Heart Sounds

Question 1

Aortic area

Answer 1

2nd ICS and RSB

Question 2

Pulmonic area

Answer 2

2nd ICS at LSB

3rd ICS at LSB

Question 3

Tricuspid area

Answer 3

5th ICS at LSB

Question 4

Mitral area

Answer 4

Apex

5th to 6th ICS in MCL

Question 5

Normal heart sounds - listen with

Answer 5

diaphragm

Question 6

Abnormal listen with

Answer 6

bell

opposite order

Question 7

Erbs point

Answer 7

confirm if something going on with aortic or pulmonic area

Question 8

Heart sounds

Answer 8

S1 - normal
S2 - normal
S3 - can be normal
S4 - abnormal
Murmurs

Question 9

S1 signifies what

Answer 9

closing of the AV valves

Question 10

S1 happens when

Answer 10

beginning of systole

Question 11

Duration of S1

Answer 11

0.10 seconds

Question 12

S1 heard loudest at

Answer 12

cardiac apex/mitral area

Question 13

two components to S1

Answer 13

tricuspid and mitral valves

Question 14

S1 intensity directly relates to

Answer 14

force of contraction and the ECG PR interval

Question 15

S1 is __ and ___ compared to S2

Answer 15

Lower pitched and longer

Question 16

S1 - listening

Answer 16

lub - the first sound

Question 17

S1 split - commonly due to

Answer 17

right bundle branch block

Also seen with ventral septal defect

Question 18

S1 - split - Reverse split when

Answer 18

mitral valve closes after tricuspid valve - severe left BBB or mitral stenosis

Question 19

S1 split - listening

Answer 19

very fine double beat at the beginning - won’t be every beat though
You will only hear this at the bottom of the heart

Question 20

S2 heart sounds - from what

Answer 20

closing of the semilunar valves at end of ventricular systole

Question 21

Components of S2 heart sound

Answer 21

aortic (A2) and pulmonic (P2)

Question 22

S2 heart sound - pulmonic valve closure is

Answer 22

delayed as the right ventricular systolic time is lengthened

Question 23

S2 heart sound - pulmonic component is a __ sound and can best be heard at

Answer 23

softer sound

Left sternal border in 2nd to 4th ICS

Question 24

S2 heart sound __ normally precedes __

how to physiologically accentuate the split

Answer 24

A2 normally precedes P2

Split is physiologically accentuated by inspiration due to delayed closure of P2 from increased filling

Question 25

S2 heart sound - accentuated by disorders associated with

Answer 25

right ventricular overload, RVH and inc right ventricular pressure

Question 26

S2 split heart sound - listening

Answer 26

double beat in "dub"

Question 27

abnormal splitting S2 heart sound is related to

Answer 27

valvular dysfunction and/or alterations in blood flow to or from ventricles

Question 28

S2 slit - if heard on expiration where A2 is heard after P2 could be caused by

Answer 28

LBB, aortic stenosis, systemic HTN, left ventricular heart dysfunction

Question 29

S2 heart sound - P2 is increased in

Answer 29

pulmonary HTN and the splitting of S2 may narrow or disappear

Question 30

S3 heart sound reflects

Answer 30

early ventricular filling that occurs after the AV valves open faint, low frequency

Question 31

S3 heart sound - rumbling sound produced by the (where in EKG)

Answer 31

ventricle after S2 during mid T to P phase of EKG

Question 32

S3 sound due to

Answer 32

diastolic distension of the ventricle and vibration arising from the wall motion

Question 33

S3 heard best with

Answer 33

expiration in left sidelying at apex

Question 34

S3 may disappear when and why

Answer 34

sitting up or standing - because of gravity there is not as much preload on the heart

Question 35

S3 sound can be normal in who

Answer 35

children and young adults but abnormal in those over 40

Question 36

S3 sound listening

Answer 36

after S2 so you have lub, dub and then "ta"

Question 37

S4 heart sound - signifies what

Answer 37

rapid ventricular filling that occurs after atrial contraction

Question 38

S4 heard before __ during __

Answer 38

S1 during expiration

Question 39

S4 heard best where

Answer 39

at apex

Question 40

S4 possibly due to

Answer 40

non-compliant ventricular wall, associated with atrial kick and is absent in atrial fibrillation

Question 41

S4 heart sound is associated with

Answer 41

ischemic heart disease, cardiomyopathies, severe systemic HTN and mitral regurgitation

Question 42

S4 heart sound correlates with what in EKG

Answer 42

PG segment

Question 43

When can S4 be "normal"

Answer 43

trained individual with left ventricular hypertrophy

Question 44

S4 listening

Answer 44

before S1 - at beginning of the lub

Question 45

split S1 versus S4

Answer 45

S1 is much quicker and split should be louder | Look at inspiration and expiration too

Question 46

Systolic murmurs occur between what

Answer 46

S1 and S2

Question 47

Diastolic murmurs occur between what

Answer 47

S2 and S1

Question 48

Loudness of murmur is a factor of what

Answer 48

the velocity of blood flow and turbulence it creates | Grades 1-VI

Question 49

Grades of murmurs

Answer 49

From faint and requires effort to hear all the way to can be heard without stethoscope

Question 50

Heart murmurs referred sounds progress

Answer 50

down stream

Question 51

Aortic stenosis radiates to

Answer 51

the carotid arteries o the neck | stenosis (forward)

Question 52

Mitral regurgitation radiates to

Answer 52

the axilla and back most often | regurgitation (backwards)

Question 53

Description of murmur

Answer 53

``` frequency of pitch intensity of grade duration of timing pattern location radiation quality presence of extra heart sounds and palpable findings ```

Question 54

Systolic murmurs include

Answer 54

aortic stenosis pulmonary stenosis mitral and tricuspid regurgitation mitral valve prolapse

Question 55

Diastolic murmurs include

Answer 55

aortic regurgitation pulmonic regurgitation Mitral and tricuspid stenosis

Question 56

Systolic more associated with

Answer 56

S1

Question 57

Diastolic more associated with

Answer 57

S2

Question 58

Pulmonic valvular stenosis - from what

Answer 58

congenital pulmonic stenosis

Question 59

Pulmonic valvular stenosis - what is normal, when does murmur begin

Answer 59

S1 is normal | Murmur begins after S1

Question 60

Pulmonic valvular stenosis - increases in intensity during

Answer 60

expiration and stops before S2

Question 61

Innocent murmur - most are what tract murmurs

Answer 61

pulmonic outflow tract murmurs and are not pathologic Dont radiate Change with activity

Question 62

Innocent murmur - associated with

Answer 62

split S2

Question 63

Mitral valve stenosis

Answer 63

Low pitched, rumbling mid-diastolic murmur

Question 64

Mitral valve stenosis heard best at

Answer 64

apex

Question 65

Mitral valve prolapse murmur

Answer 65

late systolic murmur proceeded by mid-systolic click

Question 66

Mitral valve prolapse murmur heard best

Answer 66

in upright sitting at apex inc if patient stands up or vasalva seen with pectus excavatum

Question 67

Ventral septal defect murmur - heard over what

Answer 67

lower sternal border

Question 68

Ventral septal defect murmur - heard when

Answer 68

after S1 and continues to S2 | S2 narrows and P2 becomes louder than A2

Question 69

What usually develops from ventral septal defect

Answer 69

pulmonary HTN usually develops