Interpreting Abnormal Heart Sounds
Help!
|
|
||||
|---|---|---|---|---|---|
| *When you auscultate the heart, the first and second heart sounds define: | the duration of systole and diastole
🗑
|
||||
| *Closure of the mitral valve produces: | the first heart sound, S1
🗑
|
||||
| *Closure of the aortic valve produces: | the second heart sound, S2
🗑
|
||||
| Factors that increase the force and velocity of ventricular pressure tend to increase the intensity of: | S1
🗑
|
||||
| The position of the AV valves at onset of systole also affects: | S1 intensity, as well as exercise and excitement
🗑
|
||||
| If ventricular contraction occurs against a wide open valve, | the LV leaflets attain a higher velocity (louder S1) than if the valves were partially closed
🗑
|
||||
| S1 is normally loudest at the: | apex
🗑
|
||||
| Bradycardia is associated with | an apparent softening of S1, since the AV valves are already closed at the onset of ventricular contraction
🗑
|
||||
| Splitting of S1 | (may occur in normal pts); is best heard over the left sternal border
🗑
|
||||
| A normal second heart sound (S2) is produced by the: | pressure changes and vibration of valves by movement of aortic and pulmonic leaflets towards respective ventricles
🗑
|
||||
| Since systole (the time of ventricular contraction) is usually shorter than diastole (time of ventricular relaxation) | there is a longer pause between S2 and S1 than between S1 and S2
🗑
|
||||
| S1: duration and pitch | long, low (best heard at apex)
🗑
|
||||
| S2: duration and pitch | short, high (best heard in aortic/pulmonic areas)
🗑
|
||||
| Palpation of the apical impulse or carotid pulse will assist in the identification of: | S1, since S1 occurs slightly before pulse
🗑
|
||||
| S3 physiological heart sound is a: | low-pitched vibration occuring early diastole during time of rapid ventricular filling; sound is produced by abrupt transmission of forces to the chest wall when the blood mass enters the right ventricle
🗑
|
||||
| *An S3 is commonly heard | in normal children and adolescents and in some young adults (may persist until 40 esp in women)
🗑
|
||||
| *When S3 is heard in pts over 30yo, it is called: | a gallop sound; a sign of pathology such as left ventricular failure (CHF) or volume overload of ventricle from valvular heart disease such as mitral regurgitation
🗑
|
||||
| S3 occurs after __ and is best heard at __ when the pt is __ | S2; apex; left semilateral position
🗑
|
||||
| S3 or S4 will normally disappears completely when the pt __ or __; conversely __ accentuates a physiologic S3 | sits; stands (lowering heart rate); exercise
🗑
|
||||
| *A 4th heart sound is seldom heard in young adults unless | they are well conditioned athletes (it is frequent in infants and small children)
🗑
|
||||
| *A 4th heart sound may be heard in apparently healthy older people, but it is also frequently a/w: | decreased ventricular compliance from heart disease (ex: Acute MI)
🗑
|
||||
| *S4 is usu only head at: | apex w/pt in left semilateral position
🗑
|
||||
| *Physiologic S4 is poorly transmitted and is: | rarely accompanied by a shock (when it can be felt and heard)
🗑
|
||||
| *Wide transmission of a loud S4 associated with a shock is: | pathologic and is referred to as an S4 gallop
🗑
|
||||
| *Most heart murmurs | occur w/o other evidence of CV abnormality and may be considered innocent murmurs (normal varient) and vary w/age
🗑
|
||||
| *Murmurs are caused by: | turbulance and flow disturbance in vessels or through valves (sometimes murmurs will radiate and be mistaken as a bruit in the carotids)
🗑
|
||||
| if a vessels is completely blocked: | you won't hear a bruit! need to do an ultrasound
🗑
|
||||
| Systolic murmur | innocent; children, adolescents, YAs; flow murmur reflecting pulmonic flow; heard best at 2nd-4th interspaces; may be intermittent
🗑
|
||||
| *Aortic Systolic murmur | common in middle-aged and older adults (1/3 of 60yos, 1/2 of 85yos)
🗑
|
||||
| Cause of Aortic Systolic Murmur | aging thickens/calcifies bases of aortic cusps and audible vibrations result from turbulence produced by flow into a dilated aorta
🗑
|
||||
| Concern a/w Aortic Systolic Murmurs | in most people the process of "aortic sclerosis" doesn't impede blood flow, but true aortic stenosis can obstruct flow; differentiating may require an echo or notice of delayed carotid upstroke (abnormal = stenosis)
🗑
|
||||
| *Systolic Murmur of Mitral Regurgitation | a similar process to that of aortic sclerosis, usu occurs 10yrs later (70yo)
🗑
|
||||
| *Cause of Mitral Valve Regurgitation/Sclerosis | degenerative changes w/calcification of mitral annulus (valve ring); impaired ability of normal closure during systole; extra load on heart dt mitral valve leakage
🗑
|
||||
| *Where do murmurs originate? | large blood vessels and the heart (dt flow obstruction and turbulence; also in tortuous vessels in kids have innocent flow interruption)
🗑
|
||||
| *Diastolic murmurs | usu indicate valvular heart disease (heard btw S2 and S1)
🗑
|
||||
| *Systolic murmurs | MAY indicate valvular disease, but often occur when heart is entirely normal (heard btw S1 and S2)
🗑
|
||||
| *Midsystolic murmurs | most often are related to blood flow across the aortic and pulmonic valves (heard after S1 and stops before S2)
🗑
|
||||
| *Pansystolic (holosystolic) murmur | often occur with regurgitant (backward) flow across the AV valves (heard starting with S1 and stopping at S2 w/o a gap between the murmur and heart sounds)
🗑
|
||||
| *Late Systolic Murmur | the murmur of mitral valve prolapse (heard in late or mid-systole; persists up to S2; seen mostly in women)
🗑
|
||||
| *Early diastolic murmur | typically a/w regurgitant flow across incompetent semilunar (aortic/pulmonic) valves
🗑
|
||||
| *Mid-diastolic murmur | typically reflect turbulent flow across the AV valve (heard a short time after S2 and then fades to absent before the next S1)
🗑
|
||||
| *Late diastolic (presystolic) murmur | similar to mid-diastolic murmur (reflects turbulent flow across AV valve), except it is usu heard late in diastole and continues up to S1 withough fading
🗑
|
||||
| *Grade 1 murmur | faint; must listen close
🗑
|
||||
| *Grade 2 murmur | quiet, heard right away
🗑
|
||||
| *Grade 3 murmur | moderately loud
🗑
|
||||
| *Grade 4 murmur | loud with palpable thrill
🗑
|
||||
| *Grade 5 murmur | very loud with thrill
🗑
|
||||
| *Grade 6 murmur | typically can hear w/o a stethoscope
🗑
|
||||
| *Most likely causes of murmurs in children: | Patent ductus arteriosus, atrial septal defect, ventricular septal defect, coarctation of aorta (all are pretty much fatal if not fixed)
🗑
|
||||
| *Innocent murmurs in children | Still's murmur, venous hum, pulmonary flow murmur
🗑
|
||||
| *Variations in the first heart sound: Accentuated S1 | tachycardia (anemia, exercise, hyperthyroidism); Mitral stenosis
🗑
|
||||
| *Variations in the first heart sound: Diminished S1 | First degree heart block (mitral valve closes "less loudly"); Mitral Regurgitation; Congestive Heart Failure; Coronary heart disease
🗑
|
||||
| *Variations in the first heart sound: Varying S1 (intensity) | Complete heart block; Atrial fibrillation
🗑
|
||||
| *Variations in the first heart sound: Split S1 | May be normal; Right BBB; PVCs (premature ventricular contraction)
🗑
|
||||
| *Variations in the second heart sound: Pathological splitting | all of these involve splitting during expiration and all suggest heart disease
🗑
|
||||
| *Variations in the second heart sound: Wide Splitting | caused by: 1. delayed closure of pulmonic valve (pulmonary stenosis, RBBB); 2. Early closure of aortic valve (mitral regurgitation); Persists thru respiratory cycle
🗑
|
||||
| *Variations in the second heart sound: Fixed Splitting | wide splitting that does not vary (intensity) with respiration; occurs with: 1. Atrial Septal Defect; 2. Right Ventricular Failure
🗑
|
||||
| *Variations in the second heart sound: Paradoxical or Reversed Splitting | appears on expiration and disappears on inspiration; occurs mostly with: LBBB
🗑
|
||||
| *Extra heart sounds in systole: Early Systolic Ejection Sound | occurs shortly after S1; high pitch, sharp, clicking; Heard best with diaphragm; indicative of cardiovascular disease
🗑
|
||||
| *Extra heart sounds in systole: Aortic Ejection Sound | heard at base and apex (typically louder at apex); accompanies a dilated aorta or aortic valve disease; Congenital Stenosis or Bicuspid valve
🗑
|
||||
| *Extra heart sounds in systole: Pulmonic Ejection Sound | heard best at 2nd and 3rd left interspaces; when S1 is unusually loud; Dilation of Pulmonary Artery, Pulmonary Hypertension or Pulmonic Stenosis
🗑
|
||||
| *Extra heart sounds in systole: Systolic Clicks | usu due to mitral valve prolapse; heard mid or late systole
🗑
|
||||
| *What is an opening snap? | a very early diastolic sound usu produced by the opening of a stenotic mitral valve; heard best just medial to the apex and along the lower left sternal border; heard best with the diaphragm (high pitched snapping sound)
🗑
|
||||
| *Cardiovascular Sounds with Both Systolic and Diastolic Components: Pericardial Friction Rub | At least 2 components (may have 3): Atrial Systole; Ventricular Systole; Ventricular Diastole; quality is scratchy, scraping, high-pitched; Best heard at 3rd interspace; Due to: Pericarditis
🗑
|
||||
| *Cardiovascular Sounds with Both Systolic and Diastolic Components: Patent Ductus Arteriosus | Continuous murmur in both sytole and diastole; Loudest in late systole; obscures S2 and fades in diastole; Sounds harsh/machine-like; Medium-pitch; Heard best at 2nd interspace; Due to: Congenital abnormality w/open channel btw aorta and pulmonary artery
🗑
|
||||
| *Cardiovascular Sounds with Both Systolic and Diastolic Components: Venous Hum | A continuous murmur w/o a silent interval; Loudest in diastole; Heard best above medial 3rd of clavicles on R 1st/2nd interspaces; Soft-moderate intensity; Literally a low humming/roaring sound; Benign; Best heard with bell
🗑
|
Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Created by:
bscaryp