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PCM Final > Heart Sounds > Flashcards

Heart Sounds Flashcards

1
Q

Patient position during the heart exam?

A
  • Supine, at 30 degrees for the cardiac exam
  • Left lateral decubitus position when finding the PMI
    . To listen to S3/S4/rubs, patient leans forward
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2
Q

What is the intensity scare for heart sounds?

A
  • 1: barely audible
  • 6: heard with stethoscope off the chest
    • If you can feel a thrill, already at a 4
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3
Q

Characteristics of Innocent and physiologic murmurs?

A
  • Found in the 2-4th left intercostal space
  • Usually do not radiate
  • Soft - medium pitch
  • Decreases with standing
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4
Q

What are innocent murmurs usually due to?

A

Turbulent blood flow from strong ventricle ejection

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5
Q

What is the diaphragm best at hearing?

A
  1. High pitches
  2. S1/S2/midsystolic click
  3. Aortic and mitral regurgitation
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6
Q

What is bell best at hearing?

A

Low pitched

S3/S4, mitral stenosis

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7
Q

When do systole and diastole occur?

A

Systole: between S1 and S2
Diastole: after S2 and before next S1

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8
Q

How can S1/2 be distinguished relative to carotid?

A
  • S1 immediately precedes carotid upstroke

- S2 immediately follows carotid downstroke

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9
Q

When is S1 diminished?

A
  1. At the base
  2. 1st degree heart block
  3. Mitral regurgitation
  4. Decreased contractility of ventricle
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10
Q

When is S1 accentuated?

A
  1. At the apex
  2. In tachycardia
  3. Short PR interval
  4. High CO
  5. Mitral stenosis
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11
Q

Where can split S1 normally be heard?

A

Over the LLSB

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12
Q

What can cause abnormal S1?

A

Heard due to a RBBB or PVC

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13
Q

When is Aortic S2 accentuated?

A
  1. Systemic htn

2. Dilated aortic root

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14
Q

When is Aortic S2 diminished?

A

Aortic stenosis

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15
Q

When is Pulmonic S2 accentuated?

A
  1. Pulmonary htn
  2. Dilated pulmonary arteries
  3. ASD’s
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16
Q

When is Pulmonic S2 diminished?

A
  1. Pulmonic stenosis

2. Increased AP diameter

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17
Q

Location and radiation of mitral regurg?

A

Loudest at apex radiating to the axilla

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18
Q

What does mitral regurg sound like?

A

Holosystolic high pitched blowing murmur

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19
Q

Causes of mitral regurg?

A
  1. Ischemic heart disease
  2. MVP
  3. LV dilation
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20
Q

Maneuvers for mitral regurg?

A
  1. Increases with hand grip

2. Click is later and more intense when squatting

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21
Q

What does tricuspid regurg sound like?

A
  • Medium pitched holosystolic blowing
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22
Q

Where is tricuspid regurg heard? Radiation?

A
  • Lower left sternal border radiating to sternum
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23
Q

What can increase tricuspid regurg?

A

Inspiration

24
Q

What does aortic stenosis sound like?

A
  • Harsh crescendo decrescendo
25
Q

Where is aortic stenosis best heard? Radiation?

A
  • Second right intercostal radiation to carotids, down sternal border and to apex
26
Q

What increases / decreases aortic stenosis?

A

Increase: Squatting, sitting, leaning forward
Decrease: Hand grip

27
Q

Sound of mitral valve prolapse?

A
  • Late systolic crescendo murmur with midsystolic click
28
Q

Where is mitral valve prolapse best heard?

A

Over the apex

29
Q

Maneuvers for mitral prolapse?

A

Earlier: Standing, valsalva
Delayed: squatting

30
Q

What does aortic regurg sound like?

A
  • Early blowing crescendo in diastole
31
Q

Where is aortic regurg heard?

A
  • Left upper sternal border
32
Q

What increases / decreases aortic regurg?

A

Increase: hand grip, lean forward, expiration

33
Q

When is mitral stenosis best heard?

A
  • Left lateral decubitus
  • Exercise
  • Exhalation
  • Hand grip
34
Q

Where is mitral stenosis best heard?

A
  • Apex in decubitus with bell
35
Q

What does splitting of S2 sound like?

A
  • Heard on inspiration due to more negative pleural pressure
36
Q

Where is physiologic splitting of S2 heard?

A

2-3 Left intercostal space

37
Q

What is pathologic splitting of S2?

A

Splitting of S2 that persists throughout inspiratory cycle

38
Q

Where is physiologic pathologic of S2 heard?

A

2-3 Left intercostal space

39
Q

Where is S3 heard?

A

Right sided: Apex in left lateral decubitus with bell

Left sided: left sternal border

40
Q

What hounds are heard with bell?

A
  1. S3
  2. S4
  3. Mitral stenosis
41
Q

When does S3 occur? From what?

A

During diastole from rapid ventricular filling

42
Q

When is S3 normal?

A

Children and 3rd trimester

43
Q

When is S3 louder?

A

Louder on inspiration if right sided

44
Q

Another name for S3?

A

Left ventricular gallop

45
Q

When is S4 heard?

A

Just before S1

46
Q

Where is S4 heard?

A

Right sided: Apex in left lateral decubitus with bell

Left sided: left sternal border

47
Q

Where is S1 louder than S2?

A

The apex

48
Q

Where is S2 louder than S1?

A

The base

49
Q

When is a loud S1 heard?

A
  1. Mitral stenosis
  2. High output states
    a. Anemia
    b. Thyrotoxicosis
    c. Fever
50
Q

What determines S1 intensity?

A
  1. Proper closure of mitral and tricuspid valves
  2. LV contractility
  3. Distance mitral valve has to travel to shut
  4. Rate of heart
  5. High or low output
51
Q

Why does mitral stenosis create a loud S1?

A
  • Mitral valves are open wide at onset of v. contraction and travels briskly / far to shut creating a loud sound. Whenever the valves are open wide at the onset of ventricular contraction and travel a distance to shut, result in loud sound
52
Q

Does the polmonic or aortic valve close first?

A
  • Aortic, because pressure in aorta is higher
53
Q

When is S3 heard?

A 
Heart failure: Non-compliant ventricle 
Volume overload: Increased flow 
Mitral regurgitation: Increased flow 
Tricuspid regurgitation: Increased flow 
Aortic incompetence: Increased flow
54
Q

What causes S3?

A
  • Strong elastic recoil of ventricle upon diastolic filling in healthy individual
55
Q

What causes S4?

A
  • Sound generated by atrial contraction
56
Q

What states cause S4?

A
  1. S4 is heard when the ventricles are non-compliant
  2. Pressure overload
  3. Stiff myocardium

PCM Final (14 decks)

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