Heart Sounds Flashcards
aortic valve
R 2nd ICS at SB
pulmonic valve
L 2nd ICS at SB
Tricuspid valve
L 4th ICS at SB
Mitral valve
L 5th ICS at MCL
Grading Heart Murmurs
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
Systolic murmurs
Between S1 and S2
Diastolic murmurs
Between S2 and S1
S1
Closure of TV and MV
S2
Closure of AV and PV
may split with inspiration
S3
Dull, low pitch best heard with bell Kentucky Physiologic in kids, young adults Pathogenic in older adults = HF Ventricular gallop
S4
dull low pitch; best heard with bell
Tennessee
forceful atrial contraction against stiffened low compliant ventricle
Atrial gallop
Systolic Murmurs
MR (MVP), TR
AS, PS
VSD
Aortopulmonary shunts (early, mid, late, holosystolic, pansystolic)
Diastolic Murmurs
AR, PR
MS, TS
Atrial myxoma
Continuous murmurs
PDA- machinery
AV fistula
ASD with high LA pressure
Coarctation
Valvular Heart Dz (VHD)
Most common conditions encountered today:
-degenerative (senile calcification)
-myxomatous degen (MVP)
-Congenital (bicuspid aortic valve)
Decline in incidence of Rheumatic valvular dz (RVD)
MR Chronic
MVP - most common etiology
MAC - mitral annular calcification
MR Acute
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
MR symptoms
Asymp years –> fatigue, DOE
Acute; volume overload/orthopnea, PND, RHF/LHF
PE of MR
- 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
MS symptoms
- 4th decade
- DOE, cough, orthopnea, PND, pulm edema, hemoptysis, arterial emboli, A. fib
- ortner syndrome: hoarseness d/+ compressio of L recurrent laryngeal n
MS PE
malar flush- ruddy cheeks, blue facies. increase S1; opening shape (OS) after S2
rumbling, diastolic murmur- low pitched; best heard at apex with bell
AS
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
Symptoms AS
- 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
Pathophys AS
Obstruction leads to pressure overload; LVH, incr LVED pressure
Gradient across valve
Severe AS if AoV
