Heart Sounds Flashcards
Systolic thrill found over the 4th left intercostal space:
VSD
Systolic thrill found over the apex:
Mitral regurgitation
Systolic thrill found over left lower sternal border:
Tetralogy of Fallot
Systolic thrill found over the left upper sternal border:
PDA
Diastolic thrill found over the right sternal border:
Aortic regurgitation
Diastolic thrill found over the apex:
Mitral stenosis
Fixed split S2:
ASD
S3 (3):
- Passive flow (early)
- Quiet, low, difficult to hear
- CHF or volume overload
S4 (2):
- Active atrial ejection (late)
- May be confused with a split S1
Radiation to the carotid:
Aortic stenosis
Radiation to the axilla:
Mitral murmur
High pitch murmur:
High pressure gradient (VSD)
Low pitch murmur:
Large volumes of blood across low pressure gradients (mitral stenosis)
Harsh sounding murmur:
High pressure gradient and large volumes of blood
Machine like murmur:
PDA
Exercise/clench fists/hand grip (2):
- Increases ventricular volume
- Increases afterload
Murmur that remains the same/decreases during exercise/hand grip:
Aortic stenosis
Positional change or valsalva:
Decreases preload
Murmurs that get louder with positional change or valsalva (2):
- Hypertrophic cardiomyopathy
- Mitral valve prolapse
Leg raise or squats (3):
- Increase venous return
- Increases preload
- Increases PVR
Murmurs that decrease with leg raise or squats (2):
- Hypertrophic cardiomyopathy
- Mitral valve prolapse
Breathing increases:
Right ventricular preload
Murmur changes during inspiration (2):
- Right sided murmurs increase
- Left sided murmurs decrease (except hypertrophic cardiomyopathy)
Click (3):
- Sounds like splitting of S1
- Defective valve leaflets snapping or tensing when opened or shut
- Apex
