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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
Where is aortic stenosis best heard? Radiation?
- Second right intercostal radiation to carotids, down sternal border and to apex
26
What increases / decreases aortic stenosis?
Increase: Squatting, sitting, leaning forward Decrease: Hand grip
27
Sound of mitral valve prolapse?
- Late systolic crescendo murmur with midsystolic click
28
Where is mitral valve prolapse best heard?
Over the apex
29
Maneuvers for mitral prolapse?
Earlier: Standing, valsalva Delayed: squatting
30
What does aortic regurg sound like?
- Early blowing crescendo in diastole
31
Where is aortic regurg heard?
- Left upper sternal border
32
What increases / decreases aortic regurg?
Increase: hand grip, lean forward, expiration
33
When is mitral stenosis best heard?
- Left lateral decubitus - Exercise - Exhalation - Hand grip
34
Where is mitral stenosis best heard?
- Apex in decubitus with bell
35
What does splitting of S2 sound like?
- Heard on inspiration due to more negative pleural pressure
36
Where is physiologic splitting of S2 heard?
2-3 Left intercostal space
37
What is pathologic splitting of S2?
Splitting of S2 that persists throughout inspiratory cycle
38
Where is physiologic pathologic of S2 heard?
2-3 Left intercostal space
39
Where is S3 heard?
Right sided: Apex in left lateral decubitus with bell | Left sided: left sternal border
40
What hounds are heard with bell?
1. S3 2. S4 3. Mitral stenosis
41
When does S3 occur? From what?
During diastole from rapid ventricular filling
42
When is S3 normal?
Children and 3rd trimester
43
When is S3 louder?
Louder on inspiration if right sided
44
Another name for S3?
Left ventricular gallop
45
When is S4 heard?
Just before S1
46
Where is S4 heard?
Right sided: Apex in left lateral decubitus with bell | Left sided: left sternal border
47
Where is S1 louder than S2?
The apex
48
Where is S2 louder than S1?
The base
49
When is a loud S1 heard?
1. Mitral stenosis 2. High output states a. Anemia b. Thyrotoxicosis c. Fever
50
What determines S1 intensity?
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
Why does mitral stenosis create a loud S1?
- 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
Does the polmonic or aortic valve close first?
- Aortic, because pressure in aorta is higher
53
When is S3 heard?
``` Heart failure: Non-compliant ventricle Volume overload: Increased flow Mitral regurgitation: Increased flow Tricuspid regurgitation: Increased flow Aortic incompetence: Increased flow ```
54
What causes S3?
- Strong elastic recoil of ventricle upon diastolic filling in healthy individual
55
What causes S4?
- Sound generated by atrial contraction
56
What states cause S4?
1. S4 is heard when the ventricles are non-compliant 2. Pressure overload 3. Stiff myocardium

PCM Final (14 decks)

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