Heart Sounds Flashcards
What S-sounds represent systole? What valves opening and closing do each of these sounds represent?
S1 to S2.
S1- Mitral and triscupid valve closure.
S2- Aortic and Pulmonic valve closure.
T/F
Only the closing of valves should be audible.
True. Closing of valves should be audible. Opening of valves should be SILENT!!!
When auscultating heart sounds and trying to discern which heart sound is S1 and which one is S2. HOW do you determine which is which?
Diastole is twice as long as systole. Therefore the gap between sounds is what can guide you in correctly discerning S1/S2.
Also, palpating carotid for UPSTROKE (S1) can help.
A systolic murmur is heard during your auscultation of the heart. The murmur is not heard at all during diastole. Which two murmurs would be on your Differential Dx?
Why are you hearing these during systole?
Aortic Stenosis
Mitral Regurg.
(Cannot be patent ductus arteriosus because it is constant throughout both systole and diastole)
The aortic valve opens after S1, therefore if a stenosis is present in the aortic valve the sound will be heard throughout systole.
The mitral regurg. will be heard because the backwards flow of blood is occurring even after S1 (mitral valve closure has occurred).
Which position will you best hear a mitral regurg on a PT?
Left Lateral Decubitus. Auscultation post 5.
Which position will you best hear an aortic stenosis?
PT leaning forward. Auscultation posts 1 or 2.
If a murmur is auscultated upon diastole ONLY. What murmurs would be on your DDx? WHY?
Aortic Regurg.
Mitral Stenosis
Aortic Regurgitation will occur with the backwards flow of blood into the vents after its closure @ S2.
Mitral Stenosis will result in audible sounds during diastole because the atria are attempting to fill under excessive resistance of a stenotic valve. (Closure of mitral valve occurs at S1 which is why it is heard before)
Where will you best auscultate S1 heart sounds?
Is this sound lower or higher pitched than S2?
Apex and LLSB
S1- Lower pitched than S2
S2 heart sounds are best auscultated where?
Would you hear S2 better with your diaphragm or bell of your stethoscope?
Auscultation posts 1 and 2 at the 2RICS and 2LICS
S2 Higher pitched than S1; so you will hear it better w/ your diaphragm.
What is Physiologic Splitting of heart sounds? Which sound is heard 1st and 2nd?
What does this indicate?
Is splitting increased or decreased on INSPIRATION?
S2 is split into Aortic-2 and Pulmonic-2. (A2 and P2)
This is a NORMAL finding and is not concerning for Dz processes.
Physiologic splitting is INCREASED ON INSPIRATION.
What are some potential causes of Decreased S1 sounds?
-Increased chest wall thickness or cardiomyopathies/ hypertrophies.
-Pericardial effusion
(Masking heart sounds due to increased tissue thickness or fluid presence)
DECREASED Cardiac OUTPUT
- HYPOthyroidism
- AV Valve Calcification
- Mitral/Aortic insufficiency
- Shock
- LBBB / 1st Deg. AV Block
What could cause INCREASED S1 sounds?
Increased cardiac output
AORTIC STENOSIS –> Increased valve flow velocity
What could cause wide splitting of S1 sounds?
PVC’s
V-Tach
RBBB (Best heard at Tricuspid area) (Causes wide splitting of S1 and S2 sounds)
What can cause Wide Splitting of S2 sounds?
Early-A2
Mitral regurg.
Vent. septal defect (VSD)
Delayed-P2
Pulmonary stenosis
Pulmonary HTN
RBBB (causes wide splitting of both S1 and S2 sounds)
What is Paradoxical splitting? Is it best heard on INSPIRATION or EXPIRATION?
What are some potential causes?
P2 is heard 1st, followed by A2. (Reversed from normal)
Best heard on EXPIRATION.
HOCM (hypertrophic cardiomyopathy)
LBBB
Aortic stenosis or insuffic.
