Lecture 32: Heart Sounds Flashcards

1
Q

Why do we feel the carotids?

A

It is close to the heart, so it is one of the best places to feel the arterial pulse wave

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2
Q

What maneuver can increase blood in venous system?

A

Hepatojugular reflux maneuver; if it stays elevated it means that the heart cannot compensate for the sudden increase in blood volume

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3
Q

Components of jugular waveform

A

A = atrial contraction; v = venous contraction; c wave = valve closure/carotid contribution

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4
Q

How should you palpate precordial impulse?

A

Cover territory with palms

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5
Q

What can you identify/detect with palms on the heart? (5)

A

Left ventricular apex, detect ectopic impulses, detect lifts, heaves, and thrills (vibration, a “felt murmur”)

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6
Q

Aortic area

A

2nd-3rd right interspace

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7
Q

Pulmonic area

A

2nd-3rd left interspace

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8
Q

Tricuspid area

A

Left lower sternal border

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9
Q

Mitral area

A

Apex

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10
Q

Splitting of the 2nd heart sound is…When does this happen more?

A

Physiologic (normal) splitting; splits more on inspiration –> blood comes into R side of chest due to suction –> more time to cross pulmonic valve

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11
Q

Two causes for wide splitting

A

Delayed pulmonic valve closure and early aortic valve closure

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12
Q

Three reasons for delayed pulmonic valve closure

A

Right bundle branch block (delayed activation of R ventricle), pulmonic valve stenosis (prolonged right ventricular mechanical stystole), atrial septal defect (increased trans-pulmonic blood flow)

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13
Q

Two reasons for early valve closure

A

Mitral insufficiency (short left ventricular mechanical systole), ventricular septal defect (also, short left ventricular mechanical systole)

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14
Q

What could cause paradoxical (reversed) splitting

A

Delayed aortic valve closure or early pulmonic valve closure

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15
Q

Three reasons for delayed aortic valve closure

A

Left BBB (delayed electrical activation of LV), hypertensive heart disease (prolonged LV systole), CAD w/ LV dysfunction (prolonged LV systole)

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16
Q

One reason the pulmonic valve could close

A

Pre-excitation (WPW)

17
Q

Paradoxical splitting is wider during…

A

Expiration

18
Q

S4 gallop

A

Atrial kick

19
Q

S3 gallop

A

Sound of blood due to dilated ventricle

20
Q

S3 + S4, when would this happen?

A

Summation gallop; heart is beating fast

21
Q

Murmur grades

A

Grade 6: across the room; 5: no stethoscope; 4: you can feel it; 3: w/ stethoscope; 2: murmur; 1: quiet murmur

22
Q

Pulse with aortic stenosis

A

Pulsus parvus et tardus

23
Q

What else do you feel with aortic stenosis?

A

Precordial LV impulse/lift/systolic thril

24
Q

What finding suggests a bicuspid anomaly

A

Systolic ejection click

25
Aortic stenosis murmur and when its bad
Crescendo-decrescendo; bad if late peaking
26
Aortic regurge murmur
Diastolic, decrescendo
27
Mitral regurge murmur
Holosystolic murmur
28
Mitral stenosis murmur
Opening snap, decrescendo with ending crescendo (lap da daaaaa...)
29
Mitral valve prolpase murmur
Mid systolic click w/ late systolic murmur
30
Dynamic changes with mitral valve prolapse
More prolapse/more leak and an earlier click when the ventricle has less blood, things that empty heart of blood will cause this (expiration, Valsalva manevuer, or squat, exhale, and stand)
31
Dynamic changes are also good for detecting what from what...
Dynamic left ventricular outflow track obstruction (aka LV hypertrophy, murmur gets louder) vs atrial stenosis (murmur gets softer with less ventricular filling)