heart sounds-examination/interpretation

Question 1

list the auscultation lankmarks (4)

Answer 1

aortic valve (2nd right intercostal space)
pulmonic valve (2nd left intercostal space)
tricuspid valve (4th left intercostal space)
mitral valve (5th left intercostal-mid clavical)

Question 2

what does the S1 sound indicate and where is it best heard?

Answer 2

closing of mitral and tricuspid valves/ beginning of systole, best heard in either of those areas

Question 3

what does the S2 sound indicate and where is it best heard?

Answer 3

closing of semilunar valves/end of systole; best heard at pulmonary or aortic area.

Question 4

S1, or the “lub” sound is often decreased in individuals with ____

hint: Consider what the sound indicates during normal heart rhythm

hin#2: think heart block

Answer 4

1st degree block

Question 5

S2, or the “dub” sound is often decreased in individuals with ____

Answer 5

aortic stenosis

Question 6

A heart murmur, or extra sound, can be systolic or diastolic. Either can be an indicator of valvular disease, but____could also be normal.

Answer 6

systolic murmurs

Question 7

____is an abnormal tremor accompanying a vascular or cardiac murmur and is felt on palpation .

Answer 7

a thrill

Question 8

a ____is a murmur that sounds like blowing. it’s common in carotic and femoral arteries and indicative of artherosclerosis.

Answer 8

bruit

Question 9

Gallops are associated with ventricular filling and the two main types are S3 and S4. Which is most associated with congestive HF for older adults?

Answer 9

S3

Question 10

___represent a premature beat arising from the ventricle. What do they look like on an EKG?

Answer 10

PVCs; no P-wave +abnormal/wide QRS+ pause

>6 per min, paired or sequential, multifocal, and very early are serious

Question 11

V-tach is a run of ___ PVCs at a very rapid rate (150-200 bpm) resulting from ventricular ischemia. What does it look like on an EKG?

Answer 11

4+; absent P, abnormal QRS

nonsustained <30s

Question 12

If a pt has chaotic ventricular firing and no QRS complexes, they are likely in ____. Clinical death can them occur within 4-6 min

Answer 12

ventriculat fibrillaiton

Question 13

In atrial____, though p-waves are abnormal and the rhythm is irregular, the rate is only up to 180 bpm. For ____, p waves appear repetitive and saw-like, but the rhythm is regular and between 250-350

Answer 13

• a fib
• atrial flutter

Question 14

a fib may precipitate___ in an abnormal heart.

Answer 14

ventricular failure

Question 15

What is the difference between the 3 types of heart blcoks?

Question 16

what are the primary interventions for a third degree heart block? (2)

Answer 16

atropine
pacemaker implant

Question 17

HYPERkalemia widens QRS, flattens the ___-wave, and peaks the ___-wave.

hint: if you are always “hyper” or loud, no one hears the real signial

Answer 17

flattens p; peaks t

Question 18

HYPOkalemia inverts the ___wave

Question 19

HYPERcalcemia widens QRS (and ___ QT interval)

inc CA2+ does what to time between contraction and repolarization

Question 20

HYPOcalcemia___the QT interval

relationship between contraction and repolarization

Answer 20

widens

Question 21

What is MAP? How is it calculated?

Answer 21

arterial pressure of main arteries over time (controlled by blood flow and compliance)
*(SBP+ 2DBP)/3

Question 22

normal MAP range is ___

Answer 22

70-110mmHg