S1 represented by which on the QRS?
R wave
Which side of the stethoscope is best to listen to high pitch S1/S2, aortic/mitral murmurs?
Diaphragm
Which side of the stethoscope is best used to listen to low pitch sounds S3/S4, mitral stenosis murmurs?
Bell
Lub dub tuh is which ❤️sound
S3
Tuh Lub Dub is which ❤️sound
S4
Which area of the ❤️is best to auscultate for the splitting of S2 during inspiration?
Pulmonic Area
Which area of the ❤️is best to auscultate for the S3/S4, mitral stenosis murmurs?
Tricuspid and mitral area
When using the bell to listen for S3 sounds, is it best to use light or firm pressure?
Light
Why would I ask my patient to sit up and lean forward with auscultation?
To listen for aortic and pulmonic murmurs
Systolic murmurs are caused by which area of stenosis?
Aortic and pulmonic stenosis
Tricuspid and mitral regurgitation
Crescendo decrescendo murmurs are heard in?
Aortic stenosis
Systolic ejection murmur is heard in?
Aortic stenosis
If a murmur radiates to my neck/carotid area what’s the cause?
Aortic stenosis
Aortic regurgitation, pulmonic regurgitation, tricuspid and mitral stenosis occurs during which phase of the ❤️cycle?
Diastole
Halo/pan systolic murmurs are best heard where?
Apex of the ❤️
Also known as the mitral area
If a murmur radiates to my axilla/armpit which murmur is it?
Mitral regurgitation
Which ventricle is the workforce of the body?
Left ventricle
Describe mitral regurgitation
As S1 occurs blood flows backwards in LA because the MV doesn’t close fully.
The Pressure in LV > than LA when the AV is closed.
The AV opens up but the pressure difference remains unchanged causing regurgitation to occur the entire cycle.
The LA becomes compliant.
Flat murmur occurs because the intensity of the blood flow does not change.
During MV Prolapse what causes the mid systolic click?
Tension of the cordae tendinae prevents leaflets from fully collapsing into LA
A mid systolic click with a late systolic murmur is heard during which condition?
MV prolapse?
Describe aortic stenosis
MV closes and the ❤️begins to close against a closed valve. When enough pressure build up the AV snaps open causing and ejection click.
Blood begins to flow and as the force increases the murmur increases.
When filling is completed the murmur decreases.
Hence crescendo-decrescendo name
Which condition causes early diastolic murmur?
Aortic regurgitation
A decrescendo murmur is heard during which condition?
Aortic regurgitation
Describe aortic regurgitation
AV doesn’t close fully and the pressure in the aorta is > the LV
And this is where the murmur is more intense in sound
The intensity decreases as the pressure in LV eventually increases due to simultaneous filling from the LA
What is pre-systolic accentuation?
At the end of diastole when the atria contracts to push the remaining blood into the LV
Opening snap with a mid diastolic rumble is heard during which condition?
Mitral stenosis
Describe mitral stenosis
MV doesn’t close fully and the pressure in LA > LV at the start of diastole
The leaflets snap open and rapid filling occurs
This causes a rumble
As the pressure begins to equalize the murmur decreases
Finally the intensity increases again as the LA contracts to push out the remaining blood (pre-systolic attenuation)
Volume overload occurs during which abnormal ❤️sound?
S3
Define concentric hypertrophy and it’s cause
When the ❤️ contracts again increases pressure it increase in size making the ventricle stiff
Causes such as HTN
Pressure overload occurs during which abnormal ❤️sound?
S4
Ventricular gallop and atrial gallop refers to which abnormal ❤️sounds?
S3 and S4
S3 is heard when?
After S2
S4 occurs when?
At the end of diastole when the LA is contracting to send blood into a stiff LV
Right Before S1
Describe the occurrence of S4
The ❤️contracts against increased pressure causing concentric hypertrophy.
The sound is heard @ the end of diastole when the LA is contracting to send blood into the stiff LV right before the start of S1
A patient should lay in which position to best gear S3 and S4?
Left lateral decubitus