Cardiology heart sounds

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What is the bell used for?: The bell is used to hear low-pitched sounds. Use for mid-diastolic murmur of mitral stenosis or S3 in heart failure.
What do you use to hear high pitched sounds?: The diaphragm, by filtering out low-pitched sounds, highlights high-pitched sounds. Use for analyzing the second heart sound, ejection and midsystolic clicks and for the soft but high-pitched early diastolic murmur of aortic regurgitation.
The first heart sound represents: closure of mitral and tricuspid valves and beginning of systole
Where is S1 loudest?: at the apex
What does S2 represent?: closure of aortic and pulmonic valves; beginning of diastole
Where is S2 loudest?: at the base
Which is lower pitch, S1 or S2?: S1
Which is higher pitch, s1 or s2?: s2
Where is the murmur of AS heard best?: Left second ICS
To where does the murmur of AS radiate?: carotids
Characterize the murmur of Mitral regurgitation?: Blowing holosystolic murmur
Where is the murmur of MR heard best?: apex
To where does the murmur of MR radiate?: To the axilla and inferior edge of the left scapula
What other sounds may be associated with MR?: wide physiologic splitting of S2, s3
Characterize the murmur of Aortic Insufficiency?: Soft blowing early diastolic descrescendo murmur
Where is the murmur of AI heard best?: Second ICS
To where does murmur of AI radiate?: Doesnâ€™t radiate
Sounds associated with AI?: Systolic flow murmur and diastolic rumble (Austin Flint)
Characterize the murmur of Tricuspid Regurgitation?: Soft holosystolic murmur
Where is the murmur of TR heard best?: LLSB
To where does murmur of TR radiate?: Doesnâ€™t radiate
What increases the intensity of TR murmur?: Inspiration or pressure over liver
Characterize the murmur of Pulmonic Insufficiency?: High frequency early diastolic decrescendo murmur
Where is the murmur of PI heard best?: Second to third intercostal space
What increases the intensity of PI murmur?: Inspiration
What noise is associated with PI?: Abnormal Split S2
Characterize the murmur of Pulmonary Stenosis?: Harsh crescendo-decrescendo systolic murmur
Where is the murmur of PS heard best?: sternal border bat 2nd or 3rd intercostal spaces
What increases the intensity of PS murmur?: Inspiration
Which heart sound is abnormal with PS?: Wide physiologic splitting of S2
Characterize the murmur of Mitral Stenosis?: Low frequency rumbling mid-diastolic murmur, with presystolic component possible
Where is the murmur of MS heard best?: apex
What increases the intensity of MS murmur?: Accentuated in left lateral decubitus position
Which heart sound is abn in MS?: S1 is very loud
What arrhythmia may be associated with MS?: Atrial fibrillation
What is the quality of the murmur associated with hypertrophic cardiomyopathy?: Harsh quality midsystolic murmur
Where is it heard best?: LSB
Which heart sound is abnormal with hypertrophic cardiomyopathy?: S4 may be present
What does a loud first heart sound represent?: Hyperdynamic (fever, exercise), Mitral stenosis, or Atrial myxoma (rare)
What does a soft first heart sound represent?: Low cardiac output (rest, heart failure); Tachycardia; Severe mitral reflux (caused by destruction of valve)
What does Variable Intensity of First Sound represent?: Atrial fibrillation or Complete heart block
Where is splitting of S2 best heard?: over the 2nd left intercostal space
If P2 is audible at the apex in both upright and supine positions: Significant pulmonary hypertension or Atrial septal defect
What does fixed mean in fixed split of S2?: Occurs in inspiration and expiration
Wide fixed split of S2: ASD
Wide split varying with inspiration?: Pulmonary stenosis or RBBB
Paradoxical splitting of S2 means: splits in expiration; Hypertrophic cardiomyopathy
What does a Loud Aortic Component of Second Sound represent?: Systemic hypertension or Dilated aortic root
What does a Soft Aortic Component of Second Sound represent?: Calcific aortic stenosis
What does a Loud Pulmonary Component of Second Sound represent?: Pulmonary hypertension
With which part of stethoscope is an S3 best heard?: The bell, because the sound is low-frequency
With which part of stethoscope is an S4 best heard?: The bell, because the sound is low-frequency
When is S3 heard?: Soon after s2 (early diastole)
What usually causes S3?: CHF or normal physiologic finding in young person
When is S4 heard?: Presystolic portion of diastole
What usually causes S4?: stiffened left ventricles, resulting from conditions such as hypertension, aortic stenosis, ischemic or hypertrophic cardiomyopathy

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