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    Auscultation of The Heart PDF

    Uploaded by

    JamaicaMaeCalag
    This document summarizes various heart sounds and murmurs, including: 1. Common heart sounds like S1, S2, S3, and S4 that occur during different phases of the cardiac cycle, along with factors that can increase or decrease their intensity. 2. Different types of systolic and diastolic murmurs defined by their timing within the cardiac cycle, configuration, and common causes like valvular abnormalities, shunts, and myocardial diseases. 3. Characteristics of continuous murmurs and souffles that span systole and diastole, along with benign sounds like cervical venous hum and mammary soufflé.

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    Auscultation of The Heart PDF

    Uploaded by

    JamaicaMaeCalag
    201 views3 pages
    This document summarizes various heart sounds and murmurs, including: 1. Common heart sounds like S1, S2, S3, and S4 that occur during different phases of the cardiac cycle, along with factors that can increase or decrease their intensity. 2. Different types of systolic and diastolic murmurs defined by their timing within the cardiac cycle, configuration, and common causes like valvular abnormalities, shunts, and myocardial diseases. 3. Characteristics of continuous murmurs and souffles that span systole and diastole, along with benign sounds like cervical venous hum and mammary soufflé.

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    Auscultation of the Heart.pdf

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    This document summarizes various heart sounds and murmurs, including: 1. Common heart sounds like S1, S2, S3, and S4 that occur during different phases of the cardiac cycle, along with factors that can increase or decrease their intensity. 2. Different types of systolic and diastolic murmurs defined by their timing within the cardiac cycle, configuration, and common causes like valvular abnormalities, shunts, and myocardial diseases. 3. Characteristics of continuous murmurs and souffles that span systole and diastole, along with benign sounds like cervical venous hum and mammary soufflé.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    201 views3 pages

    Auscultation of The Heart PDF

    Uploaded by

    JamaicaMaeCalag
    This document summarizes various heart sounds and murmurs, including: 1. Common heart sounds like S1, S2, S3, and S4 that occur during different phases of the cardiac cycle, along with factors that can increase or decrease their intensity. 2. Different types of systolic and diastolic murmurs defined by their timing within the cardiac cycle, configuration, and common causes like valvular abnormalities, shunts, and myocardial diseases. 3. Characteristics of continuous murmurs and souffles that span systole and diastole, along with benign sounds like cervical venous hum and mammary soufflé.

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    Heart Sounds

    Factors that decrease the intensity of the heart


    sounds and murmurs:
    1. mechanical ventilation
    2. obstructive lung disease
    3. obesity
    4. pendulous breasts
    5. pneumothorax
    6. pericardial effusion
    1. First Heart Sound (S1)
    - mitral (M1) and tricuspid (T1) valve closure
    - best heard: lower left sternal border
    - splitting: complete RBBB
    - intensity early rheumatic mitral stenosis,
    hyperkinetic states, short P-R intervals
    (<160 milliseconds)
    - intensity late rheumatic mitral stenosis,
    contractile dysfunction, -adrenergic
    receptor blockers, long P-R intervals
    (>200 milliseconds)
    2. Second Heart Sound (S2)
    - aortic (A2) and pulmonic (P2) valve closure
    - A2 is normally louder than P2
    - widening: complete RBBB
    - splitting: A2-P2 interval during inspiration
    and with expiration
    - fixed splitting: ostium secundum ASD
    - paradoxical splitting: complete left bundle
    branch block, RV apical pacing, severe
    aortic stenosis, HOCM, myocardial ischemia
    - intensity of P2 relative to A2: pulmonary
    artery hypertension
    - best heard: 2nd left interspace
    Systolic Sounds
    1. Ejection sound
    - high-pitched early systolic sound
    - coincides in timing with the upstroke of
    the carotid pulse
    - associated with congenital bicuspid
    aortic or pulmonic valve disease
    - pulmonic valve disease: intensity with
    inspiration (only right-sided cardiac
    event to behave in this manner)
    - best heard: lower left sternal border

    Diastolic Sounds
    1. Opening snap (OS)
    - high-pitched early diastolic sound
    - heard in mitral stenosis
    - distance after S2
    2. Pericardial knock (PK)
    - high-pitched early diastolic sound
    - abrupt cessation of ventricular
    expansion after AV valve opening and to
    the prominent y descent
    - seen in the jugular venous waveform in
    patients with constrictive pericarditis
    3. Tumor plop
    - low-pitched sound
    - atrial myxoma (rare)
    - arises from the diastolic prolapse of
    tumor across the mitral valve
    4. Third heart sound (S3)
    - occurs during the rapid filling phase of
    ventricular diastole
    - may be normally present in children,
    adolescents, young adults, pregnant
    - indicates systolic heart failure in older
    adults
    - left-sided S3:
    - low-pitched
    - best heard over the LV apex,
    - left lateral decubitus position
    - right-sided S3:
    - usually heard at the lower left
    sternal border or in the
    subxiphoid position
    - supine
    - louder with inspiration
    5. Fourth heart sound (S4)
    - occurs during the atrial filling phase of
    ventricular diastole
    - thought to indicate presystolic
    ventricular expansion
    - common in patients with accentuated
    atrial contribution to ventricular filling
    (e.g., LV hypertrophy)

    result from audible vibrations caused by


    increased turbulence
    defined by their timing within the cardiac
    cycle

    Grade

    Intensity

    Very faint, heard only after listener has


    tuned in; may not be
    heard in all positions
    Quiet, but heard immediately after placing
    the stethoscope
    on the chest
    Moderately loud
    Loud, with palpable thrill
    Very loud, with thrill. May be heard when the
    stethoscope is partly off the chest
    Very loud, with thrill. May be heard with
    stethoscope entirely
    off the chest

    2
    3
    4
    5
    6

    1. Systolic Murmurs
    a. Early
    - high-frequency
    - begins with S1 and ends before S2
    - decrescendo in configuration
    - causes: acute severe MR, acute TR
    with normal pulmonary artery
    pressures ( intensity with
    inspiration, may be audible at the
    lower left sternal border)
    b. Midsystolic
    - high frequency
    - begin after S1 and end before S2
    - d/t blood flow through the semilunar
    valves
    - crescendo-decrescendo in
    configuration
    - causes: aortic stenosis, HOCM,
    pulmonic stenosis, large ASD, leftto-right shunt
    - isolated grade 1 or 2 midsystolic
    murmur in the absence of
    symptoms or other signs of heart
    disease is a benign finding

    c. Late
    - starts after S1, if left sided, extends
    up to S2
    - usually in a crescendo manner
    - usually indicates MVP
    - similar murmur may be heard
    transiently during an episode of
    acute MI
    d. Holosystolic or Pansystolic
    - plateau in configuration,
    - start at S1 and extends up to S2
    - usually d/t regurgitation in cases
    such as mitral regurgitation,
    tricuspid regurgitation, or VSD
    - MR: cardiac apex
    - TR: lower left sternal border
    - SD: mid-left sternal border, thrill is
    palpable in most patients
    2. Diastolic Murmurs
    a. Early
    - start at the same time as S2, end
    before S1
    - causes: aortic or pulmonary
    regurgitation, left anterior
    descending artery stenosis
    b. Mid-diastolic
    - start after S2 and end before S1
    - due to turbulent flow across the
    atrioventricular valves during the
    rapid filling phase
    - causes: mitral or tricuspid stenosis
    c. Late diastolic or Presystolic
    - start after S2 and extend up to S1
    - crescendo configuration
    - causes: mitral stenosis, tricuspid
    stenosis, atrial myxoma, complete
    heart block, acute rheumatic mitral
    valvulitis (Carey Coombs murmur)
    d. Austin Flint murmur
    - low-pitched mid- to late apical
    diastolic murmur
    - sometimes associated with AR
    - can be distinguished from mitral
    stenosis on the basis of its
    response to vasodilators and the
    presence of associated findings

    3. Continuous Murmurs
    - implies a pressure gradient between two
    chambers or vessels during both systole
    and diastole
    - begin in systole, peak near S2, and
    continue into diastole
    - causes PDA, ruptured sinus of Valsalva
    aneurysm, and coronary, great vessel,
    hemodialysis-related arteriovenous
    fistulas
    a. Cervical venous hum
    - blood flow causing vibration of
    jugular veins
    - benign phenomenon
    - heard throughout the cardiac cycle
    - placing a finger on the jugular vein
    when listening to the heart will
    abolish or change the noise
    b. Mammary souffl
    - high-pitched
    - late pregnancy, postpartum
    lactation, adolescence
    - disappears at the end of lactation
    - best heard directly over the breast
    - pressure with a finger or
    stethoscope in the area where the
    souffle is best heard may make it
    disappear

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