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Phys: Cardio > Heart Sounds and Valves > Flashcards

Heart Sounds and Valves Flashcards

1
Q

What does S1 correspond to?

A
  1. Closing of the AV valves

2. “Lub” sound

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2
Q

When does S1 occur?

A

At beginning of ventricular systole

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3
Q

When does S2 occur?

A

At end of ventricular systole

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4
Q

What does S2 correspond to?

A
  1. Closing of semilunar valves

2. “Dub” sound

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5
Q

Define S3

A

Weak rumbling sound occasionally heard during middle third of diastole
Sound of ventricles filling causing reverberation along ventricle walls

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6
Q

What S3 sound can be heard with heart failure?

A

S3 gallop

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7
Q

Until what age is S3 normal?

A

40

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8
Q

Define S4

A

Very weak sound, if heard, abnl

Sound of atria contracting

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9
Q

What do heart sounds result from?

A
  1. Vibration of valves immediately after closure

2. Vibration of adjacent heart walls & major vessels

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10
Q

What is the order of heart sounds if all 4 are present?

A

S4
S1
S2
S3

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11
Q

Where do you auscultate to hear the aortic valve?

A

2nd intercostal space @ R sternal border

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12
Q

Where do you auscultate to hear the pulmonic valve?

A

2nd intercostal space @ L sternal border

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13
Q

Where do you auscultate to hear the tricuspid valve?

A

Over right ventricle (5th ICS left sternal border)

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14
Q

Where do you auscultate to hear the mitral valve?

A

Over apex of left ventricle @ level of 5th ICS

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15
Q

Define murmurs

A

Abnormal heart sounds produced by abnl patterns of blood flow in heart. May be from congenital condition or as a result of disease such as Rheumatic Fever.

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16
Q

How can murmurs be described?

A
  1. Timing of murmur relative to CC
    A. Systole shorter than diastole at nl HR
    B. systolic vs. diastolic
  2. Intensity (loudness)
    A. Directly related to speed of blood flow, speed is determined by pressure gradient across valve
    Grade I-VI
  3. Frequency (pitch)
    A. Also directly related to speed of blood flow at murmur’s origin
17
Q

What valves do rheumatic valvular lesions affect?

A

Usually affects mitral or aortic valves

18
Q

What is the pathophys of rheumatic valvular lesions?

A
  1. Result from Rheumatic Fever (RF)
  2. Large hemorrhagic & fibrinous lesions grow along the inflammed edges of heart valves
  3. Usually occur on adjacent leaflets simultaneously so that the leaflets become stuck together
  4. Lesions eventually become scar tissue, permanently fusing portions of leaflets
  5. Leads to stenosis & regurgitation
19
Q

Define mitral valve stenosis

A

Incomplete opening of mitral valve during diastole, creating diastolic murmur

20
Q

What are common causes of mitral valve stenosis?

A

Most commonly the result of RF

congenital

21
Q

What are the characteristics of mitral valve stenosis?

A
  1. Low-pitched (due to low velocity from narrowing of valve), rumbling murmur best heard at apex, left lateral decubitus position
    A. opening snap
    B. Heard in diastole
    C. Heard better with the bell than diaphragm
22
Q

Define mitral valve regurgitation

A

Incomplete closure of mitral valve

23
Q

What is the pathophys of mitral valve regurgitation?

A
  1. Causes: RHD, ruptured chordae tendinae, papillary muscle dysfunction or dilation of LV or valve orifice
24
Q

What are the characteristics of mitral valve regurgitation?

A
  1. High frequency systolic “blowing” murmur
    A. Holosystolic (pansystolic)
  2. Transmitted strongest to LA (LA very deep in thorax)
25
Q

What can mitral valve diseases lead to?

A

Afib

pulmonary edema

26
Q

Murmurs are more common on which side of the heart?

A

Left

27
Q

What causes aortic stenosis?

A

Congenital valve malformation and acquired calcification of valve

28
Q

What are the characteristics of aortic stenosis?

A
  1. Characterized by  resistance to ejection of blood from LV into aorta
  2. Loud systolic ejection murmur
  3. Occurs as a result of “nozzle effect” during systole
  4. Turbulent blood flow against aortic walls causes the harsh murmur
  5. Sometimes has an associated thrill over upper chest & neck
29
Q

Define aortic valve regurgitation

A
  1. Incompetent aortic valve that allows blood to flow back to LV during diastole
30
Q

What are the causes of aortic valve regurgitation?

A

Causes are varied: RF, dilation of aorta, infective endocarditis, Marfan syndrome

31
Q

What are the characteristics of aortic valve regurgitation?

A

Holodiastolic murmur

32
Q

What is the result of aortic valve regurgitation and/or stenosis?

A
  1. LV volume and pressure overload
    A. As valve deformity increases, regurg flow increases in LV, DBP falls, and LV progressively enlarges
  2. LVH
33
Q

How can S1 and S2 be differentiated?

A

Listen to heart and feel carotid pulse at the same time. S2 is right after pulse

Phys: Cardio (6 decks)

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