Module 4: Cardiac Ausculatation Flashcards
What is a cardiac auscultation?
Is a quick, inexpensive method to detect and tract the progression of the valvular heart disease
What does a doctor use for auscultation?
Stethoscope
What is the typical progression of events for cardiac auscultation? 4
- Doctor will hear a murmur before sending patient for echo
- Once echo is performed, the doctor can correlate the present disease state with the echo findings
- If the quality of the murmur changes that could indicate the disease has progressed
- A new echo is then ordered
What is the first sound?
S1 or the lub sound
What does the first sound represent?
Atrioventricular valve closure
What does the first sound S1 composed of?
M1 (mitral) and T1 (tricuspid) sounds
Normally for the first sound M1 precedes what?
T1 slightly when normal conjunction through bundle branches occur
T1 may precede what in the first sound phase?
M1 with LBBB
What causes a second heart sound (S2)?
Caused by the closure of the Semilunar valves
The second heart sound is divided into what points?
A2 and P2
For the second heart sound the A2 precedes what?
P2
A very wide split of A2 and P2 for the second heart sound may be a result of what? 3
- BBB
- AV/PV stenosis
- Atrial septal defect
When we breathe in (inspiration), the chest cavity expands causing pressure to do decrease, this causes what?
- More blood to enter the RA
- Higher volume of blood going from RA»_space; RV
What is the S3 (Lub-dub-ta) sound caused by?
Increase volume of blood in the ventricle when the MV opens
coincides with early filling of the ventricles
not caused by valves
Is the S3 (lub-dub-ta) sound heard normally?
Seldom heard
When do we see/hear the S3 sound? And why? (When would we see cases of it)
Normal in young, athletes, pregnancy because of
1. Strong early filling
2. Abnormal later in life
What condition may the S3 Sound signify?
CHF
What is the S4 sound?
A presystolic heart sound that precedes the S1
Is the S4 sound normal?
Nope
What does the S4 sound like?
Ta- lub-dub
What does the S4 represent?
Blood being forced into a very stiff ventricle from the atria
When does the S4 occur?
During the late filling phase
When does the S4 occur?
Late filling phase
What are clicks?
Sounds usually produced during valve opening
What pathology might clicks be caused by? 2
- Valvular stenosis
- Mitral valve prolapse (MVP)
When is the sound heard for Mitral valve prolapse? What is it?
- Mid systolic click
- MV bows backward into LA during mid-systole
What is a pericardial rub?
Beating of the heart against the inflamed pericardium without fluid between the layers
What might the pericardial rub be caused by?
Tiny crystals in the pericardium
What does the pericardial rub sound like?
Sandpaper
What is a knock?
Beating of the heart against hardened pericardium with fluid between the layers
During a knock what is the pericardium like?
Hard shell from pericarditis
What is a muffled heart sound caused by?
The presence of pericardial effusion
What conditions causes muffled heart sounds?
The presence of pericardial effusion
What does pericardial effusions do to the sound?
Fluid dampens the sound
Pericarditis may also result in a split what?
S1- S2
What is a split S1-S2 also called?
Paradoxical splitting
Pericarditis changes because of changes with what?
respiration/ provocative manoeuvres
For muffled heart sounds the sound may increase with what maneuver?
Valsalva
Where are murmurs produced by?
Turbulent flow in the heart through the valves/ shunts/ vessels
A murmur is what kind of sound?
Abnormal
What might murmurs be caused by? 5
- Turbulence
- High flow rate
- Forward flow - abnormal valves (maybe a stenosis)
- Backward flow
- Abnormal connections
What are 6 factors of a murmur? (acronym)
SCRIPT
What does SCRIPT stand for?
- Site
- Character
- Radiation
- Intensity
- Pitch
- timing
What does the Site in SCRIPT produced by?
By the valves and are best heard over a particular region of the chest
Where are the valve locations for auscultation sites?
What is the character in SCRIPT mean? And examples? 5
The sound characteristics, like
1. Blowing
2. Crescendo/ Decresendo
3. Soft
4. Harsh
5. Rumbling
The character in SCRIPT tend to match what?
Doppler flow profiles seen with abnormal valves
What does the crescendo/Decrescendo help to relate?
Helpful to relate doppler qualities to the quality of the murmur
What is the radiation in SCRIPT mean? 2
- Heart sounds will radiate in the direction of blood flows
- Certain murmurs may be said to radiate to other areas
In terms of radiation aortic stenosis means what?
Radiation to the carotid arteries
In terms of radiation mitral regurgitation radiates to where?
LT axillary
What are the grades of intensity for Intensity?
Grade 1: heard to hear
Grade 2: quiet
Grade 3: Easy to hear
Grade 4: Easy to hear + Palpable thrill
Grade 5: Can hear with stethoscope barely touching
Grade 6: Can hear with stethoscope off chest
What does the Pitch of Script mean?
The pitch of a murmur may be higher or lower depending on the pressure gradient
A very high pressure difference will produce what kind of pitch?
High pitched murmur
A more subtle difference in pressure will reduced what kind of pitch?
Low
What does the timing of SCRIPT mean?
Does the murmur occur during Systole, Diastole, or throughout both?
What does the timing of SCRIPT mean?
Does the murmur occur during Systole, Diastole, or throughout both
What are some terms used for timing?
- Holo/pan = throughout
- Early/Mid/ Late
- Continuous
What are stenotic murmurs?
Value is narrowed and blood is moving much faster
