Heart Sounds and Their Description Flashcards
Thrill on R Base
Aortic Stenosis/ Systemic HTN
Thrill on L Base
Pulmonic Stenosis/ Pulmonic HTN
Lift (Heave)
Left Lower Sternal Border: RVH/ Chronic Lung Disease
PMI: Volume Overload
LVH- Displaced lateral and wide spread
PMI: Pressure Overload
Increase in force and duration but not displaced
Aortic Region
Between 2nd and 3rd intercostal spaces at the R sternal border
Pulmonic Region
Between 2nd and 3rd intercostal spaces at the L sternal border
Tricuspid Region
Between the 3rd, 4th, 5th and 6th intercostal spaces at the left sternal border
Mitral Region
Near the apex of the heard between the 5th and 6th L intercostal spaces (apex of the heart)
Diaphragm
High frequency sounds (systolic murmurs, S1, S2, Ejection clicks, and opening snaps)
Bell
Low frequency sounds (diastolic murmurs, S3, S4)
S1
Closure of Mitral and Tricuspid valces
S2
Closure of aortic and pulmonary valves (pulmonary valve closes 60 msec after aortic valve)
Semilunar Valves
- Aortic and pulmonary valves close after isometric relaxation period
- Pulmonary component is softer than aortic component
S3
Rapid filling of ventricles from atrium during diastole
S4
Atrial contraction
- always abnormal due to noncompliant ventricle
S1 Intensity:
- Position of AV valve at the start of systole
- Structure of the valve leaflets
- how quickly the pressure rises in the ventricle
Accentuated S1:
AV valve wide open and no time to drift together:
- Hyperkinetics states ( Exercise, fever, hyperthyroidism)
Calcification in valve structure
Mitral Stenosis with leaflets still mobile
Diminished S1:
Delayed conduction from atria to ventricles; Change in valve structure
- 1st degree heart block
- Mitral insufficiency (decreased mobility)
Forceful atrial contraction into noncompliant ventricle (delays in the ventricular contraction)
- Severe HTN
Accentuated S2:
Higher Closing pressure
- Systemic HTN Exs
Pulmonary HTN
- Mitral Stenoiss
- CHF
Semilunar valves calcified but mobile
- Aortic/Pulmonic Stenosis
Diminished S2:
Fall in systemic blood pressure
- shock
Semilunar valve calcified and immobile
-Aortic/Pulmonic Stenosis
S2 Split: Unaffected by respiration
Atrial Septal Defect
R Ventricular Failure
S2 Split: Paradoxical (P2A2)
Aortic Stenosis
LBBB
PDA
S3: Ventricular Gallup
- Pitch: Low
- Abnormal in adults >40
- Decreased ventricle compliance /CHF
- Volume overload
- Mitral, Aortic, Tricuspid Regurgitation
- Heard at the apex in L lateral position
S4: Atrial Gallup
- Apex
- Decreased Compliance of the ventricle
- CAD
- Aortic Pulmonary Stenosis
- Systolic Afterload
- HTN
Systolic Aortic Stenosis
- Flow through semilunar valves
- LVH develops
- Thrill Present
- S1 normal
- paradoxical split S2, S4 present with LVH
Systolic Pulmonary Stenosis
- Calcification of the pulmonic valve
- Thrill present
- Diminished S2
- S4 common with RVH
Systolic Mitral Regurgitant
- Stream of blood regurgitates back into LA during systole through incompetent mitral valve
- In diastole, blood passes back into LV along with new flow
- Results in LV dilation and hypertrophy
- Thrill in systole at the apex
- S1 diminished
- S2 accentuated
- S3 at apex often present
Systolic Tricuspid Regurgitation
- Backflow of blood through incompetent tricuspid valve into RA
- Engorged pulsating neck veins
- Lift at sternum of RVH
- Thrill at the left lower sternal border
Distolic Mitral Stenosis
- Filling murmur at low pressure
- Calcified mitral valve will not open properly
- impeding forward flow of blood into LV during diastole
- Results in LA enlargement and LA pressure increased
- S1 accentuated
- Opening snap after S2
Diastolic Tricuspid Stenosis
- Filling murmur at low pressure
- Calcification of tricuspid valve impedes forward flow of blood into the right ventrilce during diastole
- diminished arterial pulse
- Jugular venous pulse prominent
Diastolic Aortic Regurgitation
- Due to semilunar valve incompetence
- Stream of blood regurgitates back through incompetent aortic valve into LV during diastole
- LV dialation and hypertrophy due to increased LV stroke volume
- Rapid ejection of large stroke volume into poorly filled aorta
- Rapid runoff in diastole as part of the blood is pushed back into LV
- Bounding pulse in carotid, brachial, and femoral arteries
- BP has wide pulse pressure
- Apical PMI displace left and inferior
Diastolic Pulmonic Regurgitation
- Due to semilunar valve incompetence
- backflow of blood through incompetent pulmonic valve from pulmonary artery to RV
- Bounding pulse in carotid, brachial, and femoral arteries
- BP has wide pulse pressure
- Apical PMI displace left and inferior
