Heart Sounds Flashcards

Terms Definitions
atrial emptying
five areas of ausculation
aorticpulmonic2nd pulmonictricuspidmitral
When does S4 occur?
just before S1
What causes the S4 sound?
atrial kick
High-pitched murmurs are associated with _____ pressures and are on the _____ side of the heart.
higher; left
-late diastole
-high atrial pressure
-associated with ventricular hypertrophy
S4 "atrial kick"
Describe the third heart sound.
short durationlow-pitcheddull, thud-like quality
The first heart sound is typically heard best at _______.
Innocent murmurs may ______ when the patient is sitting.
-occurs in early diastole during rapid ventricular filling
-more common in dilated ventricles
Where is the third heart sound heard best?
When are innocent murmurs usually heard?
early to mid-systolic
what makes the S2 sound?
aortic and pulmonic closing
You're listening to the LLSB with the diaphragm.
Patient's murmur increases in intensity with Valsalva and standing and pulsus bisferiens.
Mid-systolic murmur
Third and fourth heart sounds are NOT caused by....
valves closing
Innocent murmurs are usually grade ___ or less, heard best along the ______ _____ _____, ______-pitched, _____ quality, and of _____ duration.
IIleft sternal bordermediumsoftshort
what would cause an aortic regurgitation murmur to be heard on the L 2 intercostal space?
endocarditis, bicuspid aortic valve, lupus erythematosus, rheumatoid arthrtis, and rheumatic fever
You're listening to the 2nd LICS with the diaphragm.
Patient has prominent "a" waves, and a left parasternal sustained impulse. 
Mid-systolic murmur
pulmonic stenosis
You're listening at the LLSB with the diaphragm.
Patient presents with giant "a" waves, elevated JVP, slow "y" descent.
Mid-diastolic murmur
Tricuspid stenosis
What causes the S3 sound?
filling of the ventricles with blood
grade I murmur
barely audible in a quiet room (very faint)
what are murmurs related to the R-side of the heart?
pulmonic regurgitation, tricuspid regurgitation, tricuspid stenosis (always paired with mitral stenosis), pulmonic stenosis
Third and fourth heart sounds correspond to...
blood entering and striking against the walls of the ventricles
What are the two potential etiologies of continuous murmurs?
atrial septal defectventricular septal defect
how do you test for s3?
s3's are accentuated by hand grip, which increases systemic vascular resistance, increasing pressure - which requires an increase in volume, which prolongs the diastolic filling phase.
What is the fourth heart sound often confused with?
split S1 or opening snap
What is associated with a systolic click?
diseased mitral valve (mitral valve prolapse)
what would move the MVP mid systolic click towards s1?
exhalation, valsalva, or standing all which decrease volume and increase the pressure gradient between the atrium and the ventricle
why does an enlarged heart cause shortness of breath?
b/c the enlarged heart will pump less blood (lower capacity), require more O2, and cause some pulmonary edema
what is the difference between an MVP click and an ejection click?
w/MVP, the click will move closer to s2 (from its normal mid-systolic position), but an ejection fraction click (tightening of chordae tendinae getting ready for isovolumetric contraction) will not move
what does s3 sound like? is it a normal heart sound?
s3 sounds like "tennessee" and is heard during diastolic filling of an (abnormally) larger ventricle (which at bedside would appear displaced downward and posteriorly and hypokinetic under your hand)
atrial kick
Always consider the patient's condition before labeling the murmur as innocent!
High-pitched sounds are best heard with the...
When does S3 occur?
just after S2
Low-pitched murmurs are associated with ______ pressures and are on the ______ side of the heart.
lower; right
when are s3 & 4 heard?
in diastole
The first heart sound is typically louder than the second heart sound at ______.
What are the three types of murmurs?
What causes an opening snap?
diseased aortic valve
-late systolic murmur
-midsystolic click
-most common valvular lesion
-usually benign
-can predispose to infective endocarditis
-loudest at S2
Splitting of S2 is best heard at...
2-4 LICS
What is another name for regurgitant murmurs?
backflow murmurs
-delayed rumbling late diastolic murmur
-follows opening snap
-LA>>LV during diastole
-secondary to rheumatic fever
You're listening at the apex with the bell.
Patient has dyspnea on exertion.
Aortic stenosis
Aortic stenosis is heard loudest over the _______ and radiates to the _____ _______.
aorta; right carotid
how does s1 sound compared to s4?
s4 is lower pitched
You're listening to the apex with the diaphragm.
Patient presents with a narrow pulse pressure and a slow, delayed carotid upstroke, sustained apical impulse.
Mid-systolic murmur
Aortic Stenosis
(Can be located anywhere else along the aortic band - 2nd RICS, 3rd LICS, apex)
(remember to watch for the ES)
You're listening at the 2nd RICS with the diaphragm.
Ejection Sound
Aortic Stenosis
(without the murmur)
Vibrations of turbulence are usually heard best...
where the blood flows to
Left-sided murmurs tend to be _____ or _____ pitched.
high or medium
-holosystolic, high-pitched blowing murmur
-loudest at apex and radiates toward axilla
-MR is often caused by ischemic HD, MVP, or LV dilation
-TR is loudest at tricuspid area and radiates to R sternal border; due to RV dilation or endocarditis
You're listening at the apex with the diaphragm.
Patient presents with chest pain and dyspnea.
Mid-systolic Click
Mitral Valve Prolapse
(without the murmur)
An innocent murmur may be associated with increased ______ ______ or decreased _______.
blood flow; viscosity (pregnancy, anemia)
what causes a fixed splitting of S2?
atrial septal defect, right ventricular failure
what are associated symptoms with MVP? what causes it? when might it occur?
atypical chest pain that gets better w/exertion, dyspnea, palpitations, hypoglycemia, panic attacks, joint pain, depression, and constipation. MVPs are due to a "lazy valve" and can occur after exams, death of a parent, or breakup w/a significant other
Noting the location of where the murmur is heard the loudest is useful in...
determining the etiology of the murmur
what is paradoxical splitting of s2?
when expiration is a2 and p2 apart, and inspiration a2 and p2 simultaneously
how does mitral stenosis present audibly?
a diastolic rumble - longer it is, the worse the disease is. there is also a click and an opening snap b/c of narrowing/tightening of cords, scarring, fibrosis, calcification (remember this is diastolic, not systolic, even though it sounds systolic)
how can you tell the difference the first and second heart sound?
you have to palpate the carotid artery as you auscultate. if you hear the sound before you hear the upstroke, you are in diastole. if you hear the sound as or after you feel the upstroke, you are in systole. (you are listening to the heart, not the carotids)
ideopathic hypertrophic subaortal stenosis
can tricuspid regurgitation appear on its own?
Opening snap is ______-pitched than S4.
Increased pressure leads to _________ intensity of the murmur.
______-sided lesions tend to be louder.
Describe the fourth heart sound.
short durationlow-pitched-dull, thud-like quality
Splitting of S2 during both inspiration and expiration is called _______ _______.
persistent splitting
Right-sided murmurs tend to be _____ pitched.
S4 pathological (right sided)?
pulmonary hypertension, pulmonic stenosis
You're listening to the apex with the bell.
21 y/o athlete is asymptomatic.
What condition needs to be considered when persistent splitting of S2 is heard?
conduction defects
What is another term for third and fourth heart sounds?
Mitral regurgitation is heard loudest over the _______ and radiates to the ______ ________.
apex; left axilla
grade V murmur
loud and associated with easily palpable thrill
S4 pathological (left sided)?
hypertensive heart dx, coronary artery dx, aortic stenosis, heard in apex
how do you accentuate s1?
inspiration, which increases volume faster - thus causing the sound of the mitral and tricuspid valves closing to be louder (does not affect s4)
First and second heart sounds correspond to...
closure of the valves
grade II murmur
heard with careful aid of the stethoscope
A murmur can be heard...
anywhere in the cardiac cycle
what are things that decrease volume?
expiration, valsalva, and standing up
Describe the first heart sound in terms of pitch and duration.
high-pitched and short duration
What causes the heart sounds?
vibrations that result from the stoppage of blood against closed valves and the walls of the heart
A murmur can radiate anywhere in the _____ or ______.
thorax and neck
what causes mitral stenosis? who commonly gets this? how do they present?
rheumatic fever, which generally affects young women from southeast and central asia. they present with shortness of breath, lower extremity edema, palpitations, stroke and possibly a thrill or dilatation of pulmonary artery able to be felt if pt is standing
You're listening at the 2nd LICS with the diaphragm.
Patient is asymtomatic.
Early diastolic murmur
Pulmonary regurgitation
How is the radiation of a murmur tracked?
by "inching" the stethoscope
what does a heart rub sound like?
mitral regurgitation, but it will respond to the movement of the pt
A cardiac rub is associated with...
movement of the heart within the inflamed pericardial sac
why does the MVP mid systolic click then murmur move towards s2 with inspiration?
volume is increased with inspiration, and the pressure differential between the LA and LV ventricle is decreased - causing the prolapse to occur later, moving it closer to s2 in systole
What conditions need to be considered with an S3?
heart disease (always this until you prove it wrong)stiff/non-compliant ventricular wall
what sided murmur is aortic stenosis? when is it heard? where is it heard? where does it radiate? what will increase it? are both the aortic and pulmonic components heard?
aortic stenosis is a L sided murmur that occurs mid - late systole. it is heard at the base of the heart (at s4) at the 2nd R intercostal space. it radiates to the carotids w/bilateral carotid bruits and increases with handgrip. you only heard the pulmonic component, b/c the aortic component is so scarred/calcified, that you don't hear it (A2 is singular)
What are the three ways to determine the first heart sound from the second?
1. duration of time between S1 and S22. loudness (S1 at apex, S2 at base)3. palpate carotid pulse while auscultating (pulse corresponds with S1)
what is a heart rub? what is it caused by?
a heart rub is systolic and diastolic sound; rubbing of pericardial layers against one another are associated w/ inflammation of heart sac. they can come from chronic renal failure, viral-like syndromes, open heart surgery, infarction
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