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59 Cards in this Set

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What is the bell used for?
The bell is used to hear low-pitched sounds. Use for mid-diastolic murmur of mitral stenosis or S3 in heart failure.
What do you use to hear high pitched sounds?
The diaphragm, by filtering out low-pitched sounds, highlights high-pitched sounds. Use for analyzing the second heart sound, ejection and midsystolic clicks and for the soft but high-pitched early diastolic murmur of aortic regurgitation.
The first heart sound represents
closure of mitral and tricuspid valves and beginning of systole
Where is S1 loudest?
at the apex
What does S2 represent?
closure of aortic and pulmonic valves; beginning of diastole
Where is S2 loudest?
at the base
Which is lower pitch, S1 or S2?
S1
Which is higher pitch, s1 or s2?
s2
Where is the murmur of AS heard best?
Left second ICS
To where does the murmur of AS radiate?
carotids
Characterize the murmur of Mitral regurgitation?
Blowing holosystolic murmur
Where is the murmur of MR heard best?
apex
To where does the murmur of MR radiate?
To the axilla and inferior edge of the left scapula
What other sounds may be associated with MR?
wide physiologic splitting of S2, s3
Characterize the murmur of Aortic Insufficiency?
Soft blowing early diastolic descrescendo murmur
Where is the murmur of AI heard best?
Second ICS
To where does murmur of AI radiate?
Doesn’t radiate
Sounds associated with AI?
Systolic flow murmur and diastolic rumble (Austin Flint)
Characterize the murmur of Tricuspid Regurgitation?
Soft holosystolic murmur
Where is the murmur of TR heard best?
LLSB
To where does murmur of TR radiate?
Doesn’t radiate
What increases the intensity of TR murmur?
Inspiration or pressure over liver
Characterize the murmur of Pulmonic Insufficiency?
High frequency early diastolic decrescendo murmur
Where is the murmur of PI heard best?
Second to third intercostal space
What increases the intensity of PI murmur?
Inspiration
What noise is associated with PI?
Abnormal Split S2
Characterize the murmur of Pulmonary Stenosis?
Harsh crescendo-decrescendo systolic murmur
Where is the murmur of PS heard best?
sternal border bat 2nd or 3rd intercostal spaces
What increases the intensity of PS murmur?
Inspiration
Where is the murmur of PS heard best?
sternal border bat 2nd or 3rd intercostal spaces
What increases the intensity of PS murmur?
Inspiration
Which heart sound is abnormal with PS?
Wide physiologic splitting of S2
Which heart sound is abnormal with PS?
Wide physiologic splitting of S2
Characterize the murmur of Mitral Stenosis?
Low frequency rumbling mid-diastolic murmur, with presystolic component possible
Where is the murmur of MS heard best?
apex
What increases the intensity of MS murmur?
Accentuated in left lateral decubitus position
Which heart sound is abn in MS?
S1 is very loud
What arrhythmia may be associated with MS?
Atrial fibrillation
What is the quality of the murmur associated with hypertrophic cardiomyopathy?
Harsh quality midsystolic murmur
Where is it heard best?
LSB
Which heart sound is abnormal with hypertrophic cardiomyopathy?
S4 may be present
What does a loud first heart sound represent?
Hyperdynamic (fever, exercise), Mitral stenosis, or Atrial myxoma (rare)
What does a soft first heart sound represent?
Low cardiac output (rest, heart failure); Tachycardia; Severe mitral reflux (caused by destruction of valve)
What does Variable Intensity of First Sound represent?
Atrial fibrillation or Complete heart block
Where is splitting of S2 best heard?
over the 2nd left intercostal space
If P2 is audible at the apex in both upright and supine positions
Significant pulmonary hypertension or Atrial septal defect
What does fixed mean in fixed split of S2?
Occurs in inspiration and expiration
Wide fixed split of S2
ASD
Wide split varying with inspiration?
Pulmonary stenosis or RBBB
Paradoxical splitting of S2 means
splits in expiration; Hypertrophic cardiomyopathy
What does a Loud Aortic Component of Second Sound represent?
Systemic hypertension or Dilated aortic root
What does a Soft Aortic Component of Second Sound represent?
Calcific aortic stenosis
What does a Loud Pulmonary Component of Second Sound represent?
Pulmonary hypertension
With which part of stethoscope is an S3 best heard?
The bell, because the sound is low-frequency
With which part of stethoscope is an S4 best heard?
The bell, because the sound is low-frequency
When is S3 heard?
Soon after s2 (early diastole)
What usually causes S3?
CHF or normal physiologic finding in young person
When is S4 heard?
Presystolic portion of diastole
What usually causes S4?
stiffened left ventricles, resulting from conditions such as hypertension, aortic stenosis, ischemic or hypertrophic cardiomyopathy