Chapter 23 Heart Sounds

Front 1

The closure of what valve is Heart sound 1

Back 1

“lub” associated with closure of A-V valves

Front 2

The closure of what valves is heart sound 2

Back 2

“dub” associated with the closure out of semilunar valves

Front 3

What is the cause of the first and second heart sounds?

Back 3

vibration of the taut valves immediately after closure, along with vibrations of the adjacent walls of the heart and major vessels around the heart

Front 4

What is the duration of the First heart sound?

Back 4

The duration of the first heart sound is about 0.14 second.

Front 5

What is the duration of the second heart sound?

Which heart sound is longer?

Back 5

The second heart sound is 0.11 second.

Front 6

Why is the second heart sound has a higher frequency (2)

Back 6

1. The tautness of the semilunar valves in comparison with the much less taut A-V valves
2. the greater elastic coefficient of the taut arterial walls that provide the principal vibrating chambers for the second sound

Front 7

Describe the Third heart sound and when it occurs.

Back 7

weak, rumbling third heart sound is heard at the beginning of the middle third of diastole.

Front 8

What causes the Third Heart sound

Back 8

Logical but unproved explanation - oscillation of blood back and forth between the walls of the ventricles initiated by inrushing blood from the atria.
(Water from faucet in a paper sack) The frequency is so low that the ear cannot hear it.

Front 9

Atrial heart sound (4th heart sound).

Back 9

This sound occurs when atria contract, and presumably, it is caused by the inrush of blood into the ventricles, which initiates vibrations similar to those of the third heart sound. Can’t hear this with ear either.

Front 10

Where do you listen for the Mitral heart sound?

Back 10

mitral area: over the apex of the left ventricle, which is a portion of the heart nearest surface of the chest

Front 11

Where do you listen for the Aortic Heart sound?

Back 11

1. Aortic area: is upward along the aorta because of sound transmission of the aorta

Front 12

Where do you listen for the Tricuspid Heart sound?

Back 12

3. tricuspid area: over the right ventricle

Front 13

Where do you listen for the Pulmonic Heart sound?

Back 13

2. pulmonic area: upward along the pulmonary artery

Front 14

What is a Phonogram?

Back 14

an amplified recording of the heart sounds. The frequency is usually beyond the hearing levels of human ears.

Front 15

Why is the Mitral Valve more susceptible to the attack of antibodies produced by the body in response to Group A hemolytic streptococci?

Back 15

The Mitral Valve has high pressure of the Aorta (more trauma) 2nd most at risk valve is the Aortic Valve

Front 16

What grows simultaneously on the edges of the heart valves in Rheumatic Fever?

Back 16

Large Hemorrhagic Fibrinous bulbouls lesions
resulting in Stenosis and or Regurgitation

Front 17

Name Heart Murmurs Caused by Valvular Lesions. (4)

Back 17

Aortic Stenosis
Aortic Regurgition
Mitral Regurgitation
Mitral Stenosis

Front 18

Mitral Stenosis results from

Back 18

blood passing with difficulty through a stenosed Mitral Valve.
from Left Atrium to Left Ventricle

Front 19

Why is the murmur from Mitral stenosis detectable only by phonocardiogram or with difficulty.

Back 19

The pressure in the Left atrium never rises above 30 mmHg, (a large pressure difference never develops)
only heard after the partial filling of diastole because there must be enough blood in the left ventricle for vibration to occur

Front 20

What is the range of sound that can be heard without phonogram?

Back 20

40-520 cycles per second

Front 21

Mitral Stenosis causes an especially high risk of deveopling what condition?

Back 21

Atrial Fib

Circus Movement due to the increased length of signal transmission caused by the Enlarged Left Atrium due to High Atrial Pressure

Front 22

How does the body compensate for Mitral Valve disease?

Back 22

Blood volume increased due to kindeys not exreting Na and water

increased blood volume increases venous return helping the heart
(so the Decrease in CO is minimal in early stages)

Front 23

In late stages of Mitral Valve disease what occurs?

Back 23

1.) as Left atrial Pressure rises blood begins to dam up in the lungs and eventually the pulmonary arteries

2.) Incipient edema of the lungs causes pulmonary constriction

both factors cause increased Systolic Pulmonary Pressures and Right Ventricular Pressures. The increase in pressure causes Rt Hypertrophy

Front 24

How is pulmonary edema developed in Mitral valve disease?

Back 24

build up of blood in the left atrium leads to increased Left Atrial Pressure leading to Pulmonary edema

Front 25

When is Lethal Pulmonary Edema likely to occur?

Back 25

when mean Left Atrial Pressures are 25-40 mmHg

(lung lymphatic system is capable of moving fluid up to this point)

Front 26

What causes an Aortic Stenosis murmur?

Back 26

Jet like systolic flow of blood from the Left Ventricle to the Aorta (through a stenosed Aortic Valve)
the turbulent flow of blood in the root of the aorta. Turbulent flow of blood hitting the Aortic Wall causes intense vibration (Harsh loud murmur)

Front 27

What murmur has a trill when a hand is placed over the lower neck or upper chest?

Back 27

aortic stenosis

Front 28

Hypertrophy of the Left ventricle occurs in what valvular diseases?

Back 28

Aortic Stenosis and Aortic Regurgitation

Front 29

In Aortic Regurgitation Left Ventricle Hypertrophy allows what stroke volume?

Back 29

250 ml
but only 1/4 flows out the aorta to the body

Front 30

Left Hypertrophy in Aortic Regurgitation allows what to occur?

Back 30

the Left ventricle to hold regurgitant blood

Front 31

During Exercise a patient with Aortic valvular lesions can deveop what?

Back 31

Left Ventricular Failure followed by
acute pulmonary Edema

Front 32

During Exercise a patient with Mitral Valvular Disease can develop what?

Back 32

Daming of blood in the lungs can cause Pulmonary Edema in 10 min (can be lethal)

Front 33

What are 3 general types of Congenital Anomalies?

Back 33

1.) stenosis of the channel of blood flow at some point in the heart of close to allied blood vessels
2.) Anomaly- Left to the Right Shunt
3.) Anomaly- Right to Left Shunt

Front 34

What occurs in a Left to Right Shunt

Back 34

blood flows backward from the left side of the heart or aorta to the Right side of the heart or Pulmonary Artery
(Failing to flow through the Systemic Circulation)

Front 35

What occurs in a Right to Left Shunt

Back 35

Blood never flows through the Lungs

blood flows Directly from Right Side of the Heart to the Left