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Heart sounds Flashcards

1
Q

What makes S1?

A

Closure of mitral valve and tricuspid valve

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2
Q

What can cause wide splitting of S1?

A

Right bundle branch block

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3
Q

What makes S2?

A

Closure of aortic valve and pulmonary valve

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4
Q

What can accentuate splitting in S2?

A

Inspiration

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5
Q

Why does inspiration accentuate S2 splitting?

A

Blood is drawn into heart by negative intrathoracic pressure increasing right ventricular filling so it takes longer for blood to be ejected

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6
Q

What can cause the absence of S2 splitting?

A

Diseases of aortic or pulmonary valve

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7
Q

When is S3 heard and why?

A

Early diastole due to early ventricular filling

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8
Q

What are some physiological causes of S3?

A

Fit, young adults

Athletes with slow heart rate and compliant ventricles

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9
Q

What are the pathological causes of S3?

A

Abnormalities of left ventricle
Usually dilated with reduced compliance or when there is rapid filling of the left ventricle e.g. in severe mitral regurgitation

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10
Q

What is an ejection click?

A

Abrupt, high frequency systolic sound

Associated with abnormal aortic or pulmonary valve

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11
Q

What is the likely cause of an ejection click in an asymptomatic patient?

A

Bicuspid aortic valve

Can also occur in hypertension

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12
Q

What is an opening snap associated with?

A

Valve opening in mitral or tricuspid stenosis

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13
Q

Why does an opening snap occur?

A

Due to high atrial pressure

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14
Q

What is a pericardial rub?

A

Intermittent scratchy sound with systolic and diastolic components

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15
Q

What causes a pericardial rub?

A

Pericarditis due to inflamed visceral and parietal pericardium rubbing together

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16
Q

What are you likely to hear with prosthetic valves?

A

Additional sharp clicking opening sounds which correspond to an ejection sound and an opening snap
Closing sound corresponds to component of heart sound contributed by that valve

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17
Q

What is a pericardial knock?

A

Early diastole due to high pressure in atrium rapidly decompressing into restricted left ventricle producing audible reverberation

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18
Q

Why is a right sided murmur likely to be louder during inspiration?

A

Right heart blood flow increases during inspiration

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19
Q

What group of people are likely to have an innocent murmur?

A 
Children
Pregnancy
Fever
Anaemia
Hyperthyroidism
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20
Q

Describe a mid-ejection systolic murmur

A

Increases in early systole and decreases in late systole (crescendo decrescendo pattern)

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21
Q

What can cause a mid-ejection systolic murmur?

A

Aortic and pulmonary stenosis
Aortic sclerosis and HOCM
Atrial septal defects

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22
Q

How can you differentiate between aortic/pulmonary stenosis and aortic sclerosis?

A

Aortic sclerosis doesn’t radiate to carotids unlike aortic / pulmonary stenosis

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23
Q

What is a pan systolic murmur?

A

Murmur intensity that doesn’t vary much throughout systole

Stops when mitral valve opens

24
Q

What can cause a pan systolic murmur?

A

Mitral and tricuspid regurgitation

25
Q

What is a late systolic murmur?

A

Commences in mid to late systole
Often preceded by ejection click.
Stops when mitral valve opens

26
Q

What can cause a late systolic murmur?

A

Mitral valve prolapse

27
Q

What is the likely cause of a murmur getting softer and disappearing?

A

When a lesion is very severe the transvalvular flow starts to fall and can cause heart failure

28
Q

What is an early diastolic murmur?

A

Commences immediately following S2 and decreases during diastole (decrescendo)

29
Q

What can cause an early diastolic murmur?

A

Aortic or pulmonary regurgitation

30
Q

Why does the murmur caused by aortic or pulmonary regurgitation occur at the start of diastole?

A

Biggest pressure difference between outflow vessel and ventricle is at beginning of diastole

31
Q

What can cause a mid diastolic murmur?

A

Mitral stenosis

32
Q

How can you accentuate a mitral diastolic murmur?

A

Turn patient on left side and listen at cardiac apex with bell

33
Q

What is a continuous murmur?

A

Occurs throughout cardiac cycle. Systolic component usually louder than diastolic component.

34
Q

What can cause a continuous murmur?

A

Patient ductus arteriosus

Acute communication between right and left side of heart e.g. ruptured sinus of Valsalva or infective endocarditis

35
Q

Describe the murmur heard in aortic stenosis

A

Ejection systolic murmur

Heard loudest over aortic area during expiration and if sitting forward

36
Q

Where does an aortic stenosis murmur radiate to?

A

Carotid artery

37
Q

Why is an aortic stenosis murmur heard loudest at the cardiac apex in elderly people?

A

Due to hyper inflated lungs

38
Q

Why does aortic stenosis cause reverse splitting of S2?

A

Aortic valve closes after pulmonary valve due to the longer time required for blood to exit the left ventricle

39
Q

Describe the associated features with aortic stenosis

A

Slow rising pulse with narrow pulse pressure
Non-displaced, heaving apex beat
Reduced or absent S2
Reverse splitting of S2

40
Q

Describe the murmur heard in pulmonary stenosis

A

Ejection systolic murmur

Heard loudest in pulmonary region during inspiration

41
Q

Where does pulmonary stenosis radiate to?

A

Left shoulder (infraclavicular region)

42
Q

Describe the associated features with pulmonary stenosis

A

Prominent ‘a waves’ in JVP
Widely split S2
P2 may be soft and inaudbile
Right ventricular dilatation

43
Q

Why does pulmonary stenosis cause a widely split S2?

A

Blood from ventricle takes longer to pass through narrow pulmonary valve so pulmonary valve closure occurs much later than aortic valve closure

44
Q

What can right ventricular dilatation lead to?

A

Right ventricular heave
Tricuspid regurgitation
Peripheral signs of right-sided HF e.g. peripheral oedema, ascites

45
Q

Describe the murmur in mitral stenosis

A

Snapping sound when mitral valve opens
Heard loudest over apex in left lateral decubitus position on expiration
Low-pitched rumbling, mid-diastolic murmur

46
Q

What are some features associated with mitral stenosis?

A

Signs of pulmonary hypotension

Low-volume pulse which may be irregularly irregular

47
Q

Describe the murmur in tricuspid stenosis

A

Mid-diastolic murmur

Loudest at 3-4th ICS, left sternal edge during inspiration

48
Q

What are the signs of right atrial enlargement?

A

Raised JVP with giant ‘a waves’
Peripheral oedema
Ascites

49
Q

Describe the murmur in mitral regurgitation

A

Pansystolic murmur

Heard loudest over mitral area on expiration in left lateral decubitus position

50
Q

Where does a mitral regurgitation murmur radiate to?

A

Axilla

51
Q

Describe the murmur in tricuspid regurgitation

A

Pansystolic murmur

Heard loudest over tricuspid region during inspiration

52
Q

What features are associated with tricuspid regurgitation?

A

Large ‘v waves’ in JVP
Visibile / palpable hepatic pulsations
Signs of right sided HF

53
Q

Describe the murmur in aortic regurgitation

A

Mild AR produces soft, short, early diastolic murmur

Severe, chronic AR has loud and short murmur

54
Q

Where does an aortic regurgitation murmur radiate to?

A

Left sternal edge

55
Q

Why does a collapsing pulse occur in aortic regurgitation?

A

Due to blood flowing back into LV after systole leading to abrupt drop in BP after ventricular contraction. This causes a sudden drop in arterial pressure and subsequent collapse of arterial vessel walls

56
Q

Describe the murmur in pulmonary regurgitation

A

Early decrescendo murmur

Heard loudest over left sternal edge during inspiration

57
Q

Describe the murmur heard in mitral valve prolapse

A

Mid-systolic click followed by a mid or late systolic murmur

Heard loudest at apex during expiration

KT (6 decks)

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