Heart

NURS 314 Exam 2

S1 heart sound

First sound

“Lub”

closure of mitral and tricuspid valve

beginning of systole

Best heard at apex (5th intercostal space)

S2 heart sound

Second sound

“Dub”

closure of aortic and pulmonic valves

end of systole/beginning of diastole

best heard at base of heart (2nd intercostal space)

Splitting of S2

pulmonic valve closes slightly later than aortic

Aortic auscultation site

2nd right intercostal space

Pulmonic auscultation site

2nd left intercostal space

Erb’s Point auscultation site

3rd left intercostal space

Tricuspid auscultation site

4th left intercostal space

Mitral (apical) auscultation site

5th left intercostal space, midclavicular line

Use diaphragm of stethoscope for

higher-pitched sounds (S1, S2, pericardial friction rubs)

Use bell of stethoscope for

Lower-pitched sounds (S3, S4, murmurs)

Auscultation

Listen for rate, rhythm, extra sounds

Listen in Z pattern across all areas

Normal heart rate

60-100bpm

< 60bpm = bradycardia

> 100bpm = tachycardia

S3 heart sounds

ventricular gallop

normal in young adults and athletes, pathological in older adults (suggest CHF)

S4 heart sounds

Atrial gallop

can be normal in elderly, but can indicate stiff ventricle (HTN)

Thrills

palpable vibration

suggest turbulent blood flow from significant murmur

Heaves

visible or palpable lifting of chest wall

indicates ventricular hypertrophy

left heave: left ventricular hypertrophy (felt at apex)

right heave: right ventricular hypertrophy (felt at sternal border)

Murmur

sound produced by turbulent blood flow across valves or within heart chambers

Stenosis

narrowed valve impeding forward flow (e.g. aortic stenosis)

Regurgitation

valve doesn’t close properly, allows backflow (e.g. mitral regurgitation)

Septal defects

abnormal opening

Increased flow rate

fever, anemia, pregnancy (can cause physiological murmurs)

Characteristics of murmurs

timing (systolic/diastolic), location (where its heard), radiation, pitch and quality (blowing, harsh, rumbling), grade (I [barely audible] to VI [heard without stethoscope]), shape (crescendo, decrescendo, holosystolic)

Modifiable risk factors for heart disease

HTN, hyperlipidemia, smoking, obesity, sedentary, DM, poor diet, excessive alcohol consumption, stress

Non-modifiable risk factors for heart disease

age (increases with age), gender (males or menopausal women), family history (first-degree relatives with disease), ethnicity (African Americans at higher risk for HTN and CV disease)