Heart Sounds and Their Description

Question 1

Thrill on R Base

Answer 1

Aortic Stenosis/ Systemic HTN

Question 2

Thrill on L Base

Answer 2

Pulmonic Stenosis/ Pulmonic HTN

Question 3

Lift (Heave)

Answer 3

Left Lower Sternal Border: RVH/ Chronic Lung Disease

Question 4

PMI: Volume Overload

Answer 4

LVH- Displaced lateral and wide spread

Question 5

PMI: Pressure Overload

Answer 5

Increase in force and duration but not displaced

Question 6

Aortic Region

Answer 6

Between 2nd and 3rd intercostal spaces at the R sternal border

Question 7

Pulmonic Region

Answer 7

Between 2nd and 3rd intercostal spaces at the L sternal border

Question 8

Tricuspid Region

Answer 8

Between the 3rd, 4th, 5th and 6th intercostal spaces at the left sternal border

Question 9

Mitral Region

Answer 9

Near the apex of the heard between the 5th and 6th L intercostal spaces (apex of the heart)

Question 10

Diaphragm

Answer 10

High frequency sounds (systolic murmurs, S1, S2, Ejection clicks, and opening snaps)

Question 11

Bell

Answer 11

Low frequency sounds (diastolic murmurs, S3, S4)

Question 12

S1

Answer 12

Closure of Mitral and Tricuspid valces

Question 13

S2

Answer 13

Closure of aortic and pulmonary valves (pulmonary valve closes 60 msec after aortic valve)

Question 14

Semilunar Valves

Answer 14

• Aortic and pulmonary valves close after isometric relaxation period
• Pulmonary component is softer than aortic component

Question 15

S3

Answer 15

Rapid filling of ventricles from atrium during diastole

Question 16

S4

Answer 16

Atrial contraction

- always abnormal due to noncompliant ventricle

Question 17

S1 Intensity:

Answer 17

• Position of AV valve at the start of systole
• Structure of the valve leaflets
• how quickly the pressure rises in the ventricle

Question 18

Accentuated S1:

Answer 18

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

Question 19

Diminished S1:

Answer 19

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

Question 20

Accentuated S2:

Answer 20

Higher Closing pressure
- Systemic HTN Exs

Pulmonary HTN

• Mitral Stenoiss
• CHF

Semilunar valves calcified but mobile
- Aortic/Pulmonic Stenosis

Question 21

Diminished S2:

Answer 21

Fall in systemic blood pressure
- shock

Semilunar valve calcified and immobile
-Aortic/Pulmonic Stenosis

Question 22

S2 Split: Unaffected by respiration

Answer 22

Atrial Septal Defect

R Ventricular Failure

Question 23

S2 Split: Paradoxical (P2A2)

Answer 23

Aortic Stenosis
LBBB
PDA

Question 24

S3: Ventricular Gallup

Answer 24

• Pitch: Low
• Abnormal in adults >40
• Decreased ventricle compliance /CHF
• Volume overload
• Mitral, Aortic, Tricuspid Regurgitation
• Heard at the apex in L lateral position

Question 25

S4: Atrial Gallup

Answer 25

- Apex - Decreased Compliance of the ventricle - CAD - Aortic Pulmonary Stenosis - Systolic Afterload - HTN

Question 26

Systolic Aortic Stenosis

Answer 26

- Flow through semilunar valves - LVH develops - Thrill Present - S1 normal - paradoxical split S2, S4 present with LVH

Question 27

Systolic Pulmonary Stenosis

Answer 27

- Calcification of the pulmonic valve - Thrill present - Diminished S2 - S4 common with RVH

Question 28

Systolic Mitral Regurgitant

Answer 28

- 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

Question 29

Systolic Tricuspid Regurgitation

Answer 29

- 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

Question 30

Distolic Mitral Stenosis

Answer 30

- 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

Question 31

Diastolic Tricuspid Stenosis

Answer 31

- 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

Question 32

Diastolic Aortic Regurgitation

Answer 32

- 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

Question 33

Diastolic Pulmonic Regurgitation

Answer 33

- 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