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Cardio > Heart Sounds - Exam 1 > Flashcards

Heart Sounds - Exam 1 Flashcards

1
Q

Draw the heart sound diagram from med phys

A
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2
Q

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

A

diaphragm

bell

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3
Q

What are the listening posts for heart sounds?

A

All Physicians Take Money

Aortic
Pulmonic
Tricuspid
Money

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4
Q

The patient is in the left lateral decubitus position, what and where are you listening for?

A

because it brings the heart forward using the bell at the MV post

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5
Q

What does sitting up and leaning forward help you find? What is the pt instruction?

A

Helps distinguish aortic murmurs, have the pt exhale deeply and hold

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6
Q

How does standing affect venous return? squatting? Valsalva maneuver?

A

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

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7
Q

Why does a heart murmur get softer when you stand?

A

because the heart stretches

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8
Q

SI makes what sound? Where is it louder? When does it occur? What valves are closing?

A

S1 (“lub”)

Louder at the APEX

Occurs at the beginning of ventricular systole

Closure of AV valves (TV/MV).

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9
Q

does S1 or S2 correspond with the pulse?

A

S1

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10
Q

What is an S1 split?

A

Heard when the MV closure significantly precedes TV closure. May be normal

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11
Q

S2 makes what sound? Where is it louder? What valves are closing? When does it occur?

A

S2 (“dub”)
Louder at the BASE

Closure of semilunar valves (AV/PV).

Occurs at the end of ventricular systole

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12
Q

What is an S2 split? Where is it heard the best?

A

– 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

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13
Q

In an S2 split _____ splitting is normal and _____ splitting is abnormal. What does it indicate?

A

inspiratory splitting is normal

expiratory splitting is abnormal- right heart disease

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14
Q

What is the difference between a split S1 and S4?

A

S4 heart sound is in a lower frequency than S1

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15
Q

When can it be normal to hear a split S2?

A

during deep inspiration

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16
Q

Where is a split S2 best heard at?

A

pulmonic area

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17
Q

What is the difference between S3 and a split S2?

A

S3 is heard later in the cardiac cycle and is a lower pitch

split S2 are a higher pitch

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18
Q

What is the slang term for S3? When does it occur?

A

S3 “Kentucky” “ventricular gallop”

Occurs in the beginning of diastole after S2; not of valvular origin.

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19
Q

What does S3 sound represent? Where is it best heard? What side of the stethoscope?

A

Represents increased volume of blood striking a compliant ventricle (dilation)

Best heard with bell at apex in LLD

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20
Q

S3 is normal in what pt populations?

A

Normal in children, trained athletes and sometimes in pregnancy. In adults over 40 yrs, assoc with a dilated ventricle (as in systolic ventricular failure).

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21
Q

What is the slang term for S4? When does it occur?

A

S4 “Tennessee” “atrial gallop”

Occurs just after atrial contraction at the end of diastole, just before S1.

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22
Q

Why does S4 sound happen? Where and with what side of the stethoscope is it heard the best?

A

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

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23
Q

What pt population is S4 commonly seen in?

A

NEVER A NORMAL FINDING!!!

Usually associated with a stiffened ventricle (heard in patients with ventricular hypertrophy, myocardial ischemia, older adults) aka long-standing HTN

24
Q

S3 is heard in ____ diastole and S4 is heard in ____ diastole

A

S3: EARLY diastole

S4: LATE diastole

25
Q

What is an ejection click a result of? Immediately follows _____

A

Result of opening of AV (dilated aorta, aortic stenosis, or bicuspid AV) or PV (dilated pulmonary artery, pulm HTN, or pulmonic stenosis)

S1

26
Q

What is an opening snap caused by? What does it follow?

A

Caused by opening of MV, as in MS

Follows S2

27
Q

What phase are S3 and S4 heard in?

A

diastole

28
Q

How are murmurs differentiated from extra heart sounds?

A

murmurs are longer than extra heart sounds

29
Q

_____ have an abnormally narrowed valvular orifice that obstructs blood flow. AKA do not ____ well

A

Stenotic valves

do not OPEN well

30
Q

______ fail to fully close. A valve that allows blood to leak backwards in a retrograde direction produces a regurgitant murmur. Aka do not ____ well

A

Insufficient or regurgitant valves

do not CLOSE well

31
Q

What do you evaluate cardiac murmurs for?

A

S: site: what listening post?
C: character
R: radiation
I: intensity
P: pitch: high or low
T: timing: when is it happening?

32
Q

**What is the grading scale for cardiac murmurs?

A
33
Q

What are the options for cardiac murmurs?

A

systolic, diastolic or continuous

34
Q

What does crescendo sound like? decresendo?

A

crescendo: getting louder

decrescendo: getting softer

35
Q

Carotid pulse is _______

A

systolic

36
Q

What is the cause behind a pansystolic murmur? Is it a problem? What is a major example?

A

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

37
Q

_____ is the MC heart murmur? ** What is the clinical pearl associated with it? What is it a result of?

A

midsystolic murmur

blowing

turbulent blood flow

38
Q

What does pathologic midsystolic murmur indicate?

A

aortic stenosis

39
Q

diastolic murmurs may be _____ or ____

A

early or mid-late

40
Q

early diastolic murmurs are due to regurgitation through ______ most often aortic regurg

A

incompetent semilunar valves,

41
Q

In diastolic murmurs mid-late diastolic murmurs suggest ______, most commonly mitral stenosis

A

stenosis of an A-V valve

42
Q

**if you hear a diastolic murmur in the middle of a cycle, the most likely cause is _____

A

stenosis

43
Q

**Venous hum are considered _____ murmurs. What are they produced by? What are they characterized by?

A

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

44
Q

Pericardial Friction Rub are classified as ______ murmurs. What are they a result of? What makes these increase?

A

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

45
Q

What is a Patent Ductus Arteriosus (PDA)? What type of murmur?

A

Congenital abnormality resulting in a channel between the aorta and pulmonary artery

combined murmur

46
Q

**a heart sound is described as harsh, machinery-like, medium pitched that is typically associated with a thrill. What am I?

A

Patent Ductus Arteriosus (PDA)

47
Q

Where is a PDA the loudest? Where is it heard the best?

A

Loudest in systole and fades in diastole

Best heard at left 2nd intercostal space, radiating to left clavicle

48
Q

What are the 2 different kinds of echocardiograms?

A

Transthoracic (TTE) 2D echocardiogram

and

Transesophageal Echo (TEE)

49
Q

_____ is the most common study ordered for valvular abnormalities

A

Transthoracic (TTE) 2D echocardiogram w/Doppler imaging

50
Q

What attributes of the heart does TTE give a good view of?

A

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

51
Q

What is the advantage of the TEE?

A

Gives better view of posterior heart structures, specifically the atria, atrial appendage, and A-V valves

52
Q

TEE are better than a TTE for dx ______ and to confirm ______. TEE helps define _____ or ______

A

left atrial appendage (LAA) thrombus

severe valvular disease

septal defects

patent foramen ovale (PFO)

53
Q

What is the important pt education prior to TEE procedure?

A

Patient has to be NPO for 6-8 hours prior to procedure

54
Q

What are the risk of TEE? It is performed under ________

A

Aspiration
Throat irritation
Esophageal perforation

IV sedation and local anesthetic to reduce gag reflex

55
Q
A

Cardio (20 decks)

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