Heart Sounds I Lecture Powerpoint Flashcards
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Heart sounds are heard in the spots they are in the chest because…
…that is the rough direction of where blood is flowing in the vessels
During diastole, what valves are open?
Mitral and tricuspid valves
S1 heart sound occurs during what phase of the heart cycle? What about S2?
- At the end of diastole/start of systole
- At the end of systole/start of diastole
Blood FLOWS during which phase of the cardiac cycle?
BOTH!!!!!!!!!!!!
Diagnostic study for abnormal heart sounds
Echocardiogram
Stenotic valve definition
A valve that is partially occluded or narrowed
Sclerosis of valve definition
Thickening of valve that causes it to lose its compliance that could result in stenosis
Insufficiency/regurgitation definition
When a valve leaks allowing backward flow when it should be closed
Pulse pressure definition
Difference between systolic and diastolic blood pressure
Atrial systole and diastole ___ ventricular systole and diastole
precede
End systolic volume
Volume of blood remaining in LV following cardiac contraction and ejection of blood
Stroke volume + end systolic volume =
end diastolic volume
Ejection fraction and avg value
Stroke volue/end diastolic volume, should be about 55%
Aortic area Pulmonic area Erb's point Tricuspid area Mitral area Locations
- 2nd intercostal space right sternal border
- 2nd intercostal space, left sternal border
- third intercostal space, left sternal border
- 4th intercostal space, left sternal border
- 5th intercostal space, mid clavicular line
Carotid pulsation to determine S1 vs S2
Should be able to feel the carotid pulse between S1 and S2 if you are having trouble determining which is which
S1 is loudest at the ___, S2 at the ___
apex, base
Physiological splitting of S2
Refers to splitting of S2 into A2 (aortic valve closing) and P2 (pulmonic valve closing) that is exacerbated during inspiration because of the impedance of the pulmonary circulation vascular beds
Decreased S1 causes (2)
- thickened chest wall
- calcification of AV valves
Increased S1 causes (2)
- increased cardiac output
- increased AV valve flow velocity (acquired stenosis)
Wide splitting of S2 causes (4)
- delayed P2 from pulmonary stenosis or pulmonary hypertension
- Early A2 from mitral regurgitation or VSD
Paradoxical splitting of S2 and causes (2)
Occurs where split is widened during expiration and hsortened during inspiration (with A2 after P2)
- aortic stenosis
- aortic insufficiency
S3 gallop
Early diastolic sound following S2 with new blood entering a dilated ventricle, may be normal in children or indicative of CHF, CAD, or aortic/mitral insufficiency
S4 gallop
Late diastolic sound right before S1 due to ejection of blood from atria during atrial contraction hitting a stiff noncompliant wall, long standing hypertension causing LV hypertrophy is key, may be normal but almost always pathologic
Summation gallop
Occurs where S3 and S4 combine in a rapid heart which sounds like 3 heart sounds lined up in a row
Aortic ejection click
Early systolic sound heart just after S1, does not vary with inspiration, due to a mobile but abnormally shaped or stenotic aortic valve, usually pathologic for aortic stenosis
Opening snap
Opening of abnormal tricuspid or mitral valve, early diastolic sound heard just after S2 associated with mitral stenosis
Cardiac friction rub
Creaking, grating, or scratching sound heard with pericardial inflammation, classically has 2 systolic and one diastolic component, heard best at the left sternal border (increased when leaning forward) when patient is not breathing
