PAS-516 Heart Sounds

The 2nd intercostal space at the right sternal border.

Where is the Aortic Valve best auscultated on the chest wall?

The 2nd intercostal space at the left sternal border.

Where is the Pulmonic Valve sound best heard?

The Tricuspid Valve.

Which valve is auscultated at the 5th intercostal space along the left sternal border?

The 5th intercostal space at the midclavicular line.

What is the auscultation point for the Mitral (Bicuspid) Valve?

The 3rd intercostal space at the left sternal border.

At what anatomical location is Erb's Point found?

The mitral and tricuspid valves.

The closure of which two valves produces the S1 heart sound?

The apex of the heart.

Where on the chest is the S1 sound typically heard best?

Systole.

The S1 heart sound occurs at the beginning of which cardiac phase?

The palpable pulse.

Which physical exam finding occurs simultaneously with the S1 heart sound?

The aortic and pulmonic valves.

The closure of which two valves produces the S2 heart sound?

The base of the heart.

At which anatomical part of the heart is the S2 sound best heard?

Diastole.

The S2 heart sound marks the beginning of which cardiac phase?

Inspiration.

What is the primary physiologic cause of a split S2 sound?

Decreased intrathoracic pressure increases venous return to the right side of the heart.

How does inspiration cause the delay in pulmonic valve closure responsible for a physiologic S2 split?

Children.

A physiologic split of S2 is most commonly observed in which patient population?

A pathologic split is heard with every heartbeat regardless of the respiratory cycle.

What distinguishes a pathologic S2 split from a physiologic one?

Atrial septal defects.

A "Fixed Split" of the S2 sound is a classic finding for which cardiac defect?

Right bundle branch block.

Which conduction abnormality is a common cause of a "Wide Split" S2 due to right ventricle overload?

The aortic valve.

A "Paradoxical Split" of S2 is caused by the delayed closure of which valve?

Left bundle branch block.

What is a common cause of a Paradoxical Split S2?

Left Lateral Decubitus

During the special auscultatory maneuver for aortic regurgitation what position should the patient assume?

Exhale completely and hold your breath.

What breathing instruction is given to a patient during the maneuver to detect aortic regurgitation?

Over the 2nd intercostal spaces (left/right) and Erb’s Point.

Where should the diaphragm be placed to differentiate S2 splits or hear aortic regurgitation during special maneuvers?

Rapid filling of blood into the ventricle during early diastole.

What physiologic mechanism produces the S3 heart sound?

In early diastole

When does the S3 heart sound occur relative to other heart sounds?

"Ken-tuck-y."

What cadence mnemonic is used to identify the S3 heart sound?

Left lateral decubitus position.

Which patient position is ideal for hearing an S3 or S4 heart sound?

The bell (or light pressure with the diaphragm).

Which part of the stethoscope is used to best hear the low-pitched S3 gallop?

Less than 30 years old.

Under what age is an S3 heart sound usually considered physiologic?

Systolic Congestive Heart Failure (CHF).

In older populations, a pathologic S3 is a common sign of which condition?

Atrial contraction pushing blood into a non-compliant or stiff ventricle.

What causes the S4 heart sound?

In late diastole

When does the S4 heart sound occur in the cardiac cycle?

"Ten-nes-see."

What cadence mnemonic represents the S4 heart sound?

True.

True or False: An S4 heart sound is always considered pathologic.

Chronic hypertension and Aortic stenosis.

What are two common causes of a stiffened left ventricle that produces an S4 sound?

An S4 sound.

A patient with an acute myocardial infarction (MI) is most likely to develop which extra heart sound?

"Miss-sis-SIP-pi."

What mnemonic is used to remember the cadence when both S3 and S4 are present?

Heart murmur

Swooshing or blowing sounds caused by turbulent blood flow through or across valves.

Stenosis is narrowing that obstructs forward flow; insufficiency is inadequate closure allowing backward flow.

What is the difference between valve stenosis and valve insufficiency (regurgitation)?

Functional murmur.

What type of murmur is characterized by a physiologic abnormality (like anemia) without an anatomic cardiac defect?

Innocent murmur.

Which classification of murmur involves no anatomic or physiologic abnormality and is often idiopathic?

Systolic.

What is the timing of a murmur that occurs between S1 and S2?

Diastolic.

What is the timing of a murmur that occurs between S2 and S1?

Pan-systolic Murmur

A murmur that lasts throughout the entire duration of systole.

Grade I murmur

It is very soft and heard only with intense concentration in a quiet environment.

The presence of a palpable thrill.

What physical finding distinguishes a Grade IV murmur from lower grades?

Grade VI murmur

It is audible even with the stethoscope hovering slightly above the chest wall.

Grade III.

Which murmur grade is described as "loud" but lacks a palpable thrill?

Aortic stenosis.

A systolic murmur heard at the 2nd intercostal space, right sternal border, suggests which condition?

Aortic regurgitation.

A murmur heard at the 3rd intercostal space, left sternal border, is associated with which condition?

AS MI TI PS.

What acronym is used to identify the four common systolic murmurs?

Mitral Insufficiency.

In the acronym AS MI TI PS, what does "MI" stand for?

Pulmonic Stenosis.

Which systolic murmur is auscultated at the 2nd intercostal space, left sternal border?

The 5th intercostal space at the mid-clavicular line.

Where is Mitral Insufficiency best heard on the chest wall?

The 4th intercostal space at the left sternal border.

A murmur of Tricuspid Insufficiency is best heard at which location?

Ventricular systole (contraction and blood ejection).

What is happening to the ventricles during the period between S1 and S2?

Ventricular diastole (filling)

What is happening to the ventricles during the period between S2 and S1?

Crescendo-decrescendo

A murmur that starts loud and then softens is described by what character term?

Tricuspid valve

According to the provided guide, which valve is heard at the 5th intercostal space, left sternal border during S1?

Pulmonic Valve

Which specific valve sound is heard at the 2nd intercostal space left sternal border during S2?