Heart Sounds - Exam 1 Flashcards
Draw the heart sound diagram from med phys
The _____ is better for picking up the relatively high pitched sounds of S1 and S2
The ____ is more sensitive to the low-pitched sounds of S3 and S4
diaphragm
bell
What are the listening posts for heart sounds?
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Aortic
Pulmonic
Tricuspid
Money
The patient is in the left lateral decubitus position, what and where are you listening for?
because it brings the heart forward using the bell at the MV post
What does sitting up and leaning forward help you find? What is the pt instruction?
Helps distinguish aortic murmurs, have the pt exhale deeply and hold
How does standing affect venous return? squatting? Valsalva maneuver?
standing decreases venous return, arterial BP and stroke volume
squatting increases venous return, LV volume and arterial BP
Valsalva maneuver decreases venous return, arterial BP and stroke volume
Why does a heart murmur get softer when you stand?
because the heart stretches
SI makes what sound? Where is it louder? When does it occur? What valves are closing?
S1 (“lub”)
Louder at the APEX
Occurs at the beginning of ventricular systole
Closure of AV valves (TV/MV).
does S1 or S2 correspond with the pulse?
S1
What is an S1 split?
Heard when the MV closure significantly precedes TV closure. May be normal
S2 makes what sound? Where is it louder? What valves are closing? When does it occur?
S2 (“dub”)
Louder at the BASE
Closure of semilunar valves (AV/PV).
Occurs at the end of ventricular systole
What is an S2 split? Where is it heard the best?
– S2 is physiologically split because AV closure (A2) normally precedes PV closure (P2) and it’s usually louder.
Heard best at 2nd and 3rd ICS
In an S2 split _____ splitting is normal and _____ splitting is abnormal. What does it indicate?
inspiratory splitting is normal
expiratory splitting is abnormal- right heart disease
What is the difference between a split S1 and S4?
S4 heart sound is in a lower frequency than S1
When can it be normal to hear a split S2?
during deep inspiration
Where is a split S2 best heard at?
pulmonic area
What is the difference between S3 and a split S2?
S3 is heard later in the cardiac cycle and is a lower pitch
split S2 are a higher pitch
What is the slang term for S3? When does it occur?
S3 “Kentucky” “ventricular gallop”
Occurs in the beginning of diastole after S2; not of valvular origin.
What does S3 sound represent? Where is it best heard? What side of the stethoscope?
Represents increased volume of blood striking a compliant ventricle (dilation)
Best heard with bell at apex in LLD
S3 is normal in what pt populations?
Normal in children, trained athletes and sometimes in pregnancy. In adults over 40 yrs, assoc with a dilated ventricle (as in systolic ventricular failure).
What is the slang term for S4? When does it occur?
S4 “Tennessee” “atrial gallop”
Occurs just after atrial contraction at the end of diastole, just before S1.
Why does S4 sound happen? Where and with what side of the stethoscope is it heard the best?
Produced by the sound of blood being forced into a noncompliant (stiff/ hypertrophic) ventricle - atria has to contract harder
Best heard with bell at apex in LLD
What pt population is S4 commonly seen in?
NEVER A NORMAL FINDING!!!
Usually associated with a stiffened ventricle (heard in patients with ventricular hypertrophy, myocardial ischemia, older adults) aka long-standing HTN
S3 is heard in ____ diastole and S4 is heard in ____ diastole
S3: EARLY diastole
S4: LATE diastole
What is an ejection click a result of? Immediately follows _____
Result of opening of AV (dilated aorta, aortic stenosis, or bicuspid AV) or PV (dilated pulmonary artery, pulm HTN, or pulmonic stenosis)
S1
What is an opening snap caused by? What does it follow?
Caused by opening of MV, as in MS
Follows S2
What phase are S3 and S4 heard in?
diastole
How are murmurs differentiated from extra heart sounds?
murmurs are longer than extra heart sounds
_____ have an abnormally narrowed valvular orifice that obstructs blood flow. AKA do not ____ well
Stenotic valves
do not OPEN well
______ fail to fully close. A valve that allows blood to leak backwards in a retrograde direction produces a regurgitant murmur. Aka do not ____ well
Insufficient or regurgitant valves
do not CLOSE well
What do you evaluate cardiac murmurs for?
S: site: what listening post?
C: character
R: radiation
I: intensity
P: pitch: high or low
T: timing: when is it happening?
**What is the grading scale for cardiac murmurs?
What are the options for cardiac murmurs?
systolic, diastolic or continuous
What does crescendo sound like? decresendo?
crescendo: getting louder
decrescendo: getting softer
Carotid pulse is _______
systolic
What is the cause behind a pansystolic murmur? Is it a problem? What is a major example?
Arising from blood flow from a chamber of high pressure to one of low pressure through a valve that should be closed
YES, this is pathologic
mitral regurgitation
_____ is the MC heart murmur? ** What is the clinical pearl associated with it? What is it a result of?
midsystolic murmur
blowing
turbulent blood flow
What does pathologic midsystolic murmur indicate?
aortic stenosis
diastolic murmurs may be _____ or ____
early or mid-late
early diastolic murmurs are due to regurgitation through ______ most often aortic regurg
incompetent semilunar valves,
In diastolic murmurs mid-late diastolic murmurs suggest ______, most commonly mitral stenosis
stenosis of an A-V valve
**if you hear a diastolic murmur in the middle of a cycle, the most likely cause is _____
stenosis
**Venous hum are considered _____ murmurs. What are they produced by? What are they characterized by?
combined
Produced by turbulence of blood flow in jugular veins
Characterized by a continuous murmur that is louder in diastole and has a soft, low pitch
Pericardial Friction Rub are classified as ______ murmurs. What are they a result of? What makes these increase?
combined murmurs that last the entirety of the cycle
A result of inflammation of the pericardium
Increases as the patient leans forward, exhales, and holds their breath
What is a Patent Ductus Arteriosus (PDA)? What type of murmur?
Congenital abnormality resulting in a channel between the aorta and pulmonary artery
combined murmur
**a heart sound is described as harsh, machinery-like, medium pitched that is typically associated with a thrill. What am I?
Patent Ductus Arteriosus (PDA)
Where is a PDA the loudest? Where is it heard the best?
Loudest in systole and fades in diastole
Best heard at left 2nd intercostal space, radiating to left clavicle
What are the 2 different kinds of echocardiograms?
Transthoracic (TTE) 2D echocardiogram
and
Transesophageal Echo (TEE)
_____ is the most common study ordered for valvular abnormalities
Transthoracic (TTE) 2D echocardiogram w/Doppler imaging
What attributes of the heart does TTE give a good view of?
Provides excellent images of valve motion, intracardiac masses, cardiac abnormalities / anomalies, and pericardial fluid
Gives info about the size of all 4 chambers, regional and global systolic function, and chamber wall thickness
What is the advantage of the TEE?
Gives better view of posterior heart structures, specifically the atria, atrial appendage, and A-V valves
TEE are better than a TTE for dx ______ and to confirm ______. TEE helps define _____ or ______
left atrial appendage (LAA) thrombus
severe valvular disease
septal defects
patent foramen ovale (PFO)
What is the important pt education prior to TEE procedure?
Patient has to be NPO for 6-8 hours prior to procedure
What are the risk of TEE? It is performed under ________
Aspiration
Throat irritation
Esophageal perforation
IV sedation and local anesthetic to reduce gag reflex
