[05.19] Heart Sounds and Murmurs V2.pdf

low-frequency sounds

The bell of a stethoscope is used to listen to what type of sounds

S3, S4, Mitral Stenosis (MS)

What are three examples of low-frequency sounds heard best with the bell

high-frequency sounds

The diaphragm of a stethoscope is used to listen to what type of sounds

S1, S2, Aortic Stenosis (AS), Aortic Regurgitation (AR), Mitral Regurgitation (MR)

What are five examples of high-frequency sounds heard best with the diaphragm

light contact

The bell-low function on cardiologic stethoscopes with a floating diaphragm is achieved through what type of contact

firm contact

The high-frequency function on cardiologic stethoscopes with a floating diaphragm is achieved through what type of contact

S3, S4, MS

If a didactic exam mentions using the bell, what three heart sounds or murmurs should you look for

Always Pray To Mary

What mnemonic is used to remember the auscultatory areas

Aortic area, Pulmonic area, Tricuspid area, Mitral area

What are the four main auscultatory areas

2nd RIGHT intercostal space (ICS)

Where is the Aortic area located

2nd LEFT ICS

Where is the Pulmonic area located

3rd LEFT ICS, left sternal border

Where is Erb's Point located

4th LEFT ICS, left lower sternal border

Where is the Tricuspid area located

5th LEFT ICS, midclavicular line

Where is the Mitral area located

Grade 3

What is the grading of a murmur that is moderately upon auscultation, mostly heard, and should always provoke further investigation

thrills

The presence of what finding is the cutoff for Grade 4 and up

Grade 1

What is the grading of a murmur that is very faint, may only be heard by an expert, and is not heard in all positions

Grade 2

What is the grading of a murmur that is soft, heard in all positions, and has no thrill

Grade 4

What is the grading of a murmur that is loud and associated with a palpable thrill

Grade 5

What is the grading of a murmur that is very loud, with thrill, and heard with the stethoscope partly off the chest

Grade 6

What is the grading of a murmur that is loudest, with thrill, and heard with the stethoscope entirely off the chest

diastole

What portion of the cardiac cycle is longer, making up two-thirds of the cycle

systole

What portion of the cardiac cycle is shorter, making up one-third of the cycle

just precedes carotid/radial pulse

S1's timing is described as this relative to the pulse

follows carotid/radial pulse

S2's timing is described as this relative to the pulse

louder at apex

S1's location where it is loudest is here

louder at base

S2's location where it is loudest is here

lower pitch and longer than S2

S1's pitch and duration are described as this

higher pitch and shorter than S1

S2's pitch and duration are described as this

first of two grouped beats

S1 is described as this because systole is shorter than diastole

second of two grouped beats

S2 is described as this because systole is shorter than diastole

S1

What heart sound is known as "Lub"

S2

What heart sound is known as "Dub"

diaphragm

What part of the stethoscope is S1 best heard with

cardiac apex

Where is the intensity of S1 normally maximal

closure of atrioventricular valves (mitral and tricuspid)

What causes S1

left 2nd ICS close to the sternal border

Where is S2 best heard with the diaphragm

cardiac base

Where is the intensity of S2 normally maximal

closure of semilunar valves (aortic and pulmonic)

What causes S2

inspiration

When does physiologic splitting of S2 occur, dividing it into A2 and P2

closure of the pulmonic valve is a little bit delayed

What is the mechanism of physiologic splitting of S2

murmurs become louder on the right side upon inspiration

What is Carvallo's Sign

S3 and S4

What are the two extra heart sounds

low frequency diastolic sounds

S3 and S4 are what kind of sounds that originate in the ventricles

ventricular filling sounds

What are S3 and S4 also known as, due to abnormalities during ventricular filling

bell over the cardiac apex

Where are S3 and S4 best heard

left lateral decubitus position

What position is used to best hear LV S3 and S4

lower left sternal border

Where are RV S3 and S4 best heard

sudden limitation of the movement during ventricular filling

What is S3 related to

rapid ventricular filling

What phase of ventricular filling does S3 occur during

S2

S3 is closer to which heart sound

LUB-DU-DUB or KEN-TUC-KY

What does S3 sound like

limitation during atrial filling phase of the ventricle

What is S4 related to

atrial filling phase which is the third phase of diastole, referring to atrial contraction

What phase of the cardiac cycle does S4 occur during

S1

S4 occurs prior to which heart sound

LUH-LUB-DUB, A-STIFF-WALL, or TEN-NE-SEE

What does S4 sound like

Pulmonic Stenosis (PS), Aortic Stenosis (AS), Mitral Regurgitation (MR), Tricuspid Regurgitation (TR)

What four conditions are associated with Systolic Murmurs, based on the mnemonic Please Sneak Away Slowly, MR. TigeR

Aortic Regurgitation (AR), Mitral Stenosis (MS), Pulmonary Regurgitation (PR), Tricuspid Stenosis (TS)

What four conditions are associated with Diastolic Murmurs, based on the mnemonic ARMS PaRTs

Mitral Valve Prolapse (MVP)

A Mid Systolic Click can signify what

diaphragm at the apex

Where is a Mid Systolic Click best heard

between S1 and S2

When does the Mid Systolic Click occur

LUH-KUB-DUB

What does the Mid Systolic Click sound like

abrupt standing, sitting, or Valsalva maneuver

What maneuvers decrease left ventricular volume and can lead to an earlier onset of the click and murmur

earlier onset of the click and murmur

A decreased left ventricular volume decreases stretch on the mitral valve, making prolapse more likely, which leads to what change in timing

closer to S1

The earlier onset of the click and murmur is also described as this

squatting or passive elevation of the legs

What maneuvers increase left ventricular volume

delay in the onset of click and murmur

An increased left ventricular volume increases stretch on the mitral valve, reducing the likelihood of prolapse, which leads to what change in timing

farther from S1

The delay in the onset of click and murmur is also described as this

MVP with MR

What condition causes a midsystolic click and late systolic murmur

Valsalva

What maneuver causes an earlier click and longer murmur in MVP with MR

whooshing sound

The murmur in MVP with MR is described as what

holosystolic murmur

The murmur in MVP with MR is NOT this type of murmur, distinguishing it from classic MR

Aortic Stenosis (AS)

A Systolic Ejection Murmur indicates what condition

diaphragm at right upper sternal border

Where is the Systolic Ejection Murmur best heard

turbulent flow when the blood goes through the left ventricle into the aorta

What causes the Systolic Ejection Murmur in AS

crescendo decrescendo murmur

What type of murmur is the Systolic Ejection Murmur

angry type of murmur

The crescendo decrescendo murmur is described as sounding like this

S1

The onset of the Systolic Ejection Murmur occurs just after this heart sound, which is often obscured

S2

The Systolic Ejection Murmur may make what heart sound faint or barely heard

carotids

Where does the Systolic Ejection Murmur radiate

exhalation

Carotid stenosis bruits are usually more prominent during what breathing maneuver

Hypertrophic Obstructive Cardiomyopathy (HOCM) and Aortic Stenosis (AS)

What two conditions have similar murmurs, pertaining to obstructions in the left ventricular outflow tracts

septum is significantly thickened

What is the pathophysiology of HOCM

valve is unable to move

What is the pathophysiology of AS

louder

What happens to the HOCM murmur during the Valsalva maneuver (decrease LV preload)

softer or no change

What happens to the AS murmur during the Valsalva maneuver (decrease LV preload)

softer

What happens to the HOCM murmur during leg raising or squatting (increase LV preload)

louder

What happens to the AS murmur during leg raising or squatting (increase LV preload)

Mitral Regurgitation (MR)

What causes a Holosystolic Murmur

apex using the diaphragm in the left lateral decubitus

Where is the Holosystolic Murmur best heard

systole

When does the Holosystolic Murmur occur

continuous blowing murmur

The Holosystolic Murmur is described as this

Aortic Regurgitation (AR)

What causes an Early Diastolic Murmur

diaphragm, in the left lower sternal border

Where is the Early Diastolic Murmur best heard

sitting leaning forward with breath held in full expiration

What specific position enhances the Early Diastolic Murmur

expiration

Murmurs are loudest on the left side during what

decrescendo murmur

What type of murmur is the Early Diastolic Murmur

diastole

When is the Early Diastolic Murmur heard

increased afterload (e g hand grip exercises)

What dynamic maneuver would make the Early Diastolic Murmur louder

Mitral Stenosis (MS)

What causes a Mid Diastolic Murmur