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PCM Hearts Sounds > Heart Sounds > Flashcards

Heart Sounds Flashcards

1
Q

aortic valve

A

R 2nd ICS at SB

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2
Q

pulmonic valve

A

L 2nd ICS at SB

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3
Q

Tricuspid valve

A

L 4th ICS at SB

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4
Q

Mitral valve

A

L 5th ICS at MCL

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5
Q

Grading Heart Murmurs

A

1: very faint
2: quiet, soft, easily heard with stetoscope
3: moderately loud
4: loud with palpable thrill
5: very loud with thrill; can hear with stethoscope partly off chest
6: heard without stethoscope

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6
Q

Systolic murmurs

A

Between S1 and S2

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7
Q

Diastolic murmurs

A

Between S2 and S1

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8
Q

S1

A

Closure of TV and MV

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9
Q

S2

A

Closure of AV and PV

may split with inspiration

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10
Q

S3

A 
Dull, low pitch
best heard with bell
Kentucky 
Physiologic in kids, young adults
Pathogenic in older adults = HF
Ventricular gallop
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11
Q

S4

A

dull low pitch; best heard with bell
Tennessee
forceful atrial contraction against stiffened low compliant ventricle
Atrial gallop

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12
Q

Systolic Murmurs

A

MR (MVP), TR
AS, PS
VSD
Aortopulmonary shunts (early, mid, late, holosystolic, pansystolic)

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13
Q

Diastolic Murmurs

A

AR, PR
MS, TS
Atrial myxoma

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14
Q

Continuous murmurs

A

PDA- machinery
AV fistula
ASD with high LA pressure
Coarctation

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15
Q

Valvular Heart Dz (VHD)

A

Most common conditions encountered today:
-degenerative (senile calcification)
-myxomatous degen (MVP)
-Congenital (bicuspid aortic valve)
Decline in incidence of Rheumatic valvular dz (RVD)

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16
Q

MR Chronic

A

MVP - most common etiology

MAC - mitral annular calcification

17
Q

MR Acute

A 
rupture of the chordal tendineae
Rupture of the papillary m
Ischemic papillary m dysfxn 
-CAD/MI: next most common cause of MR
Infective endocarditis
valve perforation
18
Q

MR symptoms

A

Asymp years –> fatigue, DOE

Acute; volume overload/orthopnea, PND, RHF/LHF

19
Q

PE of MR

A
  • systolic murmur: blowing, prominent at apex; radiates into L axilla
  • loudness of murmur correlates with severity
  • Decreased S1 or normal; may have a systolic click
20
Q

MS symptoms

A
  • 4th decade
  • DOE, cough, orthopnea, PND, pulm edema, hemoptysis, arterial emboli, A. fib
  • ortner syndrome: hoarseness d/+ compressio of L recurrent laryngeal n
21
Q

MS PE

A

malar flush- ruddy cheeks, blue facies. increase S1; opening shape (OS) after S2
rumbling, diastolic murmur- low pitched; best heard at apex with bell

22
Q

AS

A 
Etiology:
-degenerative (calcific or senile)
-congenital bicuspid aortic valve (BAV)-> 1% pop born with BAV
--rheumatic or postinflamm scarring
Normal AoV area is 4.0 cm2
23
Q

Symptoms AS

A
  • 6th decade: exertional dyspnea, angina, syncope, HF
  • w/o tx prognosis is poor
  • w/o tx most will die within 3 yrs of developing syncope and within 2 yrs of onset of HF
24
Q

Pathophys AS

A

Obstruction leads to pressure overload; LVH, incr LVED pressure
Gradient across valve
Severe AS if AoV

25
Q

PE AS

A
  • Narrow pulse pressure; decreased SV and systolic pressure
  • delayed pulses: parvis/tardus
  • systolic murmur, harsh, 2nd ICS RSB; radiates into supra sternal notch/carotids
  • Gallavardin phenomenon- murmur radiates to apex (like MR)
26
Q

AR: causes of acute AR

A

IE, aortic dissection, BAV

27
Q

AR: causes of chronic AR

A

syphillis, ankylosing spondylitis

28
Q

AR PE

A
  • wide pulse pressure
  • DeMusset sign
  • Corrigan’s Pulse
  • Quincke’s pulse
  • Traube’s sign
  • Durozrey’s sign
  • Hill’s sign
  • Bisferious pulse
  • Diastolic, decrescendo murmur, 3rd ICS LSB
  • Systolic murmur usually present, soft
  • Austin Flint murmur; can mimic MS
29
Q

Tricuspid Regurg (TR)

A
  • Associated w/ pulm HTN, inferior MI/RV infarction & others
  • Pathophys: prominent “V” wave in JVP
  • Blowing systolic murmur LSB; incr with inspiration (Carvallo’s sign)
30
Q

TS

A
  • Associated with MS, TR, RHD
  • Pathophys: prominent “A” wave in JVP ascites, hepatomegalia (may pulsate)
  • Diastolic murmur LSB; incr with inspiration and decr with expiration & valsalva
31
Q

PR or PI

A

most cases due to pulm HTN

blowing, diastolic murmur 2 SB (Graham Steel)

32
Q

Pulmonary Stenosis

A

Atresia, congenital, can cause angina & syncope
Systolic murmur, ejection click
2nd-3rd ICS, LSB/radiates toward L shoulder & incr on inspiration/RVH
Maybe associate with TOF or TGA
May require balloon commissurotomy if pressure gradient > 50 mmHg

PCM Hearts Sounds (1 decks)

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