Heart Sounds Flashcards
aortic area is between what?
2nd ICS and RSB
Pulmonic area is where?
left side
2nd ICS at LSB and the 3rd ICS at LSB
Tricuspid Area best listened to where?
5th ICS at LSB
perhaps right side better if they have hypertrophy or disease
mitral area best heard where?
apex, 5th to 6th ICS in the MCL
when listening to normal heart sounds, use the ___
diaphragm
when listening for abnormal heart sounds, use the ___
bell
listening sequence for normal heart sounds
aortic, pulmonic, erb’s point, tricuspid, mitral
listening sequence for abnormal heart sounds
mitral, tricuspid, erb’s point, pulmonic, aortic
Purpose of Erb’s point?
helps detect issues in aortic or pulmonic valves. regurgitation may radiate into erb’s point area
S1 signifies the closing of which valves?
AV valves (mitral and tricuspid)
S1 begins when?
at the beginning of systole
how long does it take for the mitral and tricuspid valves to close?
0.10 seconds
which is lower pitched: S1 or S2?
S1
S1 is best heard where?
over apex of heart (mitral area)
The intensity of S1 relates to what two things?
the force of contraction and the PR interval
S1 occurs when on the ECG?
R (valves close at the end of R)
S1 is which sound?
first sound - “lub”
listen for S1 with which part of the stethescope?
diaphragm (Because it is a normal sound)
describe the S1 split
two quick beats together followed by the “dub”
S1 split due to
RBBB or ventral septal defect
S1 split is normal only when
it is heard with inspiration
T/F if you hear an S1 split it will be at the top of the heart
false - if you hear an S1 split it will be at the bottom of the heart becasue the S2 sound will be heard at the top
S2 sounds are best heard where?
top of the heart around the 2,3,4th ICS
T/F: if someone has an S1 or S2 split, you will hear it with every beat
false - you should not hear it with every beat
S2 represents which valves closing?
semilunar valves (aortic and pulmonic)
which is shorter and more high pitched?
S2
pulmonic valve closure is delayed as what is lengthened?
pulmonic valve closure is delyaed as the right ventricular systolic time is lengthened
the pulmonic component of S2 is best heard where?
left sternal border in 2-4th ICS
S2 split sounds like what?
lub followed by 2 quick beats
S3 is heard best when?
with expiration in left sidelying at the apex. Sidelying brings the apex closer to the surface (MCL)
how often will you hear S3 if the pt has it?
every 3rd or 4th beat
S3 heart sounds are normal in which two populations?
children and young adults (abnormal in those over 40)
S3 represents what
faint low frequency sound that represents early ventricular filling that occurs after the AV valves open
the S3 sound is what?
the vibration of the ventricular wall trying to elongate to let blood in
S3 occurs when o nthe ECG?
mid T to P phase
Why may an S3 sound disappear when the pt stands up?
because pre load decreases due to gravity, so there is less blood in the heart compared to in supine
S3 sound description
lub, dub, TAH
fainter and shorter
like an echo after the dub
S4 is heard when?
before S1 during expiration
what does S4 represent?
rapid ventricular filling that occurs after atrial contraction
S4 is heard best where?
apex of the heart
S4 is associated with?
atrial kick. it is due to non-compliant ventricular wall
S4 is absent with what heart pathology?
afib because there is no atrial kick to get blood flow into the ventricle
S4 correlates with which aspect of the ECG?
P-Q segment
S4 is associated with what pathologies?
ischemic heart disease, cardiomyopathies, severe HTN, mitral regurgitation
S4 can be heard in what population?
trained athletes who have LVH
an S1 or S2 split should be louder than what?
an S3 or S4 sound
Stages of murmurs: stage 1
faint: requires concentrated effort to hear (ex = innocent murmur in kids)
Stages of murmurs: stage 2
faint but sustained; won’t grow out of it
Stages of murmurs: stage 3
sustained, beginning of mitral regurg or stenosis
Stages of murmurs: stage 4
loud; intermediate intensity and can palpate turbulent flow w/ fingers
Stages of murmurs: stage 5
very loud with thrill present that you can hear w/o stethescope
Stages of murmurs: stage 6
very audible w/o stethescope. end stages
Aortic stenosis sounds radiate where?
to the carotid arteries of the neck
mitral regurg radiates where?
to the axilla and back
Bruit
heart sounds that radiate outside of the heart area
systolic
S1
diastolic
S2
listen to murmurs with which part of the stethoscope
diaphragm
Systolic murmurs (s1) include?
- aortic and pulmonary stenosis
- mitral and tricuspid regurgitations
- mitral valve prolapse
Diastolic murmurs (s2) include?
- aortic and pulmonic regurgitation
- mitral and tricuspid stenosis
Pulmonic valvular stenosis murmurs
- congenital (born with it)
- S1 will sound normal
- murmur begins after S1
- increases in intensity during expiration and stops before S2
- will hear swoosh after S1 lub
Innocent murmur
- most are pulmonic outflow tract murmurs and are not pathological
- not louder than grade 2
- do not radiate
- goes away with exercise
- associated w/ split S2 sound at rest
Mitral valve stenosis
- low pitched rumbling mid diastolic murmur
- heard best at the apex
mitral valve prolapse murmur
- late systolic murmur proceeded by mid systolic click
- heard best in upright sitting at apex
- increased if pts stand up or valsalva
- seen with pectus excavatum b/c sternum puts pressure on the heart
describe what mitral valve prolapse is
leaflet isn’t working well so you will hear an initial rumble followed by a click. the click is the bad leaflet closing
ventral septal defect murmur
- heard over lower sternal border
- after S1 and continues to S2
- S2 narrows, P2 becomes louder than A2
- pulmonary HTN can develop
- occurs during systole phase
- shunting of blood from R to L side
