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23 Cards in this Set
- Front
- Back
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The second heart sound is unsplit when the subject is holding his or her breath at peak [ expiration / inspiration ].
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expiration
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True or False:
A minimally split first heart sound is a normal variation of the first heart sound. |
Vrai!
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During normal breathing, the timing between the aortic and pulmonic components of the second heart sound varies. This causes the second heart sound to be split. Maximum splitting occurs at peak [ expiration / inspiration ].
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inspiration
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The third heart sound is heard early in [ diastole / systole ]. Along with the first and second heart sounds, this extra sound creates a gallop cadence and sounds like [ "kentucky" / "tennessee" ]. The third heart sound is very low frequency (between 25 hz and 50 hz). Listen with the [ bell / diaphragm ] of the stethoscope at [what position]. Asking the patient to [phrase, a maneuver] will frequently increase the intensity of the third heart sound.
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The third heart sound is heard early in DIASTOLE. Along with the first and second heart sounds, this extra sound creates a gallop cadence and sounds like "TENNESSEE". The third heart sound is very low frequency (between 25 hz and 50 hz). Listen with the BELL of the stethoscope at THE CARDIAC APEX. Asking the patient to LIE ON HIS LEFT SIDE will frequently increase the intensity of the third heart sound.
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When do innocent murmurs occur? How does one distinguish an innocent murmur (duration, frequency)?
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Innocent murmurs are seen with non-cardiac conditions such as pregnancy, hyperthyroidism, exercise and anemia. When these are treated appropriately the systolic murmur disappears.
The murmur is heard in early systole, is of short duration and has a frequency range of 120 hz to 250 hz. It is best auscultated in the pulmonic area and increases in intensity with inspiration. It can be heard with either the bell or diaphragm. The short duration and mid-range frequency characterize an innocent murmur. |
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Usually, the first heart sound is slightly louder than the second heart sound when heard in the [ mitral valve / tricuspid valve ] area.
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mitral valve.
The first heart sound is much louder than the second heart sound. This can be produced by a thickened, but still mobile, mitral valve. |
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True or False:
A minimally split first heart sound is a normal variation of the first heart sound. |
True
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If the splitting of the first heart sound is large (about 50 milliseconds) it is an indication of an abnormal condition called ________________ . The splitting is most clearly heard at the tricuspid area.
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Right Bundle Branch Block
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A decreased intensity first heart sound can be produced by various heart abnormalities, such as a viral infection of the heart called a cardiomyopathy. The decreased intensity first heart sound is due to a decrease in the vigor of contraction of the left ventricle.
Other conditions include... |
previous heart attack and decreased thyroid function.
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Since the S4 occurs just before the S1 it is easy to confuse a S4/S1 with a split S1. How do you tell the two apart? (Hint: frequency sound)
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An S4 is lower frequency than an S1. To differentiate between a S4/S1 and a split S1, listen carefully to the frequency of the initial sound of the pair. 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.
Note: versus S1 followed by an aortic ejection click where you listen to the second sound and if it is an AEC it will have a shorter duration and a higher pitch than the first sound of the pair (S1). |
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A single first heart sound (S1) followed by an aortic ejection click (AEC) can mimic a split first heart sound. How do you tell the two apart? (Hint: frequency sound)
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Listen carefully to the second sound of the pair. If it is an AEC it will have a shorter duration and a higher pitch than the first sound of the pair (S1). Also, the AEC is best heard at the Aortic valve area where splitting of S1 is not heard.
Note: versus in S4/S1, you listen to the first sound's frequency and 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. |
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When physiological splitting of the second heart sound occurs, which component preceeds the other?
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The aortic component of S2 (S2A) preceeds the pulmonic component (S2P). Splitting occurs upon inspiration.
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With normal physiologic splitting the second heart sound is not split at peak expiration. With persistent splitting, the second heart sound is split in both inspiration and expiration although the degree of splitting is reduced in expiration. This type of splitting is associated with what conditions?
A. Atrial septal defect B. Cardiomyopathy C. Left bundle branch block D. Right bundle branch block |
A. 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.
D. Right Bundle Branch Block RBBB is a condition in which the electrical signal which causes contraction of the right ventricle is blocked. |
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A second heart sound (S2) with fixed splitting and an aortic component with increased intensity is seen in presence of
A. atrial-septal defect B. cardiomyopathy C. long-standing severe hypertension D. long-standing severe pulmonary hypertension E. Right bundle branch block |
C. long-standing severe hypertension - because the aortic pressure is markedly increased. There is usually increased thickness of the L ventricular wall.
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A second heart sound (S2) with fixed splitting and an aortic component with decreased intensity is seen in presence of
A. atrial-septal defect B. cardiomyopathy C. long-standing severe hypertension D. long-standing severe pulmonary hypertension E. Right bundle branch block |
D. long-standing severe pulmonary hypertension - There is usually increased thickness of the R ventricular free wall.
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Certain heart sound configurations mimic a split second heart sound. One of these conditions is a late systolic click plus a single second heart sound (S2). Since the late systolic click occurs just before the S2 it is easy to confuse the two with a split S2. How do you tell the two apart?
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Listen carefully to the two sounds. If the first of the pair is of higher frequency and shorter duration than the second, it is a late systolic click followed by a single second heart sound.
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. 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. |
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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 [ what condition ].
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CHF!
The third heart sound is caused by a sudden deceleration of blood flow into the left ventricle from the left atrium. In the anatomy tab you will see a thin-walled, dilated left ventricle with generalized decreased vigor of contraction. The third heart sound is a low frequency sound best heard with the bell of the stethoscope pressed lightly on the skin of the chest. |
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True or False:
A fourth heart sound is rarely/never heard with atrial fibrillation because the contraction of the atria is ineffective in this condition. |
True
(The fourth heart sound is produced by an increase in stiffness of the left ventricle due to scar tissue formation.) |
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True or False:
An S3 pattern gives way to an S3-S4 pattern as the patient improves from heart failure. |
True
::find out why!:: |
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This murmur is caused by the calcification of the aortic valve leaflets.
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Aortic Stenosis
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A high pitched decrescendo murmur occupying the first half of diastole can be heard starting immediately after the second heart sound.
The murmur is best heard at Erb's Point and can be accentuated by having the patient sitting up and leaning forward holding his breath after expiration. What murmur? |
Aortic Regurgitation
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A high pitched decrescendo murmur occupying the first half of diastole can be heard starting immediately after the second heart sound.
The murmur is best heard at the pulmonic area and can be accentuated by having the patient sitting up and leaning forward. The intensity of the murmur increases with inspiration, indicating the right-sided origin of the murmur. What murmur is this? |
Pulmonic Regurgitation
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As mitral stenosis becomes more severe the opening snap will occur [ earlier / later ] in diastole.
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earlier
The opening snap is followed by a diamond shaped low frequency murmur. Use the bell of the stethoscope to hear this murmur. |
