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Auscultation of the heart

Auscultation of the heart. Auscultatory content. Heart rate Cardiac rhythm Cardiac sound extra cardiac sound Cardiac murmur Pericardial friction sound. Auscultatory valve. Mitral valve area (Apical ~) Pulmonary ~ Aortic ~ The second aortic ~ Tricuspid ~.

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Auscultation of the heart

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  1. Auscultation of the heart

  2. Auscultatory content • Heart rate • Cardiac rhythm • Cardiac sound • extra cardiac sound • Cardiac murmur • Pericardial friction sound

  3. Auscultatory valve • Mitral valve area (Apical ~) • Pulmonary ~ • Aortic ~ • The second aortic ~ • Tricuspid ~

  4. Normal heart sound First heart sound (S1) Second heart sound (S2) Third heart sound (S3) Fourth heart sound (S4) Variations in heart sound Intensity Quality Splitting s1  MS P-R  Contractility  MI P-R  Contractility  AVB A2 hypertension AS AI P2 MS ASD VSD PDA PS PI Cardiac Sound

  5. expiration inspiration S1 A2 P2 S1 A2 P2 Physiological ~ General ~ P2 A2 S2 Reversed ~ Fixed ~

  6. Extra cardiac sound Diastolic: • gallop rhythm • protodiastolic ~ (ventricular ~) : S3 • late diastolic~ (presystolic ~, atrial ~) : S4 • summation ~ • Openning snap (os) • Pericardial knock • Tumor plop Systolic: • Ejection sound : early systolic ~ ----aortic ~, pulmonary~ • Click : middle and late systolic click ----mitral valve prolapse

  7. Murmurs(1) • Mechanism Luminar flow  turbulent flow vortices  murmur blood flow acceleration stenostic area incefitic area abnormal tract abnormal stucture aneurythm

  8. Murmurs(2) • Skills of auscultation • Location • Phase • Character • Radiation • Intensity • Relation with position, respiration, exercise

  9. Murmurs • Grade 1—audible with special effort • Grade 2—faint but recognizable • Grade 3—moderate intensity • Grade 4—loud (commonly accompanied by a thrill) • Grade 5—louder,but still needing a stethoscope • Grade 6—audible with the stethoscope removed from contact with the chest

  10. Murmurs(4) • Clinic significance Systolic apical aortic pulmonary tricuspid • Functional • Physical  • Relatively LV ( DCM ) • Innocent • Organic MI MVP AS PS Diastolic • Organic MS AI • RelativelyAustin Flint Graham Steel Continuous Gibson murmur PDA

  11. summary • Cardiac sound • extra cardiac sound • D: gallopOS( ms) • S: ECclick • Cardiac murmur • S: • MI : >3/6, holosystolic , axilla • AS : cresendo-desendo, loud, neck • D: • MS : mid-late, rumbling • AI : early, high-pitched sigh

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