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Questions and Answers
What is the typical age range for the onset of senile aortic stenosis?
What is the typical age range for the onset of senile aortic stenosis?
What is the usual cause of accentuated P2?
What is the usual cause of accentuated P2?
What is the common cause of diminished P2?
What is the common cause of diminished P2?
What is the typical location for best hearing S3?
What is the typical location for best hearing S3?
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What is the significance of S3 in adults?
What is the significance of S3 in adults?
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What is the usual cause of widened inspiratory splitting of S2?
What is the usual cause of widened inspiratory splitting of S2?
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What is the common cause of reverse or paradoxical splitting of S2?
What is the common cause of reverse or paradoxical splitting of S2?
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What is the usual cause of atherosclerotic aorta?
What is the usual cause of atherosclerotic aorta?
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What is the common cause of P2 delay?
What is the common cause of P2 delay?
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What is the usual cause of early A2 closure?
What is the usual cause of early A2 closure?
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Study Notes
Senile Aortic Stenosis (AS)
- Begins at 70 years old, more prominent at 80 years old and above
- Causes calcification of the aortic valve, leading to stenosis
- Atherosclerotic aorta
Accentuated P2
- Caused by increased pressure against the closed pulmonic valve
- Seen in pulmonary hypertension, ASD, and truncus arteriosus
Diminished P2
- Caused by diminished pulmonary artery pressure, resulting in reduced tension on the pulmonary valve
- Seen in pulmonic stenosis (PS)
Widened Inspiratory Splitting of S2
- Caused by delayed tensing of the pulmonic valve or early tensing of the aortic valve
- Seen in Right Bundle Branch Block, Atrial Septal Defect, and Pulmonary Stenosis
Reverse or Paradoxical Splitting of S2
- Caused by delay of LV ejection, causing A2 to coincide with or occur after P2
- Seen in hypertrophic cardiomyopathy, aortic stenosis, and left bundle branch block
S3 (Ventricular or Protodiastolic Gallop)
- Occurs during the transition from rapid filling to slow filling phase
- Best heard at the apex when the patient is lying on their left side and in expiration
- Accentuated by exercise, abdominal pressure, and flexing the knees on the abdomen
- Normal in children and young adults, abnormally seen in systolic dysfunction, fever, anemia, and hyperthyroidism
Location of Heart Murmurs
- Aortic valve: auscultated at the right 2nd ICS, radiates to the neck
- Pulmonic valve: auscultated at the left 2nd ICS
- Tricuspid valve: auscultated at the parasternal border
- Mitral valve: auscultated further away (apex), radiates to the anterior axillary or at the back
- Systolic: TR and MR vs Diastolic: AR and PR
Aortic Stenosis
- Diminished S1: when AV valves are closely approximated at the onset of systole
- Varied Intensity of S1: due to asynchronous AV contraction and variable diastolic filling
- Wide Splitting of S1: seen in RBBB due to delay in ventricular contraction
S2
- Accentuated Aortic compartment of S2: caused by increased pressure against the closed AV valve
- Diminished A2: seen when the valve is rigid and immobile
Intensity of Murmurs
- Grade 1: very soft, heard only with great effort
- Grade 2: easily heard, but not particularly loud
- Grade 3: loud, but not accompanied by a palpable thrill
- Grade 4: very loud, accompanied by a thrill
- Grade 5: loud enough to be heard only with the edge of the stethoscope touching the chest
- Grade 6: loud enough to be heard with the stethoscope slightly off the chest
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Description
Learn about the locations of heart murmurs and their associations with different valves, such as the aortic valve, pulmonic valve, tricuspid valve, and mitral valve.
