Medex Yakima Tech Skills Heart Sounds Objectives Jon

Front 1

INFO Reading:
Bickley,LS, Bates’ Guide to Physical Examination and History Taking. 10th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2009: 323-371.

Back 1

.

Front 2

a. PMI

Back 2

apical impulse/point of maximal impulse brief early pulsation of left ventricle-moving anteriorly during contraction, touching chest wall. Page 357, 20%.
(Red side note) palpable in 25-40% of healthy adults and 50% and left decubitus position.

Front 3

S1

b. Page 355/356 Bates

Back 3

first sound/start of systole/contraction of atrium's,

Front 4

S2

Back 4

second sound/start of diastole/contraction of ventricles,

Front 5

S3

Back 5

(Wikipedia) caused by the oscillation of blood back and forth between the walls of the ventricles initiated by inrushing blood from the atria., protodiastolic gallop, ventricular gallop, or informally the "Kentucky" gallop

Front 6

S4

Back 6

(Wikipedia) sound occurs just after atrial contraction ("atrial kick") at the end of diastole and immediately before S1, presystolic gallop or atrial gallop (Tennessee.) blood being forced into a stiff/hypertrophic ventricle.

Front 7

c. Split S2 :


Bates page 365, 10%/Bates page 380 0%

Back 7

Splitting

Why: either aortic valve shut early or pulmonary shut late.
Increased normal splitting [wider split when inspire] DDx:
• Delayed RV emptying (pulmonary stenosis, RBBB).  

Front 8

d. Systole (systolic)


Bates 327 45 %/page 326 entirety

Back 8

.

Front 9

e. Diastole (diastolic)


Bates, 327, 20%/page 326 entirety

Back 9

.

Front 10

f. Pansystolic (holosystolic)


page 366, right, 50%

Back 10

.

Front 11

g. Continuous (as applied to heart sounds)

Back 11

plateau murmur equals same intensity throughout. Page 367 left 60%

Front 12

h. Murmur =

Back 12

turbulent blood flow. page 329, 90%

Front 13

i. Thrill (as applied to heart sounds)

Back 13

vibration palpable from a murmur

Front 14

j. Stenosis (as applied to each heart valve)

Back 14

stenotic valve which has an abnormally narrowed valvular orifice that obstructs blood flow.

Page 329 Bates 95%.

Front 15

k. Regurgitation (as applied to each heart valve)

Back 15

back flow of blood through a valve. Page 329 98%

Front 16

l. Insufficiency

Back 16

the inability to carry sufficient amounts of oxygenated blood for the needed demand to the peripheral system. (Handout)

Front 17

m. Crescendo

Back 17

one marked by progressively increasing loudness.

Front 18

n. Decrescendo

Back 18

one with increasing intensity until mid- to late systole, then a decreasing intensity, giving a diamond-shaped tracing on phonocardiography. Characteristic of pulmonary stenosis.

Front 19

Murmurs: grading
Graded on scale of 1 to 6.

Back 19

1.Only cardiologist can hear.
2.Trained doctor can hear.
3.Student can hear. No thrill.
4.Thrill barely palpable.
5.Thrill easily palpable.
6.Can hear murmur by being in the room without a stethoscope.

Front 20

Murmurs: general considerations

Back 20

Can be either systolic or diastolic.
-Students will only hear systolic.
Mnemonic for whether murmur is systolic diastolic:
• PASS and PAID:

• Pulmonary, Aortic Stenosis = Systolic.

• Pulmonary, Aortic Insufficiency = Diastolic.

• Then mitral and tricuspid must be opposite to these.

Front 21

Systolic click
a-Sound:
b-Where:
c-Why:
d--DDx:

Back 21

a-Sound: high-pitched click, soon after S1. Click followed by AS or PS murmur.

b- Where:aortic, pulmonary ausc sites.

c- Why: stiff aortic valve suddenly opened.

d- DDx: AS(aortic stenosis).

Front 22

Opening snap?

Sound:
Where:
Why:
DDx:

Back 22

Sound: high-pitched click after S2.

Where: lower L sternal edge.

Why: stiff mitral valve suddenly opened.

DDx: • Mitral stenosis.

Front 23

4th heart sound?
Sound:
Where:
Why:
DDx:

Back 23

Sound: higher pitch, late diastole, "gallop sounding"

Where:

Why: ventricular filling resistance, always pathologic.

DDx: •HTN • MI • AS • Heart block

Front 24

3rd heart sound
Sound:
Where:
Why:
DDx:

Back 24

Sound: in early-mid diastole, low-pitched, "gallop sounding".

Where: apex, louder on expiration.

Why: ventricular distension, may be normal.

DDx: • Normal in children
• Constrictive pericarditis.
• Mitral regurgitation
• Tricuspid regurgitation
• LVF, RVF