Heart Sounds -Silverstein Flashcards
The diaphragm of the stethoscope is good for hearing _____ frequency sounds.
high
The bell of the stethoscope is good for hearing _____ frequency sounds.
low
What is S1? Where is it heard the loudest?
S1=mitral and tricuspid closure
apex (5th intercostal, midclavicular)
What is S2? Where is it heard loudest?
S2=aortic and pulmonary closure
loudest at the left base (P area)
Which normal heart sound varies with the respiratory cycle?
S2
get physiologic splitting during inspiration
S1——-A2: P2
What can lead to S1 splitting?
RBBB (due to the delayed tricuspid valve closure
RV pacing
What can cause abnormal S2 intensity?
pulmonary or systemic HTN –> loud/forceful closure of the valves
or aortic or pulmonary stenosis ==> soft closure because the valves are stuck in place
What can lead to a wide splitting of S2?
RBBB or pulmonic valve stenosis delaying pulmonary valve closure
still increases with inspiration
*what should you think of when you hear fixed splitting?
ASD!!!
Where is S3 heard the loudest?
apex in the left lateral decubitus position
What is S3?
early diastole
ventricular gallop
listen with a bell (dull)
What is S4?
late diastole
atrial contraction against a non-compliant ventricle (atrial gallop)
What is an opening snap due to? What is worse, an earlier OS or a later OS?
Opening of stenotic AV valve (usually mitral)
Earlier OS (closer to A2) with more severe stenosis because LA pressure is higher so overcomes LV pressure earlier
What is a Pericardial knock due to?
When will it be heard?
Abrupt cessation of ventricular filling in early diastole due to constrictive pericarditis
Later than OS (OS has to be open for ventricle to fill)
Earlier than S3
What does a mid-systolic click indicate? Will this get better or worse with valsalva?
AV valve prolapse
leaflets bulge into the atrium during ventricular contraction
worse with valsalva
How are murmurs graded?
Systolic 1/6: Barely audible 2/6: Faint but immediately audible 3/6: Easily heard 4/6: With palpable thrill 5/6: Heard with stethoscope lightly on chest 6/6: Heard with stethoscope not touching
diastolic 1/4: Barely audible 2/4: Faint but immediately audible 3/4: Easily heard 4/4: Very loud
Is a systolic crescendo-decrescendo murmur always pathologic?
no. can be normal in kids and pregnant women (high flow states)
What can holosystolic murmurs be due to?
-Mitral regurgitation
Apex, radiates to axilla
-Tricuspid regurgitation
LLSB, increases with inspiration
-VSD
4-6th L intercostal, no radiation, no respiratory variation, small = louder
What can cause an early diastolic murmur?
heard right after S2
aortic regurgitation–> left sternal border
pulmonic regurgitation –> may increase with inspiration
What can cause a mid to late diastolic murmur?
Mitral or tricuspid stenosis
What causes a continuous murmur?
PDA
