Term
| Where the S2 is heard the loudest |
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Definition
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Term
Which valve closes first in a physiologic S2 split
Is it heard during inspiration or expiration? |
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Definition
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Term
Which valve closes first in a paradoxical split
And is it heard during inspiration or expiration |
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Definition
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Term
| Paradoxical split is common in what abnormalities? |
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Definition
LBBB (because of a delayed closure of the aortic valve)
Hypertrophic cardiomyopathy |
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Term
| Which grade murmur is chacterized by the presence of a palpable thrill? |
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Definition
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Term
| Which grade murmur can be easily heard with a stethoscope but has no associated thrills? |
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Definition
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Term
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Definition
Mitral regurgitation
Tricuspid regurg
Aortic regurg |
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Term
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Definition
Mitral stenosis
Tricuspid stenosis |
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Term
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Definition
Peak in the middle of systole
Pulmonary stenosis
Aortic stenosis
Hypertrophic cardiomyopathy |
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Term
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Definition
Unifrom intensity throughout systole
Mitral regurgitation
Tricuspid regurgitation
Ventricular septal defect |
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Term
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Definition
Peak betweenS2 and start of S1 (bad!!)
Aortic regurgitation
Mitral stenosis
Pulmonic regurg |
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Term
| Left lateral decubitus is used to heart what murmurs best |
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Definition
| Mitral stenosis and S3 and S4 gallops |
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Term
| Pt sitting up and leaning forward is used to best hear what murmurs |
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Definition
Aortic regurgitation
aortic stenosis |
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Term
| An opening snap is often heard in what murmur and what does it indicate |
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Definition
| It is the mitral valve snapping open in mitral stenosis |
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Term
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Definition
midsystolic
heard best in 2nd and 3rd left ICS
if radiation is loud, goes toward the left shoulder and neck
soft to loud intensity; if loud, assoc with a thrill
medium pitch, crescendo-decrescendo
often harsh quality
common to hear early ejection sound
if servere - S2 can be widely split; possible presence of right sided S4 |
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Term
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Definition
midsystolic
heard best in right 2nd ICS
radiates to carotids, down the left sternal border, even to apex
often loud intensity with a thrill
medium pitch, crescendo-decrescendo may be higher at apex
harsh quality
heard best when patient is sitting up and leaning forward
A2 decreases as stenosis worsens |
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Term
| Hypertrophic cardiomyopathy |
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Definition
midsystolic
heard best in 3rd and 4th left ICS
radiates down the left sternal border to the apex, possibly to base, but NOT to the neck
variable intensity
medium pitch
harsh quality
decreases with squatting, increases with valsalva and standing |
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Term
| Ventricular septal defect |
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Definition
pansystolic
best heard in 3rd and 4th left ICS
often wide radiation (entire precordium)
very loud instensity with a thrill
high pitch
harsh quality
findings very with the severity of defect and with assoc lesions
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Term
| Which murmur is harsh and high pitched that may possibly radiate over the entire precordium and to the interscapular region |
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Definition
| Ventricular septal defect |
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Term
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Definition
pansystolic
heard best at the apex
radiates to the left axilla, less often to the left sternal border
soft to loud intensity, if loud assoc with apical thrill
medium to high pitch
harsh quality
does NOT become louder in inspiration
apical S3 reflects overload of LV |
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Term
| Which murmurs commonly radiates to the axilla |
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Definition
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Term
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Definition
pansystolic
heard best at lower left sternal border
radiates to the right of the sternum, xiphoid area, and perhaps left midclavicular line, but NOT to axilla
variable intensity
medium pitch
blowing holosystolic quality
intensity may increase slightly with inspiration
JVP often elevated
S3 poss audible along lower left sternal border |
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Term
Which murmur commonly radiates to the carotid arteries
In Which carotid artery is it heard best |
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Definition
Aortic stenosis
Left carotid |
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Term
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Definition
diastolic
best heard 2nd to 4th left ICS
radiates if loud, to the apex (perhaps to right sternal border)
grade 1 to 3 intensity
high pitch (use diaphragm)
blowing decrescendo (may be mistaken for breath sounds)
heard best when pt is sitting up and leaning forward (with breath held after exhalation)
S3 or S4 present = severe regurg
pulse pressure increases, arterial pulses large and bounding |
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Term
| Aortic pressure will typically be high or low in aortic regurgitation |
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Definition
| Will be typically high because of the pressure from the ventricle contracting (because it has more fluid in it from the regurgitation) |
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Term
| Signs of aortic regurgitation |
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Definition
Austin flint murmur
Visible forceful and bounding collapsing peripheral pulses (water hammer) at carotids and femoral aa
Increased pulse pressure > 60 mm Hg
Musset sign
Quinke sign - capillary pulsations of the nail bed |
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Term
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Definition
| The fluttering of the anterior leaflet of the mitral valve due to backward flow of blood into the LV from artic regurgitation |
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Term
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Definition
diastolic murmur
heard best in apex
little to none radiation
grade 1 to 4 intensity
decrescendo low pitched rumble -> use bell
heard best when pt is in left lateral recumbent
opening snap often follows S2 and initiates the murmur
if pulmonary HTN develops P2 is accentuated |
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Term
| Which murmurs RADIATE to the apex of the heart |
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Definition
Aortic regurgitation
Pulmonic regurgitation |
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Term
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Definition
Diastolic
Heard best at the L 2nd and 3rd ICS
Palpation may reveal a RV precordium heave
Louder with inspiration and with release of valsalva (both increasing venous return to right side of the heart) |
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Term
| Diagnosis of pulmonic regurgitation is made by |
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Definition
Made by signs of RV hypertrophy and the absence of peripheral signs of aortic regurgitation
S3 and S4 sounds are heard more often in aortic regurg when severe |
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Term
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Definition
Late systolic starting in mid or late systole and persisting to S2
Heard best with the diaphragm
Heard best a the apex |
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Term
| Mitral valve prolapse maneuvers |
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Definition
Auscultate while pt is standing and squatting
When squatting the popliteal veins have become compressed,there is less gravity, and the heart slightly expands, all of this together increases venous return |
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Term
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Definition
Presystolic crescendo
Atrial contraction against the stenotic valve creates the murmur
Possible to hear an opening snap of the tricuspid valve
May see JVD in more severe cases |
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Term
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Definition
frequent in children and in young adults, last trimester of pregnancy (physiologic)
directly after S2 in diastole during rapid ventricular filling
dull and low pitch -> best heard with the bell
pathologic -> gallop; person over 40
results from altered LV compliance at the end of the rapid filling phase of diastole
commonly heard in mitral or tricuspid regurg (bc of decreased myocardial contractility, CHF, and volume overloading of a ventricle) |
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Term
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Definition
atrial gallop, directly before S1 in presystole
dull and low in pitch -> heard best with the bell
commonly due to increased resistance to ventricular filling following atrial contraction
common in aortic stenosis and cardiomyopathy (left-sided S4), and pulmonary HTN and pulmononic stenosis (right sided S4) |
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Term
| Valsalva maneuver is typically done to do what |
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Definition
Increases intrathoracic pressure
decreases both venous return and PVR
Aortic stenosis murmur is decreased
Moves MVP/MR click and murmur earlier in systole
Increases hypertrophic cardiomyopathy |
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Term
| Standing/squatting maneuvers done to do what |
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Definition
venous return increases
Also increases PVR, because of compression of the popliteal vessels
Increases ventricular volume
Increases aortic stenosis
Maeve's MVP/MR click and murmur later in systole
Decreases murmur of hypertrophic cardiomyopathy |
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Term
| Physical findings in right sided heart failure |
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Definition
| Fluid accumulation and peripheral edema in the feet, ankles, legs, liver, and abd |
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Term
| Findings in left sided heart failure |
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Definition
Fluid backs up in the lungs -causing SOB, can become Orthopnea in severe cases, pts can have paroxysmal nocturnal dyspnea
Eventually left sided causes right sided |
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Term
In right sides heart failure, fluid accumulates where when
Standing
Supine |
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Definition
Standing - fluid in the legs and feet
Supine - the lower back |
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Term
| Diaphragm is use to hear what types of sounds and what murmurs best |
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Definition
| Is better for picking up the relatively hig pitched sounds of S1 ans S2, the murmurs of aortic and mitral regurg, and pericardial friction rubs |
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Term
| The bell is used to hear what sounds and murmurs best |
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Definition
| It is more sensitive to the low pitched sounds of S3 and S4 and the murmur of mitral stenosis |
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Term
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Definition
Occurs shortly after S1, coincident with opening of the aortic and pulmonic valves
Relatively high in pitch, have a sharp clicking quality and heard better with the diaphragm
Commonly heard in aortic and pulmonary stenosis |
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Term
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Definition
usually caused by mitral valve prolapse -> an abnormal systolic ballooning of part of the mitral valve into the LA
usually mid or late systolic
high pitched -> listen with diaphragm
click is often followed by a late systolic murmur from mitral regurg |
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Term
| changes of systolic clicks when standing and squatting |
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Definition
squatting delays the click and murmur
standing moves them closer to S1 |
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Term
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Definition
very early diastolic sound usually produced by the opening of a stenotic mitral valve
its high pitch and sapping quality help to distinguish it from an S2
better heard with the diaphragm |
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Term
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Definition
midsystolic
no detectable physiologic or structural abnormality
2nd to 4th left ICS between the left sternal border and apex
little radiation
grade 1 to 2 intensity
soft to medium pitch
usually decreases or disappears on sitting |
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Term
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Definition
may have three short components, each assoc with friction from cardiac movement in pericardial sac: 1) atrial systole, 2) ventricular systole, 3) ventricular diastole
scratchy, scarping quality
high pitched |
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