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24 Cards in this Set
- Front
- Back
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Heart Sounds
S1 |
This one goes with carotid pulse
Etiology: from mitral/ tricuspid closure Heard Loudest: Apex Part of Stethoscope: Diaphragm (high pitched sound) |
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Heart Sounds:
S2 |
Etiology: aortic/ pulmonic closure
Heard Loudest: base of heart Part of Stethoscope: diaphragm (high pitched) |
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Heart Sounds:
S3 |
Other names for S3: Montreal, Kentucky, A-stiff-wall, Pericardial knock, ventricular gallop
Etiology: blood crashing against stiff ventricular walls Heard Loudest: apex, in left lateral decubitus position Part of Stethoscope: low pitch (bell) |
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Heart Sounds
S4 |
Notes: at the VERY end of diastole, aka: Toronto
Etiology: sound of atria squishing last bit of blood into the ventricle @ end of diastole Heard Loudest: apex, in left lateral decubitus position Part of Stethoscope: low pitch (bell) |
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Heart Sounds
Opening Snap |
Etiology: mitral* valve stenosis/calcification (can also be tricuspid)
Heard Loudest: apex, at LLSB Part of Stethoscope: diaphragm (high pitch) |
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Heart Sounds
Ejection Click |
Notes: think Systole
Etiology: aortic/pulmonic stenosis Heard Loudest: 2nd Right intercostal space (aortic) 2nd Left LICS for (pulmonic) Part of Stethoscope: diaphragm (high pitch) |
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Heart Sounds
Mid-Systolic Click |
Note: think later in cycle
Etiology: mitral valve prolapse Heard Loudest: apex Part of Stethoscope: diaphragm (high pitch) |
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Mid-Systolic Murmurs
(HAPI murmurs) HYPERTROPHIC Cardiopmyopathy |
Location: 3rd & 4th Left intercostal spaces
Pitch: medium Radiation:Left Sternal Border Quality: Harsh "whooshy" Increases With: standing Decreases With: squatting Notes: the defected septum(?) gets in the way when pressure decreases (standing) and gets pushed into proper place when pressure increases (squatting) |
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Mid-Systolic Murmurs
(HAPI murmurs) AORTIC Stenosis |
Location: 2nd R intercostal space
Pitch: medium Radiation: up to the neck (but it sounds like carotid bruit) Quality: harsh Increases With: squatting Decreases With: standing Notes: in this case standing causes decrease in volume/turbulence while squatting increases it |
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Mid-Systolic Murmurs
(HAPI murmurs) PULMONARY Stenosis |
Location: 2nd/3rd L intercostal sp
Pitch:medium Radiation: L shoulder/neck Quality: harsh Increases With:Inspiration Decreases With: Expiration Note: breathing in gives atria more time to fill, thereby increasing the murmur |
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Mid-Systolic Murmurs
(HAPI murmurs) INNOCENT |
Location: 2nd/4th L ICS
Pitch: medium Radiation:none Quality:variable Increases With: squatting Decreases With: standing Note: is a physiologic murmur; child, pregnancy, hyperthyroidism,anemia. murmur corrected by resolving underlying issue |
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notes in general on murmurs
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heart murmurs are different from heart SOUNDS because:
->they have a longer duration -->attributed to turbulent blood flow |
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mid-systolic murmurs:
in general |
-start low, get high, drop off
-crescendo/decrescendo -between S1 and S2 |
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Holosystolic Murmurs:
(MTV murmurs) Mitral Regurgitation |
Location: apex
Pitch: medium Radiation: Left axilla Quality: harsh (Bates says 'blowing') Increases with: handgrip Decreases with: valsalva maneuver Notes: handgrip increases ventricular pressure & peripheral resistance. Valsalva causes HR/volume to go down, works on Vagus. |
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Holosystolic Murmurs:
(MTV murmurs) Tricuspid Regurgitation |
Location: lower left sternal border
Pitch: medium Radiation: right sternal border & xiphoid region Quality: blowing Increases with: inspiration Decreases with: exhalation/valsalva |
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Holosystolic Murmurs:
(MTV murmurs) Ventricular Septal Defect |
Location: "everywhere", left sternal border =loudest
Pitch: high Radiation: wide Quality: harsh Increases with: handgrip Decreases with: valsalva |
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notes on holosystolic murmurs
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-aka- pansystolic
-go through S1-S2 -flat continuous shape |
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trick question on Test/PANCE:
-> where is the location of the AORTIC regurgitation best heard? |
LEFT 2nd & 4th intercostal spaces
(it's a DIASTOLIC murmur) |
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Diastolic Murmurs:
(ArMs murmurs) AORTIC REGURGITATION |
Location: Left 2nd/4th intercostal
Radiation: to the apex Pitch: high Quality: blowing Increases with: 1Leaning Forward 2 Expiration 3 Holding Breath Notes: is the sound of backward/retrograde flow of blood from aorta to L ventricle |
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Diastolic Murmurs:
(ArMs murmurs) MITRAL STENOSIS |
Location: Apex (mitral area)
Radiation: none Pitch: Low pitch (Bell) Quality: Rumble Increases with: Left lateral decubitus position or Exertion Notes: Forward flow/filling murmur. |
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Diastolic murmurs in general
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-heard BETWEEN S2 and S1
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in general:
sounds/murmurs from Mitral Valve: |
-usually heard best around CARDIAC APEX
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in general: sounds and murmurs originating from the Tricuspid Valve:
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-usually heard best around Lower left Sternal Border
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in general: murmurs arising from the pulmonic valve are heard best where?
-from the aortic valve? |
-pulmonic murmurs: heard best 2nd/3rd left interspaces close to sternum
-aortic anywhere from 2nd right interspace to APEX. |
