Heart Sounds and the Arterial Pulse Flashcards
the ___ site is best for auscultation if S3 is present
the mitral site best for auscultation.
S2 sound is made up of __ and ____. the splitting of S2 can be heard during ____ at the pulmonary site
S2 sound is made up of A2 and P2. the splitting of S2 can be heard during INSPIRATION at the pulmonary site
Where should you place your stethoscope if you are wanting to listen to the tricuspid valve
left lower.
note:
Do you hear S2 before systole?
no. S1-systole-S2- diastole.
The first heart sound (S1) represents closure of the ___ (__ and ___) valves as the ventricular pressures exceed atrial pressures at the beginning of systole
The second heart sound (S2) represents closure of the semilunar (__ and ___) valves
The first heart sound (S1) represents closure of the atrioventricular (mitral and tricuspid) valves as the ventricular pressures exceed atrial pressures at the beginning of systole (point a). … The second heart sound (S2) represents closure of the semilunar (aortic and pulmonary) valves
the aortic and pulmonic valves have __ leaflets
3 leaflets.
• S1 - closure of the ___ and
___ valves when pressure in ventricles exceeds pressure in atria
• S2 - closure of the __ and
__ valves when pressure in ventricles falls below pressure in
great vessels
• S1 - closure of the mitral and
tricuspid valves when pressure in ventricles exceeds pressure in atria
• S2 - closure of the aortic and
pulmonic valves when pressure in ventricles falls below pressure in
great vessels
S2 is made up of the aortic valve and pulmonary valve closing. Why does it split?
- during inspiration, intrathoracic pressure becomes negative
- this increases venous return to the right side of the heart (RV preload)
- the capacitance of the proximal pulmonary vascular tree increases as well becuase of negative interthoracic pressure.
- these two factors lead to a more prolonged ejection of the RV and delayred pulmonary valve closure.
S2 is made up of the aortic valve and pulmonary valve closing. Sometimes they can get abnormally split;
- widely split: Conditions that delay ____ valve closure - classic is something called _______ ___ block (___)
- Paradoxically split (during expiration, single during inspiration)
- Conditions that really delay ___ valve closure - classic is a ___ ____ branch block (LBBB)
• Widely split
• Conditions that delay pulmonic valve closure - classic is something called right bundle branch block (RBBB)
• Paradoxically split (during expiration, single during inspiration)
• Conditions that really delay aortic valve closure - classic is a left bundle branch block (LBBB)
Severe aortic stenosis makes ___quiet, severe mitral stenosis makes ___quiet
Severe aortic stenosis makes S2 quiet, severe mitral stenosis makes S1 quiet
- Vigour of closure:
- increased contractility makes ___ louder
- Hypertension makes ____ component of S2 louder
- Pulmonary hypertension makes ____ component of S2 louder!
- Vigour of closure
- increased contractility makes S1 louder
- Hypertension makes aortic component of S2 louder
- Pulmonary hypertension makes pulmonic component of S2 louder!
S3 and S4 are usually heard in ____
diastole (S3 and S4 are abnormal sounds)
S3 is heard in ____ diastole and best heard at the ___ of the heart. What causes it?
Could indicate ____ sided heart failure.
S3 is heard in EARLY diastole and is best. heard at the APEX of the heart.
- generated during rapid ventricular fillinf phase.
- caused by sudden limitation of ventricular expansion of LV during brisk diastolic filling
- suggests raised LV filling pressurs cause it’s stiff.
could indicate LEFT SIDED heart failure
S4 is a low pitched sound heard in ___ diastole.
- generated during ___ contraction and caused by pre-systolic ___ distension, suggesting a ____ ventricle.
it’s always abnormal.
S4 is a low pitched sound heard in LATE diastole.
- generated during ATRIAL contraction and caused by pre-systolic VENTRICULAR distension, suggesting a STIFF LEFT OR RIGHT ventricle.
it’s always abnormal.
what is a murmur and what does it suggest
- a more prolonged sound produced by the flowing of blood
- audible when flow is turbulent
- suggests either increased flow across a structurally normal valve, or normal flow across a ragged valve.
if a systolic murmur is in a crescendo-decrescendo pattern, it could indicate ____ stenosis or ___ stenosis.
if a systolic murmur is in a holosystolic pattern, it could indicate ___, ___ or ___ defect.
if a systolic murmur is in a crescendo-decrescendo pattern, it could indicate AORTIC stenosis or PULMONIC stenosis.
if a systolic murmur is in a holosystolic pattern, it could indicate MR, TR or VSD defect.
which one is aortic stenosis
the one on the right. there is normally not much of a pressure gradient between the ventricle and the aorta, but in aotic stenosis, the ventricle needs to exert a lot of pressure to overcome the narrowed valve
the murmur of aortic stenosis is a ____ sound, you’d likely hear it at the __ ___
crescnedo-decrescendo pattern with a late peak. you’d likely hear it at the right carotid.
heard best at the right upper sternal border radiating to the neck and carotid arteries
which one depicts mitral regurgitation
the one on the right. the LA will always have more pressure because fluid gets forced back into it. results in a tal CV wave on the LA tracing.
Ejected Blood Into The ___ Causes The Pul
into the aorta. therefore, youre feeling LV pressure.
label the aspects of the carotid pulse.what is the incisura?
incisura is related to the aortic valve closure.
note:
5 factors that determines pulse volume
a person with aortic stenosis will have a pulsus ___ et ___. What does this mean?
pulsus parvus et tardus indicative of aortic stenosis. weak pulse and slow upstroke. this is the characteristic pulse of aortic stenosis ro AS.
a person with aortic regurgitation will have ___ pulse. what does this mean?
AR= corrigans pulse.
- wide pulse pressure, rapid raise then rapid fall.characteristic of AI (aortic insufficiency/regurgitation)
A person is noted to have a double impulse in systole when their pulse is checked, also known as bisheriens pulse. What is going on?
Bisferiens pulse = double impulse in systole. characteristic of HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY (HOCM)
What is HCM?
• An inherited disorder characterized by hypertrophy of the
cardiac muscle, often causing septal thickning. Sometimes, it gets so thick that it impairs LV outflow, causing obstructive HCM/mitral valve leaflet gets stuck
Karotkoff sounds?
Sounds you hear during bp assessment. You will hear a squirting of blood across the resistance of the compressed artery. When the KK sound fades, that’s diastolic cause the resistance reduces.
systolic and diastolic values of hypertension. Requires serial office or home measurements to confirm
140/90.
Mean arterial pressure equation
MAP = 1/3 SBP + 2/3 DBP MAP = cardiac output x peripheral resistance
pulse pressure equation. What is pulse pressure affected by?
PP= systolicBP- diastolic BP
determined by SV, contractility, stiff of aorta.
