Unit 4 - Heart Murmurs Flashcards
what is the PMI?
point of maximal impulse (apex
what should you be looking for in the patient overall?
- signs of diminished CO
- signs of heart failure
- signs of atherosclerotic disease
what are the 5 spots you should listen to? where are they?
- aortic valve - 2nd right intercostal space at right sternal border
- pulmonic valve - 2nd left intercostal space at left sternal border
- second pulmonic - 3rd left intercostal space at left sternal border
- tricuspid valve - 4th left intercostal at left sternal border (right-sided heart sounds that radiate)
- mitral valve - at the apex; 5th intercostal space at midclavicular line
what is the diaphragm VS bell used for?
diaphragm = high pitched sounds
bell (lightly applied diaphragm) = low pitched sounds
must listen to all 5 points with both bell and diaphragm
how should you position the patient? what are they most useful for hearing?
at least 2 different positions
- sitting up and leaning slightly forward (best for high-pitched)
- supine at 30 degrees
- supine at 0 degrees
- left lateral decubitus position (best for low-pitched)
what does “lub” represent? where is it loudest?
S1; closure of mitral and tricuspid valves
- marks beginning of systole
- corresponds to upstroke of carotid pulse
- heard loudest at apex
what does “dub” represent? where is it loudest?
S2; cloure of aortic and pulmonic valves
- signals end of systole
- louder at base of heart
what is S3? when does it occur? how and where is it best heard? when is it normally present? what does it represent otherwise?
“Kentucky” ventricular gallop; represents early passive diastolic filling of ventricle (heart failure)
- heard when filling pressure is elevated
- gallop rhythm heard immediately after S2
- low pitched sound, thus heard best with bell at apex in left lateral decubitus position
- may be normally present in children, adolescents, and young adults
what is S4? when does it occur? how and where is it best heard? when is it normally present? what does it represent otherwise?
“Tennessee” atrial gallop; represents active atrial filling of ventricle (second phase of ventricular filling)
- occurs immediately before S1
- louder than S3; still heard best at apex with bell in left lateral decubitus OR supine position
- common in LVH and myocardial ischemia; never normal (always stiff and noncompliant)
what heart sound will not be heard in a patient with atrial fibrilation?
S4
what is a summation gallop? where is it best heard?
has S1, S2, then S3/4 together
-best heard at apex
where is an intense S1 sound best heard?
apex
where is a split S1 sound best heard?
tricuspid
where is an intense S2 sound best heard?
base
where is S2 splitting best heard? (physiologic expiration)
base
what are murmurs?
distortion of laminar flow through heart
- primary cause is malfunction of cardiac valve disrupting flow
- specific conventions for describing murmur and intensity
what descriptions should you use when talking about heart sounds?
- timing (systolic VS diastolic, and duration)
- pitch
- pattern (crescendo VS descresendo)
- location
- radiation
what does holosystolic mean?
the heart sound is heard throughout cycle
what are the different grades of intensity?
I - barely audible II - quiet, intensity similar to S1/2 III - moderately loud IV - loud with thrill (can feel murmur off chest) V - very loud, easily palpable thrill VI - audible with stethescope off chest
what are examples of systolic murmurs? diastolic murmurs?
SM: mitral regurgitation and aortic stenosis
DM: aortic regurgitation and mitral stenosis
what is mitral regurgitation? when does it occur? how and where is it best heard? when is it normally present? what does it represent otherwise?
systolic murmur; early/late/holosystolic depending on chronicity and severity
- typically a plateau murmur
- heard best over cardiac apex
- can radiate to back and clavicle
- intensity increases with isometric exercise (increasing afterload)
what is aortic stenosis? when does it occur? how and where is it best heard? when is it normally present? what does it represent otherwise?
mid-systolic murmur (hear S1, but then S2 is quieter)
- crescendo-descresendo
- heard best in aortic region
- radiates to neck
- intensity decreases with isometric exercise, but increases with squatting (pushes more blood into heart and increase volume)
- S2 decreases in intensity as A2 component becomes softer; if severe, S2 will disappear
what does pulsus parvus and tardus mean? associations?
slow and sustained upstroke of arterial pulse (low volume)
-related to aortic stenosis
what is aortic regurgitation? when does it occur? how and where is it best heard? when is it normally present? what does it represent otherwise?
diastolic murmur best heard along 3rd intercostal space (2nd pulmonic)
-radiates along left sternal border
-early diastolic and decrescendo in nature
0increases with isometric exercise and squatting
