CSI 202 Skills Lab 4 Abnormal Heart Sound

CSI 202 - Skills Lab 4 Abnormal Heart Sound Daryl P. Lofaso, M. Ed, RRT

Heart Sound Locations

Heart Sounds n n S 1: “lub” occurs at the beginning of systole (mitral and tricuspid close) S 2: “dub” marks the start of diastole, (aortic and pulmonic close) S 3: early signs of CHF (ventricular gallop) S 4: pulmonic stenosis, aortic stenosis, hypertension, MI & cardiomyopathy (atrial gallop)

Cardiac Murmurs n Three Main Factors n n n High flow rate through normal or abnormal orifices Forward flow through a constricted or irregular orifice or into a dilated vessel or chamber Backward or regurgitant flow through an incompetent valve, septal defect, or patent ductus arteriosus.

Timing of Heart Sounds n Systolic: Between S 1 and S 2 n Diastolic: Between S 2 and S 1 n Holosystolic: continuous throughout systole

Loudness Scale: 1 -6 n Grade 1: Very faint n Grade 5: Loud with palpable precardical thrill n Grade 6: Audible even when the stethoscope is lifted off chest

Heart Sounds: Pitch n Low-velocity – low pitched rumbling (mitral stenosis) n Large diastolic pressure gradient – high pitched murmur (aortic regurgitation)

Systolic Murmurs Systolic murmurs can be divided into n Mid-systolic n Holo-systolic (pan-systolic)

Systolic Murmur Mid-Systolic Murmurs n Aortic Stenosis ¡ n Radiates to carotid arteries; harsh or barking Pulmonic Stenosis Note: blood flow in a normal direction across a valve that is narrowed or calcified. n n Hypertrophic cardiomyopathy Flow murmur Note: valve is normal but the flow is increased and this causes turbulence.

Systolic Murmur Holo-systolic murmurs n Mitral regurgitation ¡ n n Medium-pitched blowing Tricuspid regurgitation Ventricular septal defect (VSD) Note: blood flowing the wrong way when the ventricle contracts

Diastolic Murmurs Diastolic murmurs can be divided into n Early diastolic murmurs n Diastolic rumbles

Diastolic murmur Early Diastolic Murmurs (decrescendo) n Aortic Insufficiency (Regurgitation) ¡ n Blowing early diastolic Pulmonic Insufficiency ¡ Accentuated P 2 Note: blood flowing the wrong way (backwards) during diastole

Diastolic Murmurs Diastolic Rumbles (low-pitched rumble) n Mitral stenosis ¡ n Opening snap with mid-diastolic rumble Tricuspid stenosis ¡ Mid-diastolic rumble, louder with inspiration & decrease with exhalation Note: blood flow is normal, but across a narrowed valve opening