Heart Sounds - Dolphens Flashcards
Systole
*Describe the cardiac cycle including its components: S1, S2, systole, and diastole. *
Contraction.
Pressure increases closure of AV valves S1
ventricles empty pressure decreases closure of semilunar valves S2
Diastole
*Describe the cardiac cycle including its components: S1, S2, systole, and diastole. *
Relaxation
ventricular pressure < atrial pressure, AV valves open, ventricles filling
S3: May occur during late filling of ventricles.
S4: Can occur as atria contract late to complete emptying of atria into ventricles.
Cardiac Exam: Vital Signs
- Heart Rate
- Respiratory Rate
- Blood Pressure
- both upper extremity
- one lower extremity
- Spot oximetry
Cardiac Exam: Inspection
General Appearance: nutritional status, genetic abnormalities, nail clubbing
Color: pink, cyanotic, pale
Comfort: dyspnea, diaphoresis
Breathing Pattern: tachypnea, grunting, nasal flaring, bulging or retractions
Venous Distension
Cardiac Exam: Palpation
Chest:
- Thrills
- PMI
Abdomen:
- Hepatomegaly
- Splenomegaly
Pulses:
- rate and rhythm
- Brachio-Femoral dealy
- absence of distal pulses
- bounding pulses
Cardiac Exam: Auscultation
Describe the auscultatory process and the areas of auscultation.
Auscultatory Process: listen in 3 positions: sitting, supine, left lateral recumbent, take the time to isolate individual sounds
Areas of Ascultation
- Aortic: 2 ICS RSB
- Pulmonic: 2 ICS LSB
- 2nd Pulmonic - Erb’s point: 3ICS LSB
- Tricuspid: 4ICS LSB
- Mitral or apical: 5ICS MCL
First Heart Sound
*Describe the cardiac cycle including its components: S1, S2, systole, and diastole. *
- results from closing of AV valves
- indicates beginning of systole
- best heard at apex
- lower pitch, longer
Second Heart Sound
*Describe the cardiac cycle including its components: S1, S2, systole, and diastole. *
- closure of semilunar valves
- indicates end of systole
- best heard at the (base) aortic and pulmonic areas
- higher pitch, shorter duration
- usually heard as a single sound, can be split
Splitting of Heart Sounds
Describe the abnormal extra heart sounds: S3, S4, and splitting.
- occurs due to asynchrony between valves
- A2P2 - aortic closes slightly earlier
- heard best at peak of inspiration
- often normal but may be pathologic
Third Heart Sound
Describe the abnormal extra heart sounds: S3, S4, and splitting.
- occurs normally in diastole
- normally heard to hear
- physiologic in kids
- pathologic after age 35
- due to rapid filling of the ventricles
- low pitch sound, time sequence “Ken-tuc-key”
- best heard: left lateral recumbent at apex
Fourth Heart Sound
Describe the abnormal extra heart sounds: S3, S4, and splitting.
- pathologic
- occurs in diastole, later than S3 before S1
- **low pitched heard best with bell in left lateral recumbant **
- timing: “Tenn-es-see”
- heard with decreased ventricular compliance
- HTN
- cardiomyopathy
- aortic stenosis
define Heart Murmur
Describe heart murmurs and the characteristics used to evaluate them.
disruption in the flow of blood into, through or out of heart
Causes of Heart Murmurs
Describe heart murmurs and the characteristics used to evaluate them.
diseased valves - don’t open/close properly
high output demands that increase the speed of blood:
- thyrotoxicosis
- anemia
- pregnancy
structural defects
- ASD
- PDA
diminished strength of myocardial contraction
altered blood flow in the major vessels near heart
Characteristics of Murmurs: Timing
Describe heart murmurs and the characteristics used to evaluate them.
- Systolic Murmurs: between S1 and S2
- Diastolic Murmurs: between S2 and S1
Characteristics of Murmurs:** Location**
Describe heart murmurs and the characteristics used to evaluate them.
- where is it best heard i.e. aortic area
Characteristics of Murmurs: Pattern
Describe heart murmurs and the characteristics used to evaluate them.
- crescendo: progressively gets louder
- decrescendo: progressively gets softer
- crescendo-decrescendo: gets louder than softer
- sustained: maintains constant loudness
