Heart Sounds

Question 1

aortic valve

Answer 1

right 2nd ICS at SB

Question 2

pulmonic valve

Answer 2

left 2nd ICS at SB

Question 3

triscuspid valve

Answer 3

left 4th ICS at SB

Question 4

mitral valve

Answer 4

left 5th ICS at MCL

Question 5

grading heart murmur

Answer 5

-1- very faint
-2- quiet, soft, easily heard with stethoscope
-3- moderately loud
-4- loud with palpable thrill
-5- very loud with thrill; can hear with stethoscope partly off chest
-6- heart w/o stethoscope
(4-6- thrill)

Question 6

systolic and diastolic murmur

Answer 6

• systolic- b/w S1 and S2

- diastolic- b/w S2 and S1

Question 7

S1, S2

Answer 7

• S1- closure of TV and MV

- S2- closure of AV and PV (may split with inspiration)

Question 8

S3 gallop

Answer 8

• dull, low pitch; best heard with bell- ken-tuck-y
• children, young adults- normal
• older adults- HF
• when blood goes into ventricles!

Question 9

S4 gallop

Answer 9

• dull low pitch; best heard with bell (Ten-nes-see)
• forceful atrial contraction against stiffened low compliant ventricle
• atrial gallop

Question 10

systolic murmurs

Answer 10

-MR (MVR), TR
-AS, PS, VSD
(early, mid, late, holosystolic/pansystolic)

Question 11

diastolic murmurs

Answer 11

• AR, PR

- MS, TS, atrial myxoma

Question 12

alvular HD- caused by

Answer 12

degenerative

• myxomatous degeneration (MVP)
• congenital (bicuspid aortic valve)

Question 13

Mitral regurgitation- chronic

Answer 13

• MVP- most common!!

- MAC (mitral annular calcification

Question 14

Mitral regurgitation- acute

Answer 14

• rupture of chordal tendinae
• rupture of papillary m
• ischemic papillary m dysfxn (inferior wall MI!)

Question 15

MR symptoms

Answer 15

• chronic- asymptomatic yrs- fatigue DOE

- acute- volume overload- orthopnea, PND, HF

Question 16

MR- PE

Answer 16

• systolic murmur- prominent at apex- radiates into left axilla!!
• loudness- correlates with severity
• dec S1 or normal, may have systolic click

Question 17

mitral stenosis- symptoms

Answer 17

• 4th decade
• DOE, cough orthopnea, PND, pulm edema, hemoptysis, arterial emboli, A fib
• ortner syndrome- hoarseness due to recurrent laryngeal n

Question 18

MS- PE

Answer 18

• malar flush- ruddy cheeks, blue facies
• opening snap after S2
• rumbling, diastolic murmur- low pitched; best heard at apex; use bell

Question 19

Aortic stenosis- etiology

Answer 19

• degenerative!!

- congenital bicuspid aortic valve

Question 20

Aortic stenosis- symptoms

Answer 20

6th decade- exertional dyspnea, angina, syncope, HF

-w/o treatment- poor prognosis- die within 3 yrs of syncope, 2 yrs of HF

Question 21

AS- pathophysiology

Answer 21

• obstruction- causes pressure overload- LVH

- gradient across valve

Question 22

AS- PE

Answer 22

• narrow pulse pressure
• delayed pulses- parvis/tardus (small, late)
• systolic murmur, harsh, 2nd ICS RSB, radiates into suprasternal notch/carotids
• Gallavardin phenomenon- radiates to apex

Question 23

causes of AR

Answer 23

• acute- IE, aortic dissection

- chronic- syphilis, ankylosing spondylitis

Question 24

AR- PE

Answer 24

• wide pulse pressure

- diastolic, decrescendo murmur, 3rd ICS LSB

Question 25

Tricuspid Regurgitation- assoc with

Answer 25

• assoc with pulm HTN, inferior MI
• prominent “v” wave in JVP
• systolic murmur, inc with inspiration (carvallo’s sign)

Question 26

tricuspid stenosis- assoc with

Answer 26

• MS, TR, RhD
• prominent “A” wave in JVP
• diastolic murmur, inc with inspiration, dec with expiration and valsalva

Question 27

Pulmonic regurgitation- cause

Answer 27

• pulm HTN!

- diastolic, murmur 2nd ICS SB

Question 28

pulmonary stenosis

Answer 28

• congenital
• systolic murmur
• 2/3rd ICS LSB, radiates twd left shoulder