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Heart Auscultation
LECOM D'Amico's heart auscultation lecture
34
Medical
Graduate
09/01/2012

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Cards

Term
Causes of widened splitting
Definition
Right bundle branch block, pulmonary stenosis
A2 ALWAYS before P2, increased gap on inspiration
Term
Causes of fixed splitting
Definition
atrial septal defect
A2 ALWAYS before P2 with NO change on inspiration
Term
Causes of Paradoxical splitting
Definition
Left bundle branch block, advanced aortic stenosis
P2 close before A2
Term
Causes of ejection clicks
Definition
occur shortly after S1 and coincide with OPENING of aortic or pulmonic valves; sharp high pitched, indicate presence of aortic or pulmonic valve stenosis

Pulmonic will decrease intensity during inspiration; aortic stays the same
Term
Causes of opening snaps
Definition
Occurs after S2 due to opening of stenosed mitral or tricuspid valve; sharp high pitched sound and doesn't vary with respiration
Term
how can you tell the severity of a MS or TS?
Definition
severity of stenosis can be approximated by time interval between A2 and opening snap; a shorter time interval means a more severe (advanced) stenosis

This is because severe stenosis-->increased atrial pressure (over time)-->valve pushed open earlier by the increased pressure
Term
what is a ventricular gallop referring to?
Definition
a pathologic S3-->due to volume overload due to CHF, or increased transvalvular flow accompanying advanced mitral or tricuspid regurge
Term
what is an atrial gallop referring to?
Definition
the presence of an S4-->presence of a stiff ventricle (that's what she said...)

stiff ventricle is due to decreased ventricular compliance resulting from ventricular hypertrophy or myocardial ischemia
Term
what is a summation gallop?
Definition
All 4 heart sounds
Term
Condition causing a continuous murmur that builds up from S1, peaks at S2 and descends to S1
Definition
PDA
Term
Murmurs causing early decrescendo at S2 to S1
Definition
Aortic or Pulmonic Regurge
Term
Murmurs after S2 causing mid to late decrescendo starting from an opening snap and then building to S1
Definition
mild mitral or tricuspid stenosis
Term
Murmurs after S2 causing prolonged mid to late decrescendo from opening snap and then building before S1

time from S2 to Opening Snap decreased
Definition
severe mitral or tricuspid stenosis
Term
To and fro murmur
Definition
aortic stenosis and regurgitation
pulmonic stenosis and regurgitation
Term
a wave
Definition
•a wave: small rise in right atrial pressure due to right atrial contraction
Term
C wave
Definition
•c wave: small rise in right atrial pressure as the tricuspid valve closes and bulges toward the right atrium
Term
V wave
Definition
•v wave: rise in right atrial pressure during ventricular systole, when the tricuspid valve is (supposedly) closed
Term
NAME That MURMUR!
Crescendo-Decrescendo midsystolic murmur heard at 2RSB radiating to the carotids. Palpation of carotid arteries reveals weakened, late pulse.
Definition
Aortic Stenosis
Term
NAME That MURMUR!
Mid-diastolic, low pitched rumble, best heard in lateral recumbent position
Definition
Mitral stenosis
Term
NAME That MURMUR!
Mid-diastolic, low pitched rumble, best heard in lateral recumbent position, louder on inspiration
Definition
Tricuspid stenosis
Term
Patient presents with scratchy triphasic rub at the left sternal boarder. He has a HR<120bpm. It is best heard when the patient completely expires and holds
Definition
pericardial friction rub-->acute pericarditis
Term
NAME that MURMUR!
cresendo-decresendo systolic murmur that gets louder with valsalva, amyl-nitrates, and standing.
Definition
Hypertrophic cardiomyopathy
Term
Patient presents with hypotension, jugular venous distention, and muffled/distant heart sounds. Pulse pressure is greater than 10mm Hg during quiet breathing.
Definition
Pericardial tamponade
Becks triange (fist three symptoms)
w/ Pulsus paradoxus
Term
NAME that MURMUR!
late systolic murmur, midsystolic click
Definition
MVP
Term
NAME that MURMUR!
Holosystolic murmur that doesn't get louder during inspiration, best heard at lower left sternal boarder, harsh in quality
Definition
VSD
Term
NAME that MURMUR!
Early diastolic, begins w/ loud pulmonic of S2, decrescendo, high pitched, blowing, louder during inspiration, 2 to 4th ICS, LSB
Definition
Graham Steele-->Pulmonic Insufficiency
Term
NAME that MURMUR!
Mid diastolic
Begins after pulmonic component of S2
Crescendo-decrescendo
Low-pitched
Gets louder during inspiration
Best heard with bell of stethoscope at 3rd to 4th ICS, LSB
Definition
Pulmonic insufficiency due to deformity of the pulmonic valve
Term
NAME that MURMUR!

•Holosystolic murmur
•Gets louder during inspiration (aka Carvallo’s sign)
•Pulsatile jugular venous distention (JVD)
•Pulsatile liver
Definition
Tricuspid Regurgitation
Term
NAME that MURMUR!

Crecendo-Decrecendo Systolic murmur
Gets worse with inspiration
ejection sound (that goes away with inspiration)
Doesn’t radiate to carotids
2LSB
Definition
Pulmonic Stenosis
Term
NAME that MURMUR!

Early diastolic Decrescendo
High-pitched “Blowing”
Best heard with diaphragm of stethoscope at 3L or RSB, with patient leaning forward, during held, deep, end-exhalation
Definition
Aortic Regurge/Insufficiency
Term
NAME that MURMUR
Diastolic RUMBLE best heard w/ bell @apex
Definition
Austin Flint Murmur (Aortic Insuff)
Thought to be due to “functional” mitral stenosis resulting from the aortic regurgitant jet forcing the anterior mitral leaflet into a partially closed position
OR…..
Diastolic rumble results from fluttering of the anterior mitral leaflet caused by the aortic regurgitant jet
Term
For $1,000,000 and an A+ on your PBL exam:

Name the three murmurs of aortic insufficiency
Definition
Austin Flint, systolic ejection sound, and a primary (Early diastolic Decrescendo High-pitched, “Blowing”)
Term
Causes of diastolic murmurs
Definition
-Insufficiency of either ventricular outflow valve (AR/AI, PR/PI
-Stenosis of either atrioventricular valve (MS, TS)
Term
Differentiate Chronic and Acute Mitral Regurgitation
Definition
Chronic
•Holosystolic (pansystolic) murmur
•Doesn’t get louder during inspiration
•Usually best heard at the cardiac apex, sometimes radiating to the left axilla
•Gets louder during isometric handgrip, sudden squatting, or vasopressor administration (all increase R)

Acute
•Early systolic decrescendo murmur
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