Anatomy-Heart Sounds

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Anatomy-Heart Sounds
2011-10-27 11:44:02
Heart Sounds

Heart Sounds
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  1. Heart Valves
    • AV-mitral and tricuspid-prevent backflow into atria during systole-thick and irregular
    • Semilunar valves-aortic and pulmonary-prevent backflow into ventricules during diastole
    • Aortic valve-free standing leflets, 2 aortic sinuses
    • Sinuses of Valsalva,no attachments
    • Open and close passively
    • Pathology-Stenosis and/or regurgitation (insufficiency, incompetence)
    • all 4 valves in same plane connected by fibrous tissue
  2. Diastole
    AV valves open-elastic recoil; blood coming back
  3. Systole
    • Semilunar valves open-ejection
    • blood sent out of body or comes back to heart
  4. annulusfibrosus
    anchor valve leflets
  5. Heart Sounds
    • 1st-"Lub"-closure of mitral and tricuspid valves-start of systole, louder, longer, and lower frequency because valves larger in size
    • 2nd-"Dub"-closure of semilunar valves-two componenets, aortic (A2) and pulmonary (2), physiologic splitting of 2nd HS during inspiration with delayed pulmonary closer-higher pressure and smaller diameter-pulmonary takes longer to close due to increased VR
  6. Listening areas
    • Aortic: right 2nd intercostal space
    • Mitral: left fifth intercostal space (nipple line)
    • Pulmonary: left 2nd intercostal space
    • Tricuspid: beginning of left 5th intercostal space
  7. What do murmurs occur from?
    Result from disturbances of normal blood flow patterns through heart and great vessels
  8. Types of murmurs
    • forward flow through a narrowed orifice
    • retrograde flow through an incompetent valve-leaky valve
    • blood flow past valvular or great vessel irregularities (plaue or clot), flase passages or enlarged chambers
    • sound carried in direction of blood flow
  9. Heart valve pathology
    • Stenosis (insufficiency)-flow in normal direction-plaque etc. narrow down space
    • Regurgitation (incompetence)-flow in opposite direction-leaky
  10. Systolic Murmurs
    Less significant, most common:aortic and pulmonary stenosis
  11. Diastolic Murmurs
    Almost always due to significant lesions; incompetent semilunar or AV stenosis-blood going back into chambers
  12. Continuous Murmurs
    pressure difference throughout cardiac cycle, patent ductus arteriosus-higher pressure in aorta than pulmonary
  13. Mitral Regurgitation (Incompetence)
    • Systolic murmur at apex extending to left axilla
    • moderate to severe will lead to LV enlargement, LA dilation, pulmonary congestion, and RV hypertrophy and dilatation
    • both lub-murmur-dub and lub-dub-murmur
    • diastole and systole
  14. Mitral stenosis
    • Presystolic murmur at apex
    • Acceleration of blood flow by atrial contraction
    • Diastolic murmur
    • "rub-dub"
  15. Aortic Stenosis
    • Systolic murmur over valve to right 2nd intercostal space
    • Lub-murmur-Dub
  16. Aortic Regurgitation
    • Diastolic murmur in left 3rd-4th intercostal space
    • Lub-Dub-murmur
  17. Endocarditis
    Can't completely seal off valve-leaky
  18. Calcified Deposits
    blood coming out in jet stream manner
  19. Patent Ductus Arteriosus
    • Left 2nd intercostal space
    • Murmur heard throughout cycle, both systole and diastole
    • Described as a tunnel murmur, train driving through tunnel
    • continuous-aorta always higher than pulmonary
    • newborns-should close within days or weeks