Heart Sounds & Murmurs Flashcards
What does S1 signal?
Start of systole
What happens in S1?
Closure of mitral and tricuspid valves
Where is S1 loudest?
Apex
What happens in S2?
Closure of aortic and pulmonary valves
What does S2 signal?
end of systole and beginning diastole
What can happen physiologically in S2?
Physiological splitting during inspiration
First component (aortic) is louder than second component (pulmonary)
lub-du-rub
How is S3 described?
early diastolic low frequency filling sound occurring immediately after S2
In who does S3 present in pathologically?
older patients with suspected/known cardiac disease
commonly due to LV systolic dysfunction
In who does S3 present in physiologically?
Healthy child/young person with no evidence of cardiac disease
Describe S4
Late diastolic low frequency filling sound occurring just before the 1st heart sound. This relates to the active filling of a stiff non-compliant ventricle by atrial contraction.
Da-lup-dup
What causes an innocent cardiac murmur?
turbulence of blood in the right ventricular outflow tract
when are innocent cardiac murmurs often loudest?
when circulation is hyperdynamic: pregnancy fever anaemia thyrotoxicosis
What is a cardiac murmur?
Audible turbulent blood flow
What kind of murmur would you hear in mitral stenosis?
mid diastolic rumbling murmur
Where does mitral stenosis radiate to?
Nowhere, it is localised to the apex
What are the symptoms and signs of mitral stenosis?
malar flush sob tiredness palpitations tapping apex beat
How would you position a patient to listen to mitral stenosis?
patient in left lateral position and listen with bell at apex
What kind of murmur is audible in mitral regurgitation? If it radiates, where to?
pansystolic murmur beast heard at apex but can radiate to the left axilla
What are the symptoms of mitral regurgitation?
Sob and ankle oedema
Give some cases of mitral regurgitation
Rheumatic heart disease mitral valve prolapse/ myxomatous degeneration endocarditis Marfans syndrome ASD
How is aortic stenosis heard?
Ejection systolic murmur loudest at aorta and radiating the the carotids
What kind of pulse is there in aortic stenosis?
low volume slow rising pulse
Causes of aortic stenosis
Age related calcification of valve
Rheumatic valve disease
congenital bicuspid valve
Symptoms of aortic stenosis
Often asymptomatic but dysponea, CP and syncope on exertion
