Lecture 5: Cardiac Sounds and Murmurs Flashcards
What is the point of maximal impulse?
Location where cardiac impulse can be best palpated on the chest (normally cardiac apex)
-not always palpable
Where is the point of maximal impulse found?
5th intercostal space at or just medial to left midclavicular line
A large point of maximal impulse can be evidence of what?
Left Ventricular Hypertrophy from hypertension or aortic stenosis
What does S1 correspond to?
Turbulence created when the mitral and tricuspid valves close
What does S2 correspond to?
Closure of the aortic and pulmonic valves
What does S3 correspond to?
Abrupt deceleration of inflow across mitral valve
- produced by the large amount of blood striking a very compliant left ventricle
- sounds like Kent-tuck-y
What does S4 correspond to?
Increased stiffness of the left ventricle and decreases compliance
-sounds like ten-nes-see
What does systolic heart failure mean?
Lack of proper ventricular contraction
What does diastolic heart failure mean?
Lack of proper ventricular relaxation
What is wide physiologic splitting of S2?
Increased splitting of S2 during inspiration
-caused by delayed closure of pulmonic valves or early closure of aortic valve
What is fixed splitting?
Wide splitting that does not vary with respiration
-prolonged right ventricular systole seen with atrial septal defect
What is paradoxical or reversed splitting?
Splitting that appears on expiration and disappears on inspiration
- closure of aortic valve is abnormally delayed
- most commonly due to left bundle branch block
What are early systolic ejection sounds?
Occurs shortly after S1 that halt aortic and pulmonic valves open
What can cause systolic clicks?
Mitral valve prolapse
What causes opening snaps?
Early diastolic sound
-abrupt deceleration during opening of stenotic mitral valve
What are systolic murmurs?
Aortic Stenosis and Sclerosis Innocent Murmur Hypertrophic Cardiomyopathy Ventral Septal Defect Tricuspid Regurgitation Mitral Valve Prolapse and Insufficiency
What are diastolic murmurs?
Aortic Insufficiency: heard best with bell
Pulmonic Regurgitation
Mitral and Tricuspid Stenosis
Describe a grade 1 murmur.
Very faint and might not be heard in all positions
Describe a grade 2 murmur.
Quiet but can be heard with stethescope
Describe a grade 3 murmur.
Moderately loud, no thrill
Describe a grade 4 murmur.
Loud, with palpable thrill
Describe a grade 5 murmur.
Very loud, with thrill
-can sometimes be heard when stethoscope is partly off chest
Describe a grade 6 murmur.
Very loud with thrill
-can be heard w/o stethoscope
Where are systolic murmurs heard?
Between S1 and S2
Where are diastolic murmurs heard?
After S2
