Heart Sounds and Blood/Pulse Pressure

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Questions and Answers

What causes the S1 heart sound?

  • Closure of the aortic and pulmonic valves
  • Opening of the mitral and tricuspid valves
  • Closure of the mitral and tricuspid valves (correct)
  • Opening of the aortic and pulmonic valves

Where is S2 heart sound typically loudest?

  • Left Sternal Border, 5th Intercostal Space
  • Midclavicular, 4th intercostal space
  • Right Sternal Border, 2nd Intercostal Space (correct)
  • Apex/Mitral Area

An S3 heart sound is most closely associated with which condition?

  • Hypertension
  • Myocardial Ischemia
  • Heart Failure (correct)
  • Aortic Stenosis

An S4 heart sound is caused by the:

<p>Atrial contraction of blood into a noncompliant ventricle (A)</p> Signup and view all the answers

A patient has a pulse pressure of 20 mmHg. This is most clearly associated with:

<p>Severe hypovolemia with decreased cardiac output (D)</p> Signup and view all the answers

A widened pulse pressure may indicate:

<p>Vasodilation and/or a decrease in SVR (D)</p> Signup and view all the answers

During what phase of the cardiac cycle are the coronary arteries perfused?

<p>Diastole (C)</p> Signup and view all the answers

Which of the following best describes what is happening during the S2 heart sound?

<p>Semilunar valves are closing (A)</p> Signup and view all the answers

A pericardial friction rub is primarily associated with which of the following?

<p>Pericarditis (B)</p> Signup and view all the answers

A fixed splitting of S2 during inspiration is most often caused by:

<p>Right Bundle Branch Block (D)</p> Signup and view all the answers

A nurse auscultates a heart sound best heard at the apex using the bell of the stethoscope, occurring just after S2. The nurse should suspect which of the following?

<p>S3 heart gallop (C)</p> Signup and view all the answers

A patient with a known history of hypertension is noted to have a new heart sound occurring just before S1. Which of the following would be the most likely cause?

<p>Atrial contraction into a noncompliant ventricle (B)</p> Signup and view all the answers

A patient's blood pressure is measured as 160/100 mmHg, what is the pulse pressure?

<p>60 mmHg (A)</p> Signup and view all the answers

Which of the following best describes a narrowed pulse pressure?

<p>A decrease in systolic blood pressure with a substantial increase in diastolic blood pressure (A)</p> Signup and view all the answers

Which finding is most consistent with a widening pulse pressure?

<p>Vasodilation and/or a drop in SVR (C)</p> Signup and view all the answers

During a physical exam, a nurse notices that the S2 heart sound seems to split on inspiration. This finding suggests which of the following?

<p>Normal physiological event, but requires additional investigation (D)</p> Signup and view all the answers

A patient is diagnosed with a pulmonary embolism. When auscultating, what is most likely expected of their S2 heart sound?

<p>Louder than normal (A)</p> Signup and view all the answers

A patient presents with a new onset murmur that is auscultated and described as a 'pericardial friction rub'. The nurse should anticipate which of the following?

<p>Symptoms worsen with deep inspiration (D)</p> Signup and view all the answers

You are caring for a patient presenting with heart failure. While auscultating, you hear a third heart sound (S3). Following with the 'Kentucky' mnemonic, what is happening during this sound?

<p>Rush of blood into a dilated ventricle (C)</p> Signup and view all the answers

A patient is showing signs of hypovolemic shock but has little change in their diastolic. What trend is most expected to be noted in the patient's blood pressure?

<p>A mild decrease in systolic with an increase in diastolic. (C)</p> Signup and view all the answers

What is the primary reason for the occurrence of S3 heart sound?

<p>Rush of blood into a dilated ventricle (B)</p> Signup and view all the answers

Which heart sound is best associated with myocardial ischemia?

<p>S4 (C)</p> Signup and view all the answers

In which situation is S2 expected to be louder?

<p>Pulmonary embolism (C)</p> Signup and view all the answers

Which of the following is a characteristic of S4 heart sound?

<p>Related to atrial contraction (D)</p> Signup and view all the answers

What condition is indicated by a narrowed pulse pressure?

<p>Severe hypovolemia (D)</p> Signup and view all the answers

What does a widened pulse pressure commonly indicate?

<p>Vasodilation and/or drop in systemic vascular resistance (D)</p> Signup and view all the answers

Where is pericardial friction rub best auscultated?

<p>At the Apex/Mitral area (C)</p> Signup and view all the answers

What is the normal range for pulse pressure?

<p>40-60 mmHg (D)</p> Signup and view all the answers

What causes the split of S2 heart sound during inspiration?

<p>Increased venous return to the heart (B)</p> Signup and view all the answers

What condition is commonly seen with a decreased diastolic blood pressure?

<p>Hypovolemic shock (B)</p> Signup and view all the answers

Flashcards

S1 (Lub)

This sound is caused by the closure of the Mitral and Tricuspid valves.

S2 (Dub)

This sound is caused by the closure of the Aortic and Pulmonic valves.

S3

A rush of blood into a dilated ventricle, heard early in diastole.

S4

Atrial contraction of blood into a stiff ventricle, heard right before S1.

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Pericardial Friction Rub

This happens when the pericardium is inflamed, causing a scratching sound.

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Pulse Pressure

The difference between systolic and diastolic blood pressure.

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Systolic Blood Pressure

An indirect measure of cardiac output and stroke volume.

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Diastolic Blood Pressure

An indirect measurement of systemic vascular resistance (SVR).

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Narrowing Pulse Pressure

Most often occurs with severe hypovolemia or a significant drop in cardiac output.

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Widening Pulse Pressure

Often seen in septic shock, indicating vasodilation and a drop in SVR.

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S3 (Ventricular Gallop)

A heart sound heard during diastole (relaxation) caused by blood rushing into a dilated ventricle.

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S4 (Atrial Gallop)

A heart sound heard during diastole (relaxation) caused by atrial contraction pushing blood into a stiff ventricle.

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What is Pulse Pressure?

The difference between systolic and diastolic blood pressure. A normal range is 40-60 mmHg.

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What does Systolic Blood Pressure indicate?

An indirect measurement of cardiac output and stroke volume. Decreases with low cardiac output.

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What does Diastolic Blood Pressure indicate?

An indirect measurement of systemic vascular resistance (SVR). Decreases in septic shock due to vasodilation.

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What is Narrowing Pulse Pressure?

Occurs when systolic blood pressure decreases and diastolic blood pressure stays the same or increases.

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What is Widening Pulse Pressure?

Occurs when diastolic blood pressure falls and systolic blood pressure stays the same or increases.

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Study Notes

Normal Heart Sounds

  • S1 ("Lub"): Caused by the closure of mitral and tricuspid valves. Loudest at the apex (lower left of the heart). Marks the end of diastole and the beginning of systole.

  • S2 ("Dub"): Caused by the closure of aortic and pulmonic valves. Loudest at the base (upper right of the heart). Marks the end of systole and the beginning of diastole. Can sometimes split during inspiration. Wide, fixed splitting may be a sign of a right bundle branch block. S2 is louder if there's a pulmonary embolism.

Abnormal Heart Sounds

  • S3: Caused by blood rushing into a dilated ventricle early in diastole. Heard immediately after S2. Best heard at the apex with the bell. Often associated with heart failure and/or crackles. Also known as ventricular gallop ("Kentucky"). Other causes include pulmonary hypertension, cor pulmonale, mitral, aortic, or tricuspid insufficiency.

  • S4: Caused by atrial contraction of blood into a non-compliant ventricle. Occurs just before S1. Best heard at the apex with the bell. Associated with myocardial ischemia (reduced blood flow to the heart muscle), infarction (heart attack), hypertension, ventricular hypertrophy, and aortic stenosis. Also known as atrial gallop ("Tennessee"). Can be due to pericardial friction rub (inflammation of the pericardium surrounding the heart), causing pain, especially during inspiration. Its location may change, depending on the patient's position.

Blood Pressure and Pulse Pressure

  • Pulse pressure: The difference between systolic and diastolic blood pressures. Normal is 40-60 mmHg. Systolic blood pressure is an indirect measure of cardiac output and stroke volume. A decrease in systolic pressure with little change in diastolic pressure usually indicates severe hypovolemia or a significant drop in cardiac output.

  • Diastolic blood pressure: An indirect measure of systemic vascular resistance (SVR). A decrease in diastolic pressure, often seen with widening pulse pressure, can be due to vasodilation and/or a drop in SVR. This is frequently associated with septic shock. Diastolic pressure is typically one-third the value of systolic pressure. Coronary arteries are perfused during diastole.

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