

Answer 19

Opening snap
S3
S4

Question 20

Systolic Murmurs(4)

Answer 20

SEM nonobstructive
SEM obstructive
Holosystolic
Late systolic

Question 21

Diastolic mumurs(3)

Answer 21

Early short lived murmur
Holodiastolic murmur
Mid-late diastolic (2)

• Pericardical friction rub throughout