heart sounds

Question 1

describe how to grade a murmur

Answer 1

• 1 = very faint
• 2 = quiet usually heart immediately
• 3 = moderately loud (S1/S2 around grade 3)
• 4 = loud WITH THRILL OR HEAVE (vibration thru chest wall)
• 5 = very loud with thrill

Question 2

describe S1

Answer 2

• Mitral and Tricuspid valve closing
• best heard with diaphragm
• LOUDER over APEX and along lower left sternal border

Question 3

describe S2

Answer 3

• Aortic and pulmonary valve closure
• Best heard with diaphragm
• Location is LEFT SECOND INTERSPACE CLOSE TO STERNAL BORDER
• S2 is single during expiration and SEPARTION occurs with inspiration (A2 and P2 split)

Question 4

describe S3

Answer 4

• LOW FREQUENCY diastolic sounds (heard close to S2)
• VENTRICULAR FILLING SOUND
• Heard with BELL
• Usually abnormal in patients over 40 (suggest enlarged ventricular chamber)
• Lower pitched sound than S1 and S2

Question 5

describe S4

Answer 5

• can be heard in healthy older adults without any cardiac abnormality due to decreased ventricular compliance
• Usually abnormal in children and young adults
• LOWER PITCHED SOUND (BELL)
• Heard in majority of patients during acute case of MI

–> significant Q waves means theyhave permanent damage caused by MI

Question 6

Aortic Stenosis

Answer 6

• Pitch = Medium, harsh, grades 4-6
• Found in SYSTOLIC
• Best heard over AORTIC/PULMONIC (upper right sternal edge or upper left sternal edge)
• Radiates to the carotids
• EJECTION SOUND
• can have APICAL HEAVE
• NARROW PULSE PRESSURE

Question 7

Aortic regurgitation

Answer 7

• Diastolic murmur = high ptiched, blowing - grades 1-3
• Best heard TRICUSPID AREA (lower left sternal edge)
• Left ventricular hypertrophy
• WIDE PULSE PRESSURE
• BOUNDING CAROTID PULSE

Question 8

MITRAL STENOSIS

Answer 8

• Pitch = low rumbling, grades 1-4
• DIASToLIC (HOLO)
• Best heard: left lateral decub with bell (pulmonary area = upper left sternal edge)
• RIGHT VENTRICULAR HYPERTROPHY
• NARROW PULSE PRESSURE
• WEAK PULSES

Question 9

Mitral Regurgitaiton

Answer 9

• Pitch = HIGH, blowing
• Systolic (HOLO) and Midsystolic rumble
• BEST LOCATION = MITRAL (apex of heart)
• Radiates to axilla
• S3 sound
• S4 in acute not usually in chronic

Question 10

AOrtic area indicates…

Answer 10

• Pathologic of aortic valve or left ventricular outflow tract

–> aortic stensosi (blood encoutners and obstruction while exiting left ventcile)

–> aortic regurgitation (diastolic murmur may be heard over the aortic area and you may hear an associated diastolic murmur at apex)

Question 11

Left sternal border indicates…

Answer 11

• 3rd left intercostal space
• diastolic murmur of aortic regurgitation may be heard best here and usually radiates toward apex

Question 12

APEX during systole…

Answer 12

-Systoic murmur head best at apex suggest 3 possible diagnoses

–> aortic outflow obstruction

–> mitral regurgitaiton

–> VSD

Question 13

Apex during diastole…

Answer 13

-Apical diastolic murmur suggests 2 different diagnoses

–> Mitral stenosis

–> aortic regurgitation