Where is the base of the heart
superior aspect of the heart, where the great vessels originate
where is the apex of the heart
inferolateral tip of the left ventricle
what cardiac landmarks are you listening for in the anterior chest
- aortic area
- pulmonic area
- “second” pulmonic area
- Tricuspid area
- Mitral area
What are the two atrioventricular valves
- tricuspid
- mitral
paroxysmal noctural dyspnea
sudden waking in the middle of the night with SOB
Describe what is going on during the first heart sound (S1)
- systole
- contraction of ventricles
- aortic and pulmonic valves are open
- closure of mitral and tricuspid valves produce S1 sound -> “lub”
- contraction of ventricles
Describe what is going on during the second heart sound (S2)
- Diastole
- relaxation of ventricles
- mitral and tricuspid valves open and ventricles start to refill
- closure of aortic and pulmonic valves produce the S2 sound -> “Dub”
- relaxation of ventricles
Describe what is going on during the third heart sound (S3)
- early passive rapid filling of ventricles as blood rushes from the atria, in early diastole
- S3 is produced by the rapid distension of the ventricular walls, causing vibration
- pathologic heart sounds
Describe what is going on during the fourth heart sound (S4)
- second phase of ventricular filling as the atria contract and eject blood into ventricles
- rush of blood causes vibration of valves, papillary muscles, and ventricular walls
physiologic splitting of heart sounds
- similar events on both the left and right side of the heart
- right sided pressures are lower than corresponding pressures on the left side
- sounds occur slightly later on the right than on the left
- may hear two discernible components
- A2 (aortic valve closure)
- P2 (pulmonic valve closure)
what are murmurs
sound made by blood rushing through a narrowed or leaky valve or wall between chambers of the heart
what are thrills
- buzzing or vibratory sensation
what causes thrills
- vigorous blood flow through any narrowed opening (aortic stenosis, ventricular septal defect)
if you auscultate a thrill, what should you check for
a murmur
what is the lift or heave
vigorous cardiac impulse that can be felt through the chest wall
what can cause lifts (or heaves)
- ventricular hypertrophy
- hyperdynamic ventricular activity
what is the apical impulse?
point of maximal impuse (PMI)
- represents pulsation of left ventricle
you should examine the patient from which side
ride side of the patient
how do you palpate for apical impulse
- patient is supine or on left side
- place right hand on chest with heel of hand on lower sternum and fingertips at apex
where on the patients chest should you check for lifts and thrills
- left sternal border
- base (top of heart)
when ausculatating, do you use the diaphragm or bell?
BOTH
Is the diaphragm or the bell used to detect high pitched sounds of S1 and S2
diaphragm
- press firmly against the chest wall
Is the diaphragm or the bell used to detect low-pitched sounds of S3 and S4
bell
- apply lightly, with just enough pressure to make a seal against the chest wall
where can you listen to aortic sounds
- 2nd ICS
- RSB
