Heart Sounds Flashcards
S1 is heard for how much time?
0.14 seconds
Name 3 types of abnormal s1
Soft
Loud
Splitting s1
State 4 reasons for soft S1?
Increased distance between chest and heart.
Decrease in pressure rise intensity
Valvular problems
PR intervals prolonged
4 pathology causing increased distance between chest and heart which leads to abnormal S1.
Obesity
Emphysema
Pericardial effusion
Pleural effusion
Name 4 pathology that cause decrease in rate of rise in pressure in ventricles.
Acute myocardial infarction
Myxedema
Cardiomyopathy
Mitral regurgitation
Valvular pathology that can cause soft S1
Mitral stenosis and tricuspid stenosis
State 3 reasons that can cause loud S1
Tachycardia
Increased AV flow(ASD, PDA)
Prolonged AV flow(mitral and tricuspid stenosis)
Short PR interval
Splitting of S1 occurs in what conditions.
Normal splitting where M1 occurs first- RBBB, LV ectopic beats, LV pacing, Ebstein anomaly.
Reverse split in LBBB, RV ectopic beats, RV pacing, severe mitral stenosis and atrial myxoma.
State 4 types of abnormal S2.
Wide splitting time
Reverse splitting
Wide fixed S2
Single S2.
Pathology that can cause wide S2?
VSD, Mitral regurgitation (early A2)
RBBB, LV Pacing, LV ectopic beats(Late P2 due to conduction problem).
Pulmonary stenosis, pulmonary hypertension, pulmonary artery embolism (late P2 because of longer RV systole)
Miscellaneous cause- ASD as it causes pulmonary hypertension.
Reverse splitting of S2 pathology
Wolf Parkinson white syndrome/WPW syndrome (early P2)
LBBB, RV pacing, RV ectopic beats(conduction problem)
Systemic hypertension, aortic stenosis (Increased LV systole)
PDA(increase hangout time)
Pathology which cause wide fixed split S2?
ASD
Pulmonary hypertension
Acute right heart failure
Pathology that cause single S2?
LBBB, RV pacing, RV ectopic beats,Systemic hypertension, aortic stenosis ,PDA(delayed A2)
Tetralogy of Fallot, severe pulmonary stenosis, severe aortic stenosis (one component is absent)
Emphysema, obesity (Increased chest to heart area).
Abnormalities that can cause abnormal S3
Ventricular dysfunction (SID CV) Restrictive cardiomyopathy Constructive pericarditis Hyperkinetic states Hypertrophic obstructive cardiomyopathy
Best location to hear S3?
Apex of heart
Other name for S3
Ventricular diastolic gallop
Physiological S3 is heard in?
Children
Pregnancy
Athletes
Basically whenever heart is overly compliant.
Pathology that can make S4 heart sound audible?
Ventricular hypertrophy
Hyperkinetic states
Ischemic heart disease
Complete heart block
Name 4 abnormal diastolic heart sounds
Opening snap
Pericardial Knock
Tumor plop
Quadruple rhythm
Opening snap can occur in what pathologies.
Tricuspid stenosis
Mitral stenosis
What is the duration between S2 and opening snap?
0.05-0.12 seconds
Opening snap presence indicates what ?
Pliable valves
Severe stenosis
High AV pressure gradients
What is expected to be heard just after opening snap?
Mud systolic murmur
Pericardial Knock can be heard in what pathologies?
Constrictive pericarditis
Atrial myxoma
Tumor plop is heard in which pathology?
Atrial myxoma
Quadruple rhythm is heard in which condition?
Left ventricular heart failure
Name 2 systolic abnormal heart sounds?
Ejection systolic click
Mid-systolic click
Which diastolic abnormal heart sound is high pitched?
Opening snap
Where do you hear opening snap?
Left lateral sternal border
In which position do you listen S4
Left lateral decubitus
Best location for S2 S3 S4
S2 erbs point
S3 apex of heart
S4 apex of heart
What are the areas of auscultation?
. .
.
. .
Correlation of S1, S2 , S3 S4 with cardiac cycle?
S1 IVC
S2 protodiastole
S3 first rapid filling phase
S4 second rapid filling phase
What does S1 signifies?
AV Valve closure
Ventricular contraction
Explain 2 inaudible components of S1
First is muscular in original ( LV contacts)
Followed by AV valve closure
Second is simultaneous closure of semilunar valves.
What wave of JVP corresponds to S1
C wave
What is duration of S2
0.11 second
During Inspiration A2 is heard earlier than P2 by how much time?
40-50 msec.
