Heart Sounds Flashcards
When do we percuss the chest?
Confirm liver size, if sign pleural effusions, or lung cancer
S1
Mitral and tricuspid valve closinh at the begining of systole.
Mitral before tricuspid. Although cannot hear it.
S2- what is it?
Closure of aortic and pulmonary valves- delay is bigger than first one, so might be heard.
Normal splitting becomes wider with inspiration and narrower with expiration
Added sounds- S3+S4
Low frequency sounds occuring in diastole.
S3- early diastole at time of maximum ventricular filling.
May be heard in young fir adults and pregnancy.
S4: time of atrial contraction and is only present if patient is in sinus rhythm.
Both sounds best heard with bell of stethoscope and pt slightly lying on left.
What are clicks and snaps?
Openinh of a normal heart valve is silent.
Ejection clicks- abnormal aortic or pulmonary valve as it opens in early systole.
Opening snap: abnormal mitral or tricuspid valve so occurs in diastole.
As valves become more severly damaged, the snap or click will dissapear.
Whats knock and rub?
In Constrictive pericarditis- loud , low frequency diastolic noise aka knock.
Pericardial rub: high frequency noise, loudest in systole, but can be in diastole as well.
If significant effusion is present, it will dissapear.
What are murmurs?
- Timing: systolic or Diastolic? Ir tachy- hard
S, d, systolic and diastolic, or continuous. - Pitch
Low- mitral stenosis
High: small VSDs-> loud
Systolic murmurs are graded out of 6.
1/6 - quiet.
Diastolic out of 4.
- Does it change during respiration?
Murmurs arising from R side are accentuated on inspiration. - Where does it radiate?
What is the grading of systolic murmurs?
Grade Thril. Murmur
1/6 Absent. V. Quiet
2/6. A. Quiet
3/6. A. Easily audible
4/6. Present. Loud
5/6. P. Audible with stethoscope half off chest
6/6. P. Audible w/o stethoscope
General physical examination- what do we look out for?
Obesity- stress factor
Thin tall stature: Marfaan synsrome
Xanthelesmas: raised serum cholesterol
Distal or central cyanosis: + finger clubbing?
Oedema- initially of legs, but severe HF–> generalised: ascites, pleural effusions.
Structural heart disease- more common in ots w/ other congenital abnormalities- look for dysmorphic features in face, skeletal, GI.
What murmurs are best heard over the aortic area? UPper R sternal edge
- Aortic stenosis- loudest in aortic area but the click is loudest at the apex. An abnormal aortic valve may be assc with coarcation. In very severe aortic stenosis - LVF - murmur may be soft.
Murmur occurs in systole, loudest in aortic area, could also be Still’s murmur. But usually lower left sternal edge.
Valvar aortic stenosis: radiation to neck, click or thrill present.
- Venous hum: common innocent murmur in childhood.
Loudest: above clavicle
When: through systole and diastole
What else could it be?: patent ductus arteriosus if loudest to left.
What makes it a venous hum?: variability with posture and pressure in neck.
What sounds are best heard over the pulmonary area?
2 L ICS Atrial septal defect Pulmonary stenosis Innocent pulmonary flow Patent ductus arteriosus Loud S2
ASD- what happens?
L-> R (as R atrial pressure is less) leading to:
1. Invrease in size (dilatation) of R atrium and ventricle
2. Increased blood flow to lungs
Dur to extra lung volume.
At times when R atrial pressure exceeds L, R-> L shunt eg during exrecise.
Commonest- secundum ASD in fossa ovalis.
Primum ASD- Av valve junction- mitral regurg..
Wide fixed splitting in larfe defects.
Signs and sx are identical. Asx until complications in adulthood
ECG: R deviation axisb
CXR: large heart, large R atrium,. If pulmonary HTN- peripheral pruining of vessels
Loudest?: pulm area
When? Mid systole
What else could it be? Pulm stenosis
What makes an ASD? Presence of wide splitting of S2.
Aortic stenosis- what happens?
Loudest- aortic area
When?: systole
What makes it valvar aortic stenosis?: radiation into neck
What is a venous hum?
Common inncoent murmur of childhood and cardiac anatomy is normal. The continuous noise originates from great vessels in the neck.
Common: 12M-6 Y
Also in fit young adults
But also in hyperdynamic circulation- anaemia, pregnancy and thyrotoxicosis.
When? Systole and diastole : Continuous murmur max above the clavicles often audible in pulmonary and aortic areas. Usually louder on R than L.
Ask pt to look over shoulder and look up- loudest when sitting, disappear when lying flat.
What else could a venous hum be?
PDA if loudest to left
What makes it a venous hum? Viariability with posture and pressure in the neck
