Murmurs and Heart Sounds Flashcards
What factors contribute to S3
Rapid passive filling of the ventricles. This is a left sided sound
What is S3
A typical normal sound in children. It is not normal in adults, except during exercise or with fever.
What causes S4 and what is it?
A low-frequency sound during active filling (atrial contraction). It follows the P-wave. It can indicate many diseases: RV + LV failure, mitral stenosis, atrial dilatation, atrial failure.
What are systolic murmurs?
a) also referred to as ejection murmurs
b) forward flow through stenotic valves
c) retrograde flow through normally closed valves: MV or TV
What is the character of a systolic murmur
Usually harsh, can be pansystolic, even in intensity
What are diastolic murmurs?
Abnormal diastolic murmurs occur by bloodflow over stenotic or incompetent valves
Which murmurs occur during diastole?
Tricuspid or mitral stenosis; Aortic or pulmonic insufficiency
What events lead to the formation of S2
a) Aortic and pulmonic closure, mitral and tricuspid opening
b) the end of systole, start of diastole.
c) has two components: A2 and P2
d) Best heard over Erbs point ( Left IC 3)
Describe the cause of normal physiologic splitting
On inspiration, more venous return to right heart, more time needed to eject greater right heart volume, so P2 is delayed. -Best heard over Erbs point ( Left IC 3) -S2 is louder due to higher pressure on left side at end systole
What are the events leading to formation of S1
a) MV & TV valve closure
b) Aortic and Pulmonic opening c) onset of maximal ejection
d) acceleration of bloodflow Delivery of the stroke volume!
- Best heard at PMI (left IC 4-5 mid clavicular)
What is a Grade I murmur
Barely audible
What is a Grade II murmur
Quiet ,but heard immediately after placing the stethescope on the chest wall
What is a Grade III murmur
Moderate/loud
What is a Grade IV murmur
Loud with a palpable thrill
When is S4 normal
Never
