Heart Sounds Flashcards

1
Q

S1

A

Closure of mitral and tricuspid valves – beginning of systole
(long, soft, low-pitched sound)

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2
Q

S2

A

Closure of aortic and pulmonic valves – beginning of diastole
(short, sharp, high-pitched sound)

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3
Q

S3

A

Due to rapid ventricular filling – deceleration of blood against ventricular wall (volume overload)

  • Physiologic: children and young adults
  • Pathologic (‘S3/ventricular gallop’): ventricular volume overload (heart failure, mitral regurgitation)
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4
Q

S4

A

Due to atrial contraction against stiff ventricular wall (pressure overload)

  • Physiologic: trained athletes
  • Pathologic (‘S4/atrial gallop’): resistance to ventricular filling due to decreased compliance (ventricular hypertrophy, restrictive cardiomyopathy)
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5
Q

Points of auscultation

Pulmonic valve

A

2nd left intercostal space, parasternal

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6
Q

Points of auscultation

Aortic valve

A

2nd right intercostal space, parasternal

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7
Q

Points of auscultation

Mitral valve

A

5th left intercostal space, midclavicular line (apex)

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8
Q

Points of auscultation

Tricuspid valve

A

Over lower sternum

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9
Q

Timing in the cardiac cycle

Pan (holo) - systolic/diastolic murmur

A

Along the entire phase

Mitral regurgitation

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10
Q

Timing in the cardiac cycle

Early (proto) - systolic/diastolic murmur

A

Beginning of the phase

Aortic Regurgitation

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11
Q

Timing in the cardiac cycle

Mid (meso) - systolic/diastolic

A

Middle of the phase

Aortic stenosis

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12
Q

Timing in the cardiac cycle

Late (tele) - systolic/diastolic

A

End of the phase

Mitral stenosis

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13
Q

Timing in the cardiac cycle

Continuous murmur

A

During the entire cardiac cycle

Friction rub, VSD

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14
Q

Shape (configuration) of the murmur

Aortic stenosis

A

Crescendo-decrescendo murmur

first rises in intensity, then falls

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15
Q

Shape (configuration) of the murmur

Mitral regurgitation

A
Plateau murmur
(the same intensity throughout)
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16
Q

Shape (configuration) of the murmur

Mitral stenosis

A
Crescendo murmur
(intensity grows louder)
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17
Q

Shape (configuration) of the murmur

Aortic Regurgitation

A
Decrescendo murmur
(intensity falls)
18
Q

Location of maximal intensity (‘punctum maximum’)

Aortic murmurs

A

Loudest at the base

19
Q

Location of maximal intensity (‘punctum maximum’)

Mitral murmurs

A

Loudest at the apex

20
Q

Radiation - Where to

Aortic murmurs

21
Q

Radiation - Where to

Mitral murmurs

A

Axillary line

22
Q

Intensity on a ‘6-point-scale’ (Levine scale, 1933)

Grade 1

A

Very faint murmur, heard only after listener has ‘tuned in’; may not be heard in all positions

23
Q

Intensity on a ‘6-point-scale’ (Levine scale, 1933)

Grade 2

A

Quiet, but heard immediately after placing the stethoscope on the chest

24
Q

Intensity on a ‘6-point-scale’ (Levine scale, 1933)

Grade 3

A

Moderately loud

25
Intensity on a '6-point-scale' (Levine scale, 1933) | Grade 4
Loud, with palpable thrill
26
Intensity on a '6-point-scale' (Levine scale, 1933) | Grade 5
Very loud, with thrill; may be heard when the stethoscope is partly off the chest
27
Intensity on a '6-point-scale' (Levine scale, 1933) | Grade 6
Very loud, with thrill; | may be heard with stethoscope entirely off the chest
28
Diastolic heart murmurs : Mitral stenosis Etiology
- Rheumatic heart disease | - Non-rheumatic etiology: congenital, degenerative calcification, endocarditis, carcinoid heart disease
29
Diastolic heart murmurs : Aortic regurgitation Etiology
- Valvular (leaflet) abnormality: endocarditis, degenerative, rheumatic - Annulus dilatation – aortic root disease: dilatative cardiomyopathy, atrial remodeling, aortic root dissection, Marfan's syndrome
30
Graham Steell murmur
Early diastolic murmur due to pulmonary regurgitation from pulmonary hypertension, may be heard rarely
31
Opening snap of the mitral valve - When is it best heard
heard best at or medial to the apex in expiration
32
Diastolic heart murmurs: Aortic regurgitation Etiology
- Valvular (leaflet) abnormality: endocarditis, degenerative, rheumatic - Annulus dilatation – aortic root disease: dilatative cardiomyopathy, atrial remodeling, aortic root dissection, Marfan's syndrome
33
Austin Flint Murmur
Mid-diastolic murmur heard at the apex due to antegrade flow across a mitral valve orifice which has been narrowed by a combination of rising LV pressure and jet of AR directed at the anterior MV leaflet
34
Traube's sign
(‘pistol shot femora') – loud systolic and diastolic bruit heard with stethoscope over femoral artery
35
Diastolic heart murmurs: Mitral stenosis Murmur Sound
1. Mid-/late- diastolic 2. Crescendo 3. Apex 4. Axilla 5. Low-pitched
36
Diastolic heart murmurs: Aortic regurgitation Murmur Sound
1. Early diastolic (duration of murmur correlated with severity of regurgitation) 2. Decrescendo 3. Left upper sternal border 4. Left sternal area 5. High-pitched
37
Systolic heart murmurs: Mitral regurgitation Etiology
- Valvular (leaflet) abnormality: endocarditis, degenerative, rheumatic - Sub-valvular apparatus abnormality: Chordal rupture, papillary muscle rupture, papillary muscle dysfunction - Annulus dilatation: dilatative cardiomyopathy, atrial remodeling, Marfan's syndrome
38
Systolic heart murmurs: Mitral regurgitation Murmur Sound
1. Holosystolic 2. Plateau 3. Apex 4. Axilla
39
Systolic heart murmurs: Aortic stenosis Etiology
- Acquired: degenerative, rheumatic, Paget disease of the bone - Congenital: bicuspid aortic valve
40
Systolic heart murmurs: Aortic stenosis Murmur Sound
Murmur 1. Mid-systolic 2. Crescendo-decrescendo 3. Right upper sternal border (aortic area) 4. Carotid * Systolic ejection click may be heard (severe stenosis)
41
Systolic heart murmurs: Aortic stenosis Murmur Sound - If severity worsens
Murmur peaks later, extends later through systole, and may obscure S2