Heart Sounds - Johnston Flashcards
Listening posts:
AV - R 2nd ICS at SB
PV - L 2nd ICS at SB
TV - L 4th ICS at SB
MV - L 5th ICS at MCL
6 gradings of a heart murmur
Which have thrill, which do not?
Grade 1 - very faint
Grade 2 - quiet, soft, easily heart WITH STETH
Grade 3 - Moderately loud
——–
Grade 4 - LOUD with PALPABLE THRILL
Grade 5 - VERY LOUD with thrill, heard partially without steth
Grade 6 - Heard WITHOUT STETH
What type of murmurs are heard between S1 and S2? Between S2 and S1?
S1-2 = systolic (TV, MV closure) S2-1 = diastolic (AV, PV closure)
S3 sound. Use what part of steth?
Kent-Tuck-y
dull, low pitch. Use bell.
S3 is physiologic in what age group and pathologic in what age group?
Physiologic in kids, YA
Pathologic in older adults = HF
S4 sound. Use what part of steth?
Ten-Nes-See.
Bell.
FORCEFUL ATRIAL CONTRACTION against stiffened low compliant ventricle.
Name the diastolic murmurs
AR, PR
MS, TS
Atrial myxoma
Name the systolic murmurs
MR (MVP), TR
AS, PS
VSD
Aortopulmonary shunts
NAme the continuous murmurs
PDA machinery
AV fistula
ASD with high LA pressure
Coarctation of the aorta
Valvular heard disease - the most commonly encountered conditions
Degenerative (senile calcification)
Myxomatous degeneration (MVP)
Congenital (bicuspid AV)
Two most common etiologies of chronic MR
MVP
MAC
Four most common etiologies of acute MR.
Rupture of chordae tendineae
Rupture of papillary mm
Ischemic papillary muscle dysfunction
IE; valve performation
What is this?
Asympomatic for years
Acute - volume overload, orthopnea, PND, RHF/LHF
MR
What has this murmur: blowing, prominent at apex; radiates to left axilla. May have systolic click. Decreased S1 or normal S1
MR
What is this?
- 4th decade
- DOE, cough, orthopnea, PND, pulm edema, hemoptysis, arterial emboli, Afib.
- MALAR RASH
- Ortner syndrome
MS
What has this murmur:
- Rumbling, diastolic murmur, low pitch, best heard at apex with bell.
- Increased S1, opening shape after S2
MS
Etiology of AS
- Degenerative (calcific or senile)
- Congenital bicuspid aortic valve
- Rheumatic or post inflammatory scarring
AoV Area in normal aortic valve v. in severe AS
Normal is 4square cm.
Severe AS if AoV is less than 1square cm.
S/s of what?
6th decade»_space; ** exertional DYSPNEA, ANGINA, SYNCOPE, HF **
AS
What is the prognosis of AS?
Without tx, prognosis is poor.
- Die w/in three years of developing SYNCOPE, w/in two years of onset of HF.
Pathophysiology of AS
Obstruction leads to PRESSURE OVERLOAD; LVH
AS PE
- Narrowed Pulse Pressure, dec. SV and systolic pressure
- Delayed pulses - Parvis/Tardus
- Harsh systolic murmur, 2nd ICS RSB, radiates to supra sternal notch/carotids.
- Gallavardin phenomenon (murmur radiates to apex)
Causes of acute AR
Causes of chronic AR
Acute - IE, aortic dissection, BAV
Chronic - Syphilis, ankylosing spondylitis
AR PE
Diastolic, decrescendo murmur, 3rd ICS LSB. Soft systolic murmur may be present.
- De Musset Sign, Austin flint murmur
What indicates TR? (ECG and PE)
ECG: Prominent “V” wave in JVP
PE: blowing systolic murmur LSB; increase with inspiration (Carvallo’s sign).
Tricuspid Regurgitation (TR) is associated with what three things?
pulmonary HTN, inferior MI, RV infarction
Tricuspid Stenosis (TS) is associated with what three things?
MS, TR, RHD
What indicates TS? (ECG and PE)
ECG: Prominent “A” wave in JVP ascites
PE: (Possible) Pulsatile hepatomegalia, Carvallo’s sign, Diastolic murmur LSB that increases with inspiration (Carvallo’s sign) and decreases with expiration.
Pulmonary Regurgitation (PR or PI) - PE
Blowing diastolic murmur 2 LEFT SB (Graham Steell).
Most cases are due to pulmonary HTN
Murmur in PR/PI
- 2nd-3rd ICS, LSB
- Radiates to L shoulder and increases on inspiration/RVH
***Will you hear an S4 in afib?
No - atria beating too fast to contract. So you cannot have S4 in afib.
