Daryl P Lofaso MEd RRT Heart Sound Locations Heart Sounds S 1 lub occurs at the beginning of systole mitral and tricuspid close S 2 dub marks the start of diastole ID: 775839
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Slide1
CSI 202 - Skills Lab 4
Abnormal Heart Sound
Daryl P. Lofaso,
M.Ed
, RRT
Slide2Heart Sound Locations
Slide3Heart Sounds
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)
Slide4Cardiac Murmurs
Three Main Factors
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.
Slide5Timing of Heart Sounds
Systolic: Between S
1
and S
2
Diastolic: Between S
2
and S
1
Holosystolic
: continuous throughout systole
Slide6Heart Murmurs with EKG
Slide7Loudness Scale: 1-6
Grade 1: Very faint
Grade 5: Loud with palpable
precardical
thrill
Grade 6: Audible even when the stethoscope is lifted off chest
Slide8Heart Sounds: Pitch
Low-velocity – low pitched rumbling (mitral stenosis)
Large diastolic pressure gradient – high pitched murmur (aortic regurgitation)
Slide9Systolic Murmurs
Systolic murmurs can be divided into
Mid-systolic
Holo
-systolic (pan-systolic)
Slide10Systolic MurmurMid-Systolic Murmurs
Aortic Stenosis Radiates to carotid arteries; harsh or barkingPulmonic StenosisNote: blood flow in a normal direction across a valve that is narrowed or calcified.Hypertrophic cardiomyopathyFlow murmurNote: valve is normal but the flow is increased and this causes turbulence.
Slide11Systolic MurmurHolo-systolic murmurs
Mitral regurgitationMedium-pitched blowingTricuspid regurgitationVentricular septal defect (VSD)Note: blood flowing the wrong way when the ventricle contracts
Slide12Diastolic Murmurs
Diastolic
murmurs can be
divided into
Early diastolic murmurs
Diastolic rumbles
Slide13Diastolic murmurEarly Diastolic Murmurs
Early Diastolic Murmurs (decrescendo) Aortic Insufficiency (Regurgitation)Blowing early diastolicPulmonic InsufficiencyAccentuated P2Note: blood flowing the wrong way (backwards) during diastole
Slide14Diastolic MurmursDiastolic Rumbles
Diastolic Rumbles (low-pitched rumble)Mitral stenosisOpening snap with mid-diastolic rumbleTricuspid stenosis Mid-diastolic rumble, louder with inspiration & decrease with exhalationNote: blood flow is normal, but across a narrowed valve opening