Murmurs and Sounds Flashcards
left upper sternal border location
left second intercostal space
hear at left upper sternal border
pulmonary valve (to pulmonary trunk)
right upper sternal border location
right second intercostal space
hear at right upper sternal border
aortic valve (to aorta)
lower left sternal border, location
left fifth intercostal space
hear at fifth intercostal, medial to left midclavicular line (medial to apex)
mitral valve (to left ventricle)
hear at lower left sternal border
tricuspid valve (to right ventricle)
S1
mitral and tricupsid valves closing, mitral normally first
S2
aortic and pulmonary valves closing, usually aortic first.
S3
blood sloshing in ventricle: increased blood volume.
detect S3 with
bell (lower frequency) at apex
S4
sound of atrium contracting to force blood into a stiff ventricle
Wide S2 splitting
RBBB, pulmonic stenosis (P2 as a whole is delayed)
Fixed S2 splitting
atrial septal defect (PVR very low: closing is delayed and less affected by change in pressure with inspiration)
Paradoxical S2 splitting
LBBB, aortic stenosis (A2 as a whole is delayed)
S3 causes
increased, CO (athletes, pregnant), mitral regurgitation, CHF, HCM, tricuspid regurgitation, constrictive pericarditits
S4 causes
LVH/RVH caused by HTN/PAH, aortic/pulmonic stenosis, HCM (LA/RA pumping into stiff LV/RV, low frequency)
Ejection click
aortic/pulmonic stenosis, Ao/PA dilation, HTN ( from stenotic valve or aortic/pulmonary root stress)
midsystolic murmur
aortic/pulmonic stenosis (ejection type: follows rise and fall of ventricular P during systole)
Early diastolic decrescendo
aortic/pulmonic regurgitation ( rapid relaxation during diastole)
To-and-fro murmur
aortic/pulmonic regurg + stenosis
Opening snap
mitral/tricuspid valve stenosis
Continuous murmur
mitral/tricuspid stenosis (flow is always Ao to PA, slightly lags behind LVP)
Mid-to-late diastolic murmur
mitral/tricuspid stenosis (loudest when ventricle first starts filling)
