Heart Sounds and Murmurs (incomplete, important info) Flashcards
ejection click what + cause
early systolic. opening of aortic and pulm valves.
ejection click shows what
aortic or pulm stenosis OR pulm trunk or aorta distension
non-ejection click what + cause (mid - late systole)
mitral or tricuspid valve prolapse
diastolic heart sounds
Opening snap, pericardial knock, S3 and S4
Opening snap when and cause
bit after S2. early diastolic. from STENOTIC mitral and tricuspid opening.
opening snap shows what
rheumatic fever. ex. untreated strep throat when younger
S3 best way to hear
bell (LOW PITCHED), cardiac apex if left sided, left lateral decubitus
S3 corresponds to what
rapid ventricle filling
S3 in older people sign of what
dilated ventricle, heart failure, bad ventricle contraction. ex. pushing against high BP
pathologic S3 sometimes referred to as _______
ventricular gallop
S4 best way to hear it
bell (LOW PITCHED), cardiac apex if left sided, left lateral decubitus
S4 cause
stiff ventricle. (hypertrophy or myocardial ischemia)
S4 sometimes referred to as ____
atrial gallop
quadruple beat vs summation gallop
both in patient with both S3 and S4. becomes summation gallop when tachycardia (S3 and S4 fuse. long dull mid diast sound)
pericardial knock heard when, cause and shows what
early diastole, high pitched, caused by stiff pericardium and abrupt cessation of vent. filling, shows pericarditis
heart sounds order if have all
S1, ejection click, non ejection click, S2, opening snap, S3, pericardial knock, S4
7 things to describe murmur
timing, intensity, pitch, shape, location, radiation, response to maneuvers
how to know murmur timing
sense pulse at same time and listen to when appears
murmur intensity how to express it
grading on 6 (systolic) or 4 (diastolic). heard easily at 3.
thrill def and at what murmur intensity
palpable buzzing or vibration (at grade 4)
murmur pitch reflects what
high pitch: high P gradient (blood coming from high P chamber as in aortic stenosis. comes from LV)
low pitch: low P gradient (ex. mitral stenosis)
murmur location def
where best heard
how to describe murmur location
auscultatory area (one of 4)
4 auscultatory areas
aortic area: 2nd intercostal space right to sternum
pulmonic area: 2nd intercostal space left to sternum
tricuspid area: lower left sternal border
mitral area: cardiac apex
2 ex of murmur radiation
aortic and pulm murmurs radiate to the neck
mitral regurg radiates to armpit (axilla)
goal of maneuvers in murmurs
increase intensity
maneuvers affect what
heart loading conditions
3 systolic murmur types
ejection, pansystolic (holosystolic), late systolic
systolic ejection murmur description
cres-decres, bit after S1 (after isovol contraction) ends b4 S2
systolic ejection murmur shows what
aortic or pulm stenosis
benign systolic ejection murmur seen where
young adults
pansystolic murmur when
systole + isovol relax
3 causes of pansystolic murmur
mitral regurg, tricuspid regurg, VSD
where to hear murmur of a VSD + charact
4th-6th interc space high pitch, thrill
how to diff between VSD murmur and AV valve murmur
doesn’t increase in intensity with inspiration (as tricuspid regurg) and doesn’t radiate to axilla (as mitral regurg)
late systolic murmur timing
half to end systole
late systolic murmur cause
mitral regurg from mitral valve prolapse
2 types of diastolic murmurs
early decrescendo
mid to late rumbling
2 causes of diastolic early decresc murmur
aortic regurg and pulm regurg
pulm regurg min cause
pulm arterial hypertension
cause of mid-late diastolic rumble murmur + when is it prolonged
mitral or tricuspid stenosis. prolonged if severe stenosis
mid-late diastolic rumble charact.
low pitched. bell, left lateral decubitus, apex. (mitral) lower sternum if tricuspid
mid-late diastolic rumble accompanied by what**
Opening snap (bc is a disease of AV valve stenosis)
other cause of mid-late diastolic rumble
high flow through normal AV valves: hyperdynamic state (fever, anemia, exercise, hyperthyroidism)
continuous murmur def + example
during whole cardiac cycle. ex. patent ductus arteriosus. P aorta greater than P pulm artery during whole cardiac cycle
continuous murmur shape
crescendo from S1 to S2, decrescendo from S2 to S1
to and fro murmur charact
diamond shaped in systole, decrescendo in diastole
to and fro murmur cause
both stenosis and regurg of aortic valve or of pulm valve
to and fro murmur: sounds we can expect
ejection click
