Heart Sounds Flashcards
S1
closure of the AV valves
S2
closure of the aortic and pulmonary valves
S3
heard during rapid ventricular filling and may represent tensing of chordae tendineae and AV ring during ventricular relaxation and filling
S4
sometimes noted during atrial contraction, caused by vibration of the ventricular wall during atrial contraction
Split S1
the mitral and tricuspid components of S1 have become separated enough to be distinguished as two separate sounds
Split S2
the aortic and pulmonic components of S2 have become separated enough to be distinguished as two separate sounds. This happens normally during inspiration
Opening Snap
a high-pitch additional sound may be heard after the A2 (aortic) component of the second heart sound (S2), which correlates to the forceful opening of the mitral valve
loud ejection click that decreases with inspiration followed by a loud, harsh systolic murmur (or high pitched systolic ejection murmur) with a thrill that radiates to the left shoulder and worsens with inspiration
Pulmonary Valve Stenosis
a continuous murmur heard superiorly mid-line in the back or over the left anterior chest
Coarctation of the Aorta
first heart sound normal or split, mid-systolic murmur, split second heart sound, and a mid-diastolic murmur along the left sternal border
Atrial Septal Defect
systolic ejection murmur with a widely split second heart sound
Atrial Septal Defect
Harsh, holosystolic murmur heard best along left sternal border
Ventricular Septal Defect
harsh systolic ejection murmur
Tetralogy of Fallot
continuous rough “machinery” murmur and a loud S2 heard best in the first and second intercostal spaces along the left sternal border
Patent Ductus Arteriosus
prominent S1, opening snap after S2, and apical diastolic rumble heard best at the apex with the patient in the left lateral position
Mitral Stenosis
high pitched blowing pansystolic murmur prominent at the apex and radiating to the axilla; prominent third heart sound (mid-systolic click)
Mitral Regurgitation
mid-to-late systolic click that is accentuated during the Valsalva Maneuver and standing
may hear a late systolic murmur
Mitral Valve Prolapse
harsh crescendo-decrescendo systolic ejection murmur often radiating to the neck and apex
soft, absent, or paradoxically split S2
sometimes with thrill along left sternal border
Aortic Stenosis
soft systolic flow murmur and high-pitched decrescendo diastolic murmur with a late diastolic rumble heard along the left sternal border (Austin Flint Murmur)
Aortic Regurgitation
Right-sided murmurs ____ with inspiration.
Increase - called Cavalio’s Sign
exception: ejection click of Pulmonary Valve Stenosis
Left-sided murmurs _____ with exhalation.
Increase
Most murmurs increase with more _____.
Preload (squatting or leg-lifts)
exceptions: Mitral Valve Prolapse and hypertrophic cardiomyopathy
Pansystolic Murmurs
Mitral Regurgitation, Tricuspid Regurgitation, and Ventricular Septal Defect
Continuous “Machinery” Murmur
Patent Ductus Arteriorsus
diastolic rumble along left sternal border that increases with inspiration
Tricuspid Stenosis
S3 gallop; high-pitched holosystolic, pansystolic murmur, loudest at the fourth intercostal space in the parasternal region that increases with inspiration
decreases with standing or Valsalva
short early diastolic flow rumble
Tricuspid Valve Regurgitation
widely split S2; loud diastolic decrescendo murmur (Graham-Steell murmur); Murmur increases with inspiration
Pulmonary Valve Regurgitation
reverse splitting of S2, presence of S3 or S4, new or worsening apical systolic murmur, or rales or cackles
Unstable Angina
