January 7, 2016 - Heart Sounds

Question 1

Examination of Aterial Pulse

Answer 1

The initial tap is due to the percussion wave, which is a rapid rise to the peak blood pressure.

This is followed by a tidal wave, which are waves refllected back from peripheral arteries.

Question 2

Listen for Arteries

Answer 2

You must listen to the carotid and the femoral arteries bilaterally.

Question 3

Auscultation of Heart Sounds

Answer 3

Active listening for…

1. Intensity

2. Splitting

3. ? Extra heart sounds
4. ? Gallop rhythym (S3 and S4)
5. ? Murmurs

Question 4

Mitral Stenosis

Answer 4

The narrowing of the orifice of the mitral valve in the heart.

Almost all cases are caused secondarily to rheumatic fever and the consequent rhematic heart disease. Uncommonly, can be caused by calcification.

Question 5

Soft First Heart Sound

Answer 5

Can be caused by a long PR interval or by severe mitral stenosis.

Question 6

Third Heart Sound (S3)

Answer 6

Common in children but not in adults. This is pathological if found in adults.

Generated during early diastole rapid filling phase. This is caused by the sudden limitation of longitudinal expansion of the left ventricle during brisk diastolic filling. It is a low frequency sound.

Question 7

Fourth Heart Sound (S4)

Answer 7

Generated during atrial contraction during late diastole.

Caused by presystolic ventricular distension. S4 is not normal in young patients and is a low frequency sound.

S4 indicates LV or RV stiffness, and is common with hypertrophy and ischemic heart disease.