AV valves are?
Mitral
Tricuspid
Semilunar valves?
Aortic
Pulmonary
First Heart Sound?
closing of AV valves
S1
Systole (vents contract)
Second Heart Sound?
closing of aortic and pulmonic valves
S2
diastole (vents relax
Third Heart Sound?
rapid distension of vent walls during filling
S3
low-pitch
heard w/ bell at apex
Fourth Heart Sound?
atrial systole
S4
low-pitch
heard w/ bell at apex
Systolic or Diastolic Murmur?
blood rushing thru narrow/leaky valve or chamber walls
Thrill?
palpable murmur
(U) vibrations of loud murmur
Lift/Heave?
vigorous cardiac impulse palpable through chest wall
Apical Impulse (Point of Maximal Impulse) is?
Felt where?
What size?
systolic pulse of LV
5th ICS, medial to MCL
1-2 cm across
Palp w/ pt both seated and supine
Examine pt from which side?
Pt’s right
Palpate for Lifts and Thrill where?
L sternal border
Base of heart
Steth diaphragm best for what sound?
high-pitched
S1/2
Steth bell best for what sounds?
Low-pitched
S3/4
Aortic sounds heard where?
2nd ICS, RSB
Pulmonic sounds hear where?
2nd ICS, LSB
Second Pulmonic sounds heard where?
3rd ICS, LSB
Tricuspid sounds heard where?
4th/5th ICS, LSB
Mitral sounds heard?
apex
5th ICS, MCL
What sound is at 2nd ICS, RSB ?
Aortic
What sound is at 2nd ICS, LSB?
Pulmonic
What sound is at 3rd ICS, LSB?
Second Pulmonic
What sound is at 4th/5th ICS, LSB?
Tricuspid
What sound is at 5th ICS, MCL?
Mitral
Palp of Axillary Nodes in what 4 places?
Anterior axillary line
Midaxillary line
Posterior axillary line
Medial upper arm
JVD is sign of?
fluid overload in heart
Measure jugular venous pressure how?
head at 30º
find point of highest pulse in internal jugular vein
measure from sternal angle (~5cm above R atrium)
> 4cm above sternal angle = elevated heart pressure
Hepatojugular reflux exam tests for?
How is exam performed?
test for fluid cardiac overload
apply pressure RUQ over liver
JVP will increase then decrease when released
Cardiac impluse felt lateral to MCL indicates what?
LV enlargement
Cardiac Percussion of L border tests for?
Exam performed how?
use to estimate size of heart
percuss from 5th ICS at MAL medially
listening for onset of dullness
Auscultation sitting up/lean forward tests for what?
Exam performed how?
aortic and pulmonic regurge
Pt sitting, leans forward
Exhale and hold breath
Listen at base and apex
Best way to hear low-pitch filling sounds (gallops, murmurs)?
L lateral decubitus position:
Pt on L side, arm above head
listen w/ bell at apical impulse
S1 should be > S2 where?
at apex
S1 should be < S2 where?
at base
Louder than normal S1 due to?
disease AV valve or
more forceful closure of AV valve
Softer than normal S1 due to? (3)
1) weak heart contractions
2) thick chest wall
3) emphysematous lungs
S2 splits when?
A2 sound is?
P2 sound is?
plumonic valve closure is delayed
A2 = aortic valve closure
P2 = pulmonic valve closure
S2 split is normal when?
Heard where?
during inspiration
2nd/3rd ICS
Wide S2 split due to? (2)
1) pulmonic stenosis
2) R bundle branch block (RBBB)
Fixed S2 splitting: “Fixed” means?
Due to? (2)
“fixed” means does not vary w/ respiration
1) atrial septal defect
2) RV failure
Paradoxical S2 splitting: “Paradoxical” means?
Due to?
A2/P2 sounds present in what order?
“paradoxical” means happens during expiration, but not insp
delayed contraction of LV from LBBB
A2 follows P2
S1 + S2 + S3 =
ventricular gallop rhythm
Pathologic S3 vent gallop? (4)
>40yo from: HF anemia vol overload of vents decreased contractility
S1 + S2 + S4 =
atrial gallop rhythm
Pathologic S4 atrial gallop?
from resistance to vent filling
stiff heart mm
typical heart diseases cause this
Route of cardiac inpulse?
SA node -> R atrium -> AV node -> atrial septum -> bundle of His -> Purkinje fibers in vents
Tachycardia bpm?
> 100
Normal bpm?
60-100
Bradycardia bpm?
<60
Arrhythmia definition?
irregular or lost rhythm
Aortic/Pulmonic Ejection Click sounds like what?
Heard where?
Caused by (3)?
high-pitch
just after S1
1) valve disease
2) dilated aorta/pulm artery
3) pulmonary HTN
Late Systolic Murmur happens when?
Sounds like?
Cause by?
pre S2
variable pitch
mitral prolapse into L atrium
Systolic Ejection Murmur happens when?
Heard where?
Sounds like?
Cause by?
HIGH PRESSURE TO HIGH PRESSURE
b/w S1/S2
heard at base, R & LSB
(U) crescend-decrescendo
(U) from blood flow across semilunar valves,
Aortic/Pulmonic stenosis
Pansystolic Murmur happens when?
Sounds like?
Caused by?
HIGH PRESS TO LOW PRESS
b/w S1/S2
(U) sound remains same connecting S1/S2
(U) from regurge across AV valves
or ventricular septal defect
Innocent Systolic Murmur sounds like?
Caused by?
(U) grade 1-2, medium pitch
turbulent blood flow
no narrowing/obstruction or disease
(C) kids, young adults
Mitral Insufficiency (Regurge) from?
Rheumatic HD
Atrial Septal Defect (ASD) from?
congenital anomaly
blood flow LA -> RA
enlarged RV
inc flow thru pulmonic valve
ASD murmur is?
Systolic ejection:
fixed splitting S2
Ventral Septal Defect causes what kind of shunt?
L to R shunt
VSD murmur sounds like?
Heard where?
harsh pansystolic
heard and felt at low LSB
Early Diastolic Murmur sounds like?
Heard when?
Caused by?
(U) decrescendo
just post S2
(U) regurge across leaky semilunar valves
(aortic regurge)
Mid Diastolic Murmur sounds like?
Heard where?
Caused by?
low decresc
b/w S2/S1
from turbulent flow across AV valves,
mitral/tricuspid stenosis
Late Diastolic Murmur sounds like?
Heard when?
(presystolic)
low decresc
from S2 to S1
Opening Snap Diastolic Rumble sounds like?
Heard when?
Caused by?
high snap, low rumble
b/w S2/S1
mitral stenosis
Aortic Stenosis and Aortic Insufficiency (Regurge) murmur sounds like?
Heard when?
Caused by?
Crescendo-decres
Syst-Diast murmur (to-fro)
reduced outflow from narrowed valve
leakage from failure to close
Patent Ductus Arteriosus
failure of channel b/w aorta/pulm artery to close
Strain phase of Valsalva does?
↓ LV vol
↓ vascular tone
↓ BP and peripherial vascular resistance
Squatting or release of Valsalva does?
opposite of strain