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Semester 5 PMCP Exam 1 > Heart Sounds > Flashcards

Heart Sounds Flashcards

1
Q

aortic area is between what?

A

2nd ICS and RSB

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2
Q

Pulmonic area is where?

A

left side

2nd ICS at LSB and the 3rd ICS at LSB

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3
Q

Tricuspid Area best listened to where?

A

5th ICS at LSB

perhaps right side better if they have hypertrophy or disease

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4
Q

mitral area best heard where?

A

apex, 5th to 6th ICS in the MCL

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5
Q

when listening to normal heart sounds, use the ___

A

diaphragm

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6
Q

when listening for abnormal heart sounds, use the ___

A

bell

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7
Q

listening sequence for normal heart sounds

A

aortic, pulmonic, erb’s point, tricuspid, mitral

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8
Q

listening sequence for abnormal heart sounds

A

mitral, tricuspid, erb’s point, pulmonic, aortic

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9
Q

Purpose of Erb’s point?

A

helps detect issues in aortic or pulmonic valves. regurgitation may radiate into erb’s point area

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10
Q

S1 signifies the closing of which valves?

A

AV valves (mitral and tricuspid)

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11
Q

S1 begins when?

A

at the beginning of systole

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12
Q

how long does it take for the mitral and tricuspid valves to close?

A

0.10 seconds

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13
Q

which is lower pitched: S1 or S2?

A

S1

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14
Q

S1 is best heard where?

A

over apex of heart (mitral area)

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15
Q

The intensity of S1 relates to what two things?

A

the force of contraction and the PR interval

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16
Q

S1 occurs when on the ECG?

A

R (valves close at the end of R)

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17
Q

S1 is which sound?

A

first sound - “lub”

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18
Q

listen for S1 with which part of the stethescope?

A

diaphragm (Because it is a normal sound)

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19
Q

describe the S1 split

A

two quick beats together followed by the “dub”

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20
Q

S1 split due to

A

RBBB or ventral septal defect

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21
Q

S1 split is normal only when

A

it is heard with inspiration

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22
Q

T/F if you hear an S1 split it will be at the top of the heart

A

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

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23
Q

S2 sounds are best heard where?

A

top of the heart around the 2,3,4th ICS

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24
Q

T/F: if someone has an S1 or S2 split, you will hear it with every beat

A

false - you should not hear it with every beat

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25
Q

S2 represents which valves closing?

A

semilunar valves (aortic and pulmonic)

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26
Q

which is shorter and more high pitched?

A

S2

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27
Q

pulmonic valve closure is delayed as what is lengthened?

A

pulmonic valve closure is delyaed as the right ventricular systolic time is lengthened

28
Q

the pulmonic component of S2 is best heard where?

A

left sternal border in 2-4th ICS

29
Q

S2 split sounds like what?

A

lub followed by 2 quick beats

30
Q

S3 is heard best when?

A

with expiration in left sidelying at the apex. Sidelying brings the apex closer to the surface (MCL)

31
Q

how often will you hear S3 if the pt has it?

A

every 3rd or 4th beat

32
Q

S3 heart sounds are normal in which two populations?

A

children and young adults (abnormal in those over 40)

33
Q

S3 represents what

A

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

34
Q

the S3 sound is what?

A

the vibration of the ventricular wall trying to elongate to let blood in

35
Q

S3 occurs when o nthe ECG?

A

mid T to P phase

36
Q

Why may an S3 sound disappear when the pt stands up?

A

because pre load decreases due to gravity, so there is less blood in the heart compared to in supine

37
Q

S3 sound description

A

lub, dub, TAH
fainter and shorter
like an echo after the dub

38
Q

S4 is heard when?

A

before S1 during expiration

39
Q

what does S4 represent?

A

rapid ventricular filling that occurs after atrial contraction

40
Q

S4 is heard best where?

A

apex of the heart

41
Q

S4 is associated with?

A

atrial kick. it is due to non-compliant ventricular wall

42
Q

S4 is absent with what heart pathology?

A

afib because there is no atrial kick to get blood flow into the ventricle

43
Q

S4 correlates with which aspect of the ECG?

A

P-Q segment

44
Q

S4 is associated with what pathologies?

A

ischemic heart disease, cardiomyopathies, severe HTN, mitral regurgitation

45
Q

S4 can be heard in what population?

A

trained athletes who have LVH

46
Q

an S1 or S2 split should be louder than what?

A

an S3 or S4 sound

47
Q

Stages of murmurs: stage 1

A

faint: requires concentrated effort to hear (ex = innocent murmur in kids)

48
Q

Stages of murmurs: stage 2

A

faint but sustained; won’t grow out of it

49
Q

Stages of murmurs: stage 3

A

sustained, beginning of mitral regurg or stenosis

50
Q

Stages of murmurs: stage 4

A

loud; intermediate intensity and can palpate turbulent flow w/ fingers

51
Q

Stages of murmurs: stage 5

A

very loud with thrill present that you can hear w/o stethescope

52
Q

Stages of murmurs: stage 6

A

very audible w/o stethescope. end stages

53
Q

Aortic stenosis sounds radiate where?

A

to the carotid arteries of the neck

54
Q

mitral regurg radiates where?

A

to the axilla and back

55
Q

Bruit

A

heart sounds that radiate outside of the heart area

56
Q

systolic

A

S1

57
Q

diastolic

A

S2

58
Q

listen to murmurs with which part of the stethoscope

A

diaphragm

59
Q

Systolic murmurs (s1) include?

A
  • aortic and pulmonary stenosis
  • mitral and tricuspid regurgitations
  • mitral valve prolapse
60
Q

Diastolic murmurs (s2) include?

A
  • aortic and pulmonic regurgitation

- mitral and tricuspid stenosis

61
Q

Pulmonic valvular stenosis murmurs

A
  • 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
62
Q

Innocent murmur

A
  • 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
63
Q

Mitral valve stenosis

A
  • low pitched rumbling mid diastolic murmur

- heard best at the apex

64
Q

mitral valve prolapse murmur

A
  • 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
65
Q

describe what mitral valve prolapse is

A

leaflet isn’t working well so you will hear an initial rumble followed by a click. the click is the bad leaflet closing

66
Q

ventral septal defect murmur

A
  • 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

Semester 5 PMCP Exam 1 (3 decks)

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