Heart Sounds and Murmurs (incomplete, important info)

Question 1

ejection click what + cause

Answer 1

early systolic. opening of aortic and pulm valves.

Question 2

ejection click shows what

Answer 2

aortic or pulm stenosis OR pulm trunk or aorta distension

Question 3

non-ejection click what + cause (mid - late systole)

Answer 3

mitral or tricuspid valve prolapse

Question 4

diastolic heart sounds

Answer 4

Opening snap, pericardial knock, S3 and S4

Question 5

Opening snap when and cause

Answer 5

bit after S2. early diastolic. from STENOTIC mitral and tricuspid opening.

Question 6

opening snap shows what

Answer 6

rheumatic fever. ex. untreated strep throat when younger

Question 7

S3 best way to hear

Answer 7

bell (LOW PITCHED), cardiac apex if left sided, left lateral decubitus

Question 8

S3 corresponds to what

Answer 8

rapid ventricle filling

Question 9

S3 in older people sign of what

Answer 9

dilated ventricle, heart failure, bad ventricle contraction. ex. pushing against high BP

Question 10

pathologic S3 sometimes referred to as _______

Answer 10

ventricular gallop

Question 11

S4 best way to hear it

Answer 11

bell (LOW PITCHED), cardiac apex if left sided, left lateral decubitus

Question 12

S4 cause

Answer 12

stiff ventricle. (hypertrophy or myocardial ischemia)

Question 13

S4 sometimes referred to as ____

Answer 13

atrial gallop

Question 14

quadruple beat vs summation gallop

Answer 14

both in patient with both S3 and S4. becomes summation gallop when tachycardia (S3 and S4 fuse. long dull mid diast sound)

Question 15

pericardial knock heard when, cause and shows what

Answer 15

early diastole, high pitched, caused by stiff pericardium and abrupt cessation of vent. filling, shows pericarditis

Question 16

heart sounds order if have all

Answer 16

S1, ejection click, non ejection click, S2, opening snap, S3, pericardial knock, S4

Question 17

7 things to describe murmur

Answer 17

timing, intensity, pitch, shape, location, radiation, response to maneuvers

Question 18

how to know murmur timing

Answer 18

sense pulse at same time and listen to when appears

Question 19

murmur intensity how to express it

Answer 19

grading on 6 (systolic) or 4 (diastolic). heard easily at 3.

Question 20

thrill def and at what murmur intensity

Answer 20

palpable buzzing or vibration (at grade 4)

Question 21

murmur pitch reflects what

Answer 21

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)

Question 22

murmur location def

Answer 22

where best heard

Question 23

how to describe murmur location

Answer 23

auscultatory area (one of 4)

Question 24

4 auscultatory areas

Answer 24

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

Question 25

2 ex of murmur radiation

Answer 25

aortic and pulm murmurs radiate to the neck

mitral regurg radiates to armpit (axilla)

Question 26

goal of maneuvers in murmurs

Answer 26

increase intensity

Question 27

maneuvers affect what

Answer 27

heart loading conditions

Question 28

3 systolic murmur types

Answer 28

ejection, pansystolic (holosystolic), late systolic

Question 29

systolic ejection murmur description

Answer 29

cres-decres, bit after S1 (after isovol contraction) ends b4 S2

Question 30

systolic ejection murmur shows what

Answer 30

aortic or pulm stenosis

Question 31

benign systolic ejection murmur seen where

Answer 31

young adults

Question 32

pansystolic murmur when

Answer 32

systole + isovol relax

Question 33

3 causes of pansystolic murmur

Answer 33

mitral regurg, tricuspid regurg, VSD

Question 34

where to hear murmur of a VSD + charact

Answer 34

4th-6th interc space high pitch, thrill

Question 35

how to diff between VSD murmur and AV valve murmur

Answer 35

doesn’t increase in intensity with inspiration (as tricuspid regurg) and doesn’t radiate to axilla (as mitral regurg)

Question 36

late systolic murmur timing

Answer 36

half to end systole

Question 37

late systolic murmur cause

Answer 37

mitral regurg from mitral valve prolapse

Question 38

2 types of diastolic murmurs

Answer 38

early decrescendo

mid to late rumbling

Question 39

2 causes of diastolic early decresc murmur

Answer 39

aortic regurg and pulm regurg

Question 40

pulm regurg min cause

Answer 40

pulm arterial hypertension

Question 41

cause of mid-late diastolic rumble murmur + when is it prolonged

Answer 41

mitral or tricuspid stenosis. prolonged if severe stenosis

Question 42

mid-late diastolic rumble charact.

Answer 42

low pitched. bell, left lateral decubitus, apex. (mitral) lower sternum if tricuspid

Question 43

mid-late diastolic rumble accompanied by what**

Answer 43

Opening snap (bc is a disease of AV valve stenosis)

Question 44

other cause of mid-late diastolic rumble

Answer 44

high flow through normal AV valves: hyperdynamic state (fever, anemia, exercise, hyperthyroidism)

Question 45

continuous murmur def + example

Answer 45

during whole cardiac cycle. ex. patent ductus arteriosus. P aorta greater than P pulm artery during whole cardiac cycle

Question 46

continuous murmur shape

Answer 46

crescendo from S1 to S2, decrescendo from S2 to S1

Question 47

to and fro murmur charact

Answer 47

diamond shaped in systole, decrescendo in diastole

Question 48

to and fro murmur cause

Answer 48

both stenosis and regurg of aortic valve or of pulm valve

Question 49

to and fro murmur: sounds we can expect

Answer 49

ejection click