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Semester 5 PMCP Exam 1 > Heart Sounds > Flashcards

Heart Sounds Flashcards

1
Q

Aortic area

A

2nd ICS and RSB

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2
Q

Pulmonic area

A

2nd ICS at LSB

3rd ICS at LSB

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3
Q

Tricuspid area

A

5th ICS at LSB

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4
Q

Mitral area

A

Apex

5th to 6th ICS in MCL

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5
Q

Normal heart sounds - listen with

A

diaphragm

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6
Q

Abnormal listen with

A

bell

opposite order

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7
Q

Erbs point

A

confirm if something going on with aortic or pulmonic area

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8
Q

Heart sounds

A 
S1 - normal
S2 - normal
S3 - can be normal
S4 - abnormal
Murmurs
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9
Q

S1 signifies what

A

closing of the AV valves

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10
Q

S1 happens when

A

beginning of systole

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11
Q

Duration of S1

A

0.10 seconds

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12
Q

S1 heard loudest at

A

cardiac apex/mitral area

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13
Q

two components to S1

A

tricuspid and mitral valves

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14
Q

S1 intensity directly relates to

A

force of contraction and the ECG PR interval

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15
Q

S1 is __ and ___ compared to S2

A

Lower pitched and longer

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16
Q

S1 - listening

A

lub - the first sound

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17
Q

S1 split - commonly due to

A

right bundle branch block

Also seen with ventral septal defect

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18
Q

S1 - split - Reverse split when

A

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

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19
Q

S1 split - listening

A

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

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20
Q

S2 heart sounds - from what

A

closing of the semilunar valves at end of ventricular systole

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21
Q

Components of S2 heart sound

A

aortic (A2) and pulmonic (P2)

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22
Q

S2 heart sound - pulmonic valve closure is

A

delayed as the right ventricular systolic time is lengthened

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23
Q

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

A

softer sound

Left sternal border in 2nd to 4th ICS

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24
Q

S2 heart sound __ normally precedes __

how to physiologically accentuate the split

A

A2 normally precedes P2

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

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25
Q

S2 heart sound - accentuated by disorders associated with

A

right ventricular overload, RVH and inc right ventricular pressure

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26
Q

S2 split heart sound - listening

A

double beat in “dub”

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27
Q

abnormal splitting S2 heart sound is related to

A

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

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28
Q

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

A

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

29
Q

S2 heart sound - P2 is increased in

A

pulmonary HTN and the splitting of S2 may narrow or disappear

30
Q

S3 heart sound reflects

A

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

31
Q

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

A

ventricle after S2 during mid T to P phase of EKG

32
Q

S3 sound due to

A

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

33
Q

S3 heard best with

A

expiration in left sidelying at apex

34
Q

S3 may disappear when and why

A

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

35
Q

S3 sound can be normal in who

A

children and young adults but abnormal in those over 40

36
Q

S3 sound listening

A

after S2 so you have lub, dub and then “ta”

37
Q

S4 heart sound - signifies what

A

rapid ventricular filling that occurs after atrial contraction

38
Q

S4 heard before __ during __

A

S1 during expiration

39
Q

S4 heard best where

A

at apex

40
Q

S4 possibly due to

A

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

41
Q

S4 heart sound is associated with

A

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

42
Q

S4 heart sound correlates with what in EKG

A

PG segment

43
Q

When can S4 be “normal”

A

trained individual with left ventricular hypertrophy

44
Q

S4 listening

A

before S1 - at beginning of the lub

45
Q

split S1 versus S4

A

S1 is much quicker and split should be louder

Look at inspiration and expiration too

46
Q

Systolic murmurs occur between what

A

S1 and S2

47
Q

Diastolic murmurs occur between what

A

S2 and S1

48
Q

Loudness of murmur is a factor of what

A

the velocity of blood flow and turbulence it creates

Grades 1-VI

49
Q

Grades of murmurs

A

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

50
Q

Heart murmurs referred sounds progress

A

down stream

51
Q

Aortic stenosis radiates to

A

the carotid arteries o the neck

stenosis (forward)

52
Q

Mitral regurgitation radiates to

A

the axilla and back most often

regurgitation (backwards)

53
Q

Description of murmur

A 
frequency of pitch
intensity of grade
duration of timing
pattern
location
radiation
quality
presence of extra heart sounds and palpable findings
54
Q

Systolic murmurs include

A

aortic stenosis
pulmonary stenosis
mitral and tricuspid regurgitation
mitral valve prolapse

55
Q

Diastolic murmurs include

A

aortic regurgitation
pulmonic regurgitation
Mitral and tricuspid stenosis

56
Q

Systolic more associated with

A

S1

57
Q

Diastolic more associated with

A

S2

58
Q

Pulmonic valvular stenosis - from what

A

congenital pulmonic stenosis

59
Q

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

A

S1 is normal

Murmur begins after S1

60
Q

Pulmonic valvular stenosis - increases in intensity during

A

expiration and stops before S2

61
Q

Innocent murmur - most are what tract murmurs

A

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

62
Q

Innocent murmur - associated with

A

split S2

63
Q

Mitral valve stenosis

A

Low pitched, rumbling mid-diastolic murmur

64
Q

Mitral valve stenosis heard best at

A

apex

65
Q

Mitral valve prolapse murmur

A

late systolic murmur proceeded by mid-systolic click

66
Q

Mitral valve prolapse murmur heard best

A

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

67
Q

Ventral septal defect murmur - heard over what

A

lower sternal border

68
Q

Ventral septal defect murmur - heard when

A

after S1 and continues to S2

S2 narrows and P2 becomes louder than A2

69
Q

What usually develops from ventral septal defect

A

pulmonary HTN usually develops

Semester 5 PMCP Exam 1 (6 decks)

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