Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
58 Cards in this Set
- Front
- Back
|
What is this sound?
|
1st and 2nd HS without a split
|
|
|
'What sound is this?
|
Innocent murmur
|
|
|
1st heart sound
1 Chestpiece Position? 2 Maneuver? 3 Chestpiece? |
1 Chestpiece Position: Mitral
2 Maneuver: Supine 3 Chestpiece: Diaphragm |
|
|
At the mitral valve, which heart sound has slightly greater intensity?
|
The first heart sound has slightly greater intensity than the second heart sound.
The first heart sound is produced by the closing of the mitral and tricuspid valve leaflets. The second heart sound is produced by the closing of the aortic and pulmonic valve leaflets. The second heart sound is unsplit when the subject is holding his or her breath at peak expiration. |
|
|
The first heart sound is produced by the closing of which valves?
|
mitral and tricuspid valve leaflets
|
|
|
The 2nd heart sound is produced by the closing of which valves?.
|
The second heart sound is produced by the closing of the aortic and pulmonic valve leaflets.
|
|
|
When is the second heart sound is unsplit?
|
The second heart sound is unsplit when the subject is holding his or her breath at peak expiration.
|
|
|
When is the second heart sound is split?
|
The second heart sound can be split at peak inspiration.
|
|
|
Innocent murmur
Chestpiece Position? Maneuver? Chestpiece? |
Chestpiece Position: Pulmonic
Maneuver: Supine Chestpiece: Bell/Diaphragm |
|
|
Innocent murmurs are seen with non-cardiac conditions such as?
|
1 pregnancy
2 hyperthyroidism 3 exercise 4 anemia When these are treated appropriately the systolic murmur disappears |
|
|
An innocent murmur is heard in?
It is best auscultated where? It increases in intensity with? |
The murmur is heard in early systole
It is best auscultated in the pulmonic area and increases in intensity with inspiration. It can be heard with either the bell or diaphragm. |
|
|
Minimally split first HS
Chestpiece Position? Maneuver? Chestpiece? |
Chestpiece Position: Tricuspid
Maneuver: Supine Chestpiece: Diaphragm |
|
|
Minimally split first HS
|
On occasion the first heart sound can be made up of two separate sounds separated by a very small interval
The Mitral component (caused by closure of the Mitral valve) comes first and is louder than the Tricuspid component (caused by closure of the Tricuspid valve). A minimally split first heart sound is a normal variation of the first heart sound. |
|
|
Normal HS?
|
1 Minimally split first heart sound 2 First and Second Heart Sounds
Normal & Unsplit 3 Second Heart Sound Physiologically Split 4 Third Heart Sound Physiologic 5 Innocent Murmur |
|
|
A very loud first heart sound can be an indication of ?
|
A very loud first heart sound can be an indication of mitral stenosis.
first heart sound is much louder than the second heart sound. This can be produced by a thickened, but still mobile, mitral valve |
|
|
AEC
Chestpiece Position? Maneuver? Chestpiece? |
Chestpiece Position: Aortic
Maneuver: Sitting Chestpiece: Diaphragm |
|
|
To differentiate between a AEC and a split S1?
|
The AEC is best heard at the Aortic valve area where splitting of S1 is not heard.
AEC it will have a shorter duration and a higher pitch than the first sound of the pair (S1). |
|
|
To differentiate between a S4/S1 and a split S1?
|
Listen with the bell and diaphragm
S4 is lower frequency than an S1. If it is lower in frequency than the second sound it is an S4. If the two sounds are the same it is a split S1. |
|
|
What other heart sound configuration mimics a split first heart sound.
|
S4
AEC |
|
|
First Heart Sound - Decreased Intensity (listen over mitral area)
|
A decreased intensity first heart sound can be produced by various heart abnormalities, such as a viral infection of the heart called a cardiomyopathy-previous heart attack and decreased thyroid function.
|
|
|
First Heart Sound (Markedly Split)
Chestpiece Position? Maneuver? Chestpiece? |
Chestpiece Position: Tricuspid
Maneuver: Supine Chestpiece: Diaphragm |
|
|
First Heart Sound (Markedly Split) is an indication of?
Best heard where? |
If the splitting of the first heart sound is large (about 50 milliseconds) it is an indication of an abnormal condition called Right Bundle Branch Block. The splitting is most clearly heard at the tricuspid area.
In the mitral valve area, the mitral component is louder. |
|
|
S3 is best heard w/
Chestpiece Position?l Maneuver? Chestpiece? |
Chestpiece Position: Mitral
Maneuver: Supine Chestpiece: Bell |
|
|
Why does an S3 occur?
|
The third heart sound is caused by a sudden deceleration of blood flow into the left ventricle from the left atrium.
|
|
|
S3
When does it occur? To whom? |
A third heart sound occurs early in diastole. In young people and athletes it is a normal phenomenon. In older individuals it indicates the presence of congestive heart failure.
|
|
|
First and Second Heart Sounds - Reduced Intensity can be heard in which pts?
|
This can be seen in an obese patient or a patient with emphysema
|
|
|
Opening Snap and Second Heart Sound
Chestpiece Position?l Maneuver? Chestpiece? |
Chestpiece Position: Mitral
Maneuver: Supine Chestpiece: Diaphragm |
|
|
An opening snap occurring early in diastole along with a single second heart sound can mimic a split second heart sound.
An opening snap is caused by thickened valve leaflets. When they open it produces a snapping sound. |
An opening snap occurring early in diastole along with a single second heart sound can mimic a split second heart sound.
An opening snap is caused by thickened valve leaflets. When they open it produces a snapping sound. |
|
|
Second Heart Sound and Late Systolic Click
Chestpiece Position? Maneuver? Chestpiece? |
Chestpiece Position: Mitral
Maneuver: Supine Chestpiece: Diaphragm |
|
|
A late systolic click is caused by?
|
A late systolic click is caused by degeneration of the mitral valve leaflets. This degeneration causes the closing of the leaflets to make a "clicking" sound during late systole.
|
|
|
Another way of distinguishing a late systolic click from a split S2 is to?
|
Another way of distinguishing a late systolic click from a split S2 is to move the stethoscope head to the pulmonic area. The late systolic click will disappear and you will only hear the single S2.
|
|
|
Fixed splitting of the second heart sound (along with murmurs) indicates the presence of an ?
|
Fixed splitting of the second heart sound (along with murmurs) indicates the presence of an Atrial Septal Defect, a congenital heart defect in which the intra-atrial septum is incomplete resulting in a hole between the left and right atria.
|
|
|
S4 is due to?
|
The fourth heart sound is produced by an increase in stiffness of the left ventricle due to scar tissue formation. This may be a manifestation of coronary heart disease.
A fourth heart sound can also be caused by a greatly thickened left ventricular wall such as with essential hypertension or aortic stenosis. |
|
|
In what rhythm would you not hear an S4?
|
A fourth heart sound is never heard with atrial fibrillation because the contraction of the atria is ineffective in this condition.
|
|
|
S4 is best heard with which part of the stethoscope?
|
The fourth heart sound is a low frequency sound best heard with the bell of the stethoscope pressed lightly on the skin of the chest.
|
|
|
Sound for S4
|
A- Stiff-Wall
Ken-tuck-y |
|
|
Sound for S3?
|
Slosh-ing-in
Ten-nes-ee |
|
|
Third and Fourth Heart Sound Gallop
|
This is a pattern that occurs with improvement of heart failure. That is, an S3 pattern gives way to an S3 S4 pattern as the patient improves.
|
|
|
Summation Gallop at 120 beats per minute
|
At a heart rate of 120 beats per minute, the diastolic period is shortened. This causes the third and fourth sound to be superimposed, creating a single loud sound.
|
|
|
Summation Gallop at 120 beats per minute
Chestpiece Position? Maneuver? Chestpiece? |
Chestpiece Position: Mitral
Maneuver: Supine Chestpiece: Diaphragm |
|
|
Second Heart Sound - Fixed Splitting
|
The separation of the two components of the second heart sound remains unchanged through inspiration and expiration at sixty milliseconds in this example
|
|
|
Fixed splitting of the second heart sound (along with murmurs) indicates the presence of an atrial septal defect?
|
Fixed splitting of the second heart sound (along with murmurs) indicates the presence of an atrial septal defect, a congenital heart defect in which the intra-atrial septum is incomplete resulting in a hole between the left and right atria.
|
|
|
Mid-Systolic Click
Chestpiece Position? Maneuver? Chestpiece? |
Chestpiece Position: Mitral
Maneuver: Supine Chestpiece: Diaphragm |
|
|
The mid-systolic click is produced by?
|
The mid-systolic click is produced by the sudden prolapse of the leaflet.
A mid-systolic click is often followed by a late systolic murmur of mitral valve leaflet prolapse. |
|
|
Mitral Valve Regurgitation
|
A mid-systolic click is followed by a late systolic diamond shaped murmur.
On the animation tab you can see prolapse of both the anterior and posterior mitral valve leaflets and turbulent flow across the incompetent mitral leaflets (murmur of mitral regurgitation). |
|
|
Mitral Valve Leaflet Prolapse
|
Chestpiece Position: Mitral
Maneuver: Supine Chestpiece: Diaphragm |
|
|
Anatomy of Aortic Stenosis
|
Aortic Stenosis (Diamond Shaped Systolic Murmur)
The anatomy tab shows a markedly thickened left ventricle. The aortic valve leaflets are thickened and immobile. The murmur is caused by turbulent flow across the stenotic aortic valve. |
|
|
Aortic Stenosis
Chestpiece Position? Maneuver? Chestpiece? |
Chestpiece Position: Aortic
Maneuver: Sitting Chestpiece: Diaphragm |
|
|
Aortic Stenosis sounds like?
|
The first and second heart sounds are normal. The murmur starts shortly after the first heart sound and ends before the second heart sound.
The murmur is mid to high pitched. |
|
|
Aortic Regurgitation (Decrescendo Diastolic Murmur)
|
starting early in diastole.
(Decrescendo Diastolic Murmur The first and second heart sounds are normal. |
|
|
Aortic Regurgitation (Decrescendo Diastolic Murmur)
|
The decrescendo murmur is high pitched. The anatomy tab shows a enlarged left ventricle with normal contractility. You can see regurgitant flow from the aorta into the left ventricle which causes the murmur.
|
|
|
Mitral Regurg
|
This is an example of a pan-systolic murmur usually associated with mitral regurgitation.
The first and second heart sounds are normal. A mid-frequency rectangular murmur fills all of systole. |
|
|
Anatomy of Mitral Regurg Murmur?
|
In the anatomy tab you can see the enlarged left ventricle and left atrium and turbulent flow from the left ventricle into the left atrium which creates the murmur.
|
|
|
Mitral Regurg
Chestpiece Position? Maneuver? Chestpiece? |
Chestpiece Position: Mitral
Maneuver: Supine Chestpiece: Diaphragm |
|
|
Mitral Stenosis
Chestpiece Position? Maneuver? Chestpiece? |
Chestpiece Position: Mitral
Maneuver: Supine Chestpiece: Diaphragm |
|
|
Mitral Stenosis shape?
Associated with a ? |
This is an example of a diastolic decrescendo murmur occuring after an opening snap. It is associated with mitral stenosis.
|
|
|
Anatomy of Mitral Stenosis?
|
anatomy tab you can see an enlarged left atrium and thickened but mobile mitral leaflets.
Turbulent blood flow from the left atrium into the left ventricle is responsible for the murmur. |
|
|
Cardiac Conditions Associated with Sudden Death?
|
Cardiac Conditions Associated with Sudden Death
1 Hypertrophic Cardiomyopathy 2 Aortic Stenosis - Severe 3 Arrythmogenic RV Dysplasia 4 Mitral Valve Prolapse (Click with Late Systolic Murmur) 5 Myocarditis 6 Commotio Cordis 7 Ebstein's Anomaly |
