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slow heart rate, usually below 60 beats per minute


soft, blowing sound heard on auscultation; murmur

capillary refill

a test of blood circulation in the fingers or toes. Pressure is applied to a fingernail or toenail until normal color is lost. The pressure is then removed, and, if the circulation is normal, color should return almost immediately, within about 2 seconds. The time may be prolonged by dehydration; a compromise of circulation, such as arterial occlusion; hypovolemic shock; or hypothermia.


the period between contractions of the atria or the ventricles during which blood enters the relaxed chambers from the systemic circulation and the lungs.


swelling from excessive accumulation of serous fluid in tissue

ejection click

a sharp, clicking sound arising from near the heart. It may be caused by sudden swelling of a pulmonary artery, abrupt dilation of the aorta, or forceful opening of the aortic cusps


a chronic pulmonary disease, similar to human pulmonary emphysema, characterized by wheezing,
pulmonary emphysema, characterized by wheezing, coughing, and dyspnea on exertion. The cause of the condition is unknown.

Homan's sign

doriflexing feet to monitor for thrombosis in legs


a gentle blowing, fluttering, or humming sound

opening snap

In the presence of stenosis, increasily higher atrial pressure is required to open the valve and creates a noise. Sharp and high pitched with snapping quality after S2 at the third or forth interspace at the sternal border.


an abnormal condition in which a person must sit or stand to breathe deeply or comfortably.


a pounding or racing of the heart.

paroxysmal nocturnal dyspnea

a disorder characterized by sudden attacks of respiratory distress that awaken the person, usually after several hours of sleep in a reclining position. This occurs because of increased fluid central circulation with reclining position.

pericardial friction rubs

the rubbing together of inflamed membranes of the pericardium


the part of the front of the chest wall that overlays the heart and the epigastrium.


point of maximal impulse. the place where the apical pulse is palpated as strongest, often in the fifth intercostal space of the thorax, just medial to the left midclavicular line.

pulse pressure

the difference between the systolic and diastolic blood pressures, normally 30 to 50 mm Hg.

pulse deficit

a condition in which a peripheral pulse rate is less than the ventricular contraction rate as auscultated at the apex of the heart or seen on the electrocardiogram, indicating a lack of peripheral perfusion.


the first heart sound in the cardiac cycle, occurring at the outset of ventricular systole. It is associated with closure of the mitral and tricuspid valves and is synchronous with the apical pulse.


the second heart sound in the cardiac cycle. It is associated with closure of the aortic and pulmonic valves at the outset of ventricular diastole. The second sound is louder and shorter than the first.


the third heart sound in the cardiac cycle. Normally, it is audible only in children and physically active young adults and usually disappears with age. In older people, it is an abnormal finding and usually indicates myocardial failure. It is heard with the bell of a stethoscope placed lightly over the apex of the heart with the patient lying down and facing left. A weak, low-pitched, dull sound, it is thought to be caused by vibrations of the ventricle walls when they are suddenly distended by blood from the atria.


the fourth heart sound in the cardiac cycle. It occurs late in diastole on contraction of the atria. Rarely heard in normal subjects, it indicates an abnormally increased resistance to ventricular filling, as in hypertensive cardiovascular disease, coronary artery disease, cardiomyopathy, and aortic stenosis.

sinus arrhythmia

The rate usually increases with inspiration and decreases with expiration.This rhythm is most commonly seen with breathing due to fluctuations in parasympathetic vagal tone. During inspiration stretch receptors in the lungs stimulate the cardionhibitory centers in the medulla via fibers in the vagus nerve. The non respiratory form is present in diseased hearts and sometimes confused with sinus arrest(akso known as sinus pause). Treatment is not usually required unless symptomatic brachycardia is present.


the contraction of the heart, driving blood into the aorta and pulmonary arteries.


a condition in which the heart contracts at a rate greater than 100/min. It may occur normally in response to fever, exercise, or nervous excitement.


a fine vibration, felt by an examiner's hand on a patient's body over the site of an aneurysm or on the precordium, resulting from turmoil in the flow of blood and indicating the presence of an organic murmur of grade 4 or greater intensity.

venous hum

a continuous murmur heard on auscultation over the major veins at the base of the neck and around the umbilicus.

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