Cardiac Auscultation
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Created by:
MDE_GoPens on December 5, 2011
Description:
Dr. Colyer's Lecture on 12/5/2011
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37 terms
Terms | Definitions |
|---|---|
 Diaphragm | High Frequency sounds |
| Bell | Low Frequency Sounds |
| Hand Grip Maneuver & Squatting | Increases Left Ventricular Volume |
| Valsalva Maneuver & Standing | Decreases Left Ventricular Volume |
| S1 Heart Sounds | Mitral and Tricuspid Components |
| S2 Heart Sounds | Aortic and Pulmonic Components |
| Increased Intensity of S1 | Tachycardia High Output States (e.g. fever) Mitral Stenosis (mitral valve open at onset of ventricular systole with sudden closure) |
| Decreased Intensity of S1 | 1st Degree Block (Long PR) Cardiomyopathy |
| S1 Splitting | Listen At LLSB Seen in RBBB |
| S2 Splitting - Physiologic | Due to Respiration Inspiration will decrease intrathoracic pressure leading to increased filling of RV and longer RV systole PV Closes after AV |
| S2 Splitting - Paradoxical | Delayed onset (LBBB, RV pacing) Prolongation (Aortic Stenosis) P2 is before A2 May resolve with inspiration |
| S2 Splitting - Fixed | ASD VSD RV Failure |
| Ejection Click | Cause: Sudden upward doming of semi-lunar valve Listen: Apex DDx: Aortic stenosis, pulmonic stenosis |
| Only Right-Sided Sound to Decrease in Intensity upon Inspiration | Pulmonic Ejection Click |
| Mid Systolic Click | Late in Systole Mitral Valve Prolapse Increase LV (hand grip) = later Decreased LV (valsalva) = earlier |
| Metallica Click | Prosthetic Heart Valve Type: probably St. Jude Valve |
| Opening Snap | Mitral Stenosis Column of blood from LA runs into fused commisures of MV Heard at Base |
| Gauging Severity of Mitral Stenosis? | Closer to S2 - More Severe <0.07 - very severe |
| S3 Gallop - Normal | Young people High Output States (anemia, pregnancy) |
| S3 Gallop - LV | Ventricle resists filling as blood "slaps" into it Cardiomyopathy Mitral Regurgitation Aortic Regurgitation |
| S3 Gallop - RV | RV enlargement/failure Pulmonary Embolism Pulmonary HTN |
| S4 | "Pre-Diastolic" Sound Stiff ventricle (always pathologic) Causes: LVH, Severe HTN, Aortic Stenosis, Acute Coronary Syndromes |
| Characterizing a Murmur | Timing: Systolic, Diastolic, Continuous Intensity: I-VI Shape: (De)Crescendo, Plateau) Location of Max Intensity Pitch Quality Radiation |
| Causes of Systolic Murmur | Mitral Regurgitation Aortic Stenosis Hypertrophic Obstructive Cardiomyopathy Pulmonic Stenosis Small Muscular VSD |
| Mitral Regurgitation - Causes | Endocarditis, Ischemia, MVP |
| Mitral Regurgitation - Characteristics | Systolic Murmur High Frequency Holosystolic Intensity does NOT CHANGE with cycle length Plateau murmur Loudest at Apex Radiates around back to Triangle Intensifies with handgrip (increase LV) |
| Aortic Stenosis - Causes | Congenital Rheumatic Degenerative/Calcific |
| Aortic Stenosis - Characteristics | Systolic Murmur Heard at right base Crescendo-decrescendo Intensity varies with cycle length Loss of A2 - severe |
| Gallavardin Effect | Musical quality of Aortic Stenosis heard at Apex during systole |
| Diastolic Murmurs | Aortic Insufficiency Mitral Stenosis Austin-Flint Graham Steele Tricuspid Stenosis |
| Aortic Insufficiency - Causes | Congenital, Rheumatic, Endocarditis, VSD, CVD |
| Aortic Insufficiency - Characteristics | High Frequency Decrescendo 3-4 Left Intercostal Space Radiation implies Marfans Often co-morbid with Aortic Stenosis |
| Mitral Stenosis - Characteristics | Low Frequency Rumble Heard at Apex Loud S1 Opening Snap Present (unlike Austin-Flint) |
| Austin-Flint Murmur | Aortic Regurgitation AR Jet causes turbulence of mitral inflow jet, thus mimicking mitral stenosis NO opening snap |
| Graham-Steele Murmur | Pulmonary Insufficiency Heard in Pulmonic Area |
| Patent Ductus Arteriosis | Continuous Murmur Differential cyanosis Left Base Envelops S2 |
| Pericardial Friction Rub | Triple Phased Scratchy/Leathery Pathology: apposition of abnormal visceral and parietal pericardia Exacerbated by: push hard with stethoscope, bending forward, held exhalation |
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