Where is S1 the loudest? - ANSWERApex
(Closer to mitral valve)
Where is S2 loudest? - ANSWERBase
(Closer to the aortic/pulmonic valves)
What are some reasons for an accentuated S1? - ANSWERTachycardia
High Cardiac Output states (exercise, anemia, hyperthyroidism)
Mitral Stenosis
Mitra...
What are some reasons for an accentuated S1? - ANSWERTachycardia
High Cardiac Output states (exercise, anemia, hyperthyroidism)
Mitral Stenosis
Mitral valve is still open wide at the onset of ventricular systole and closes quickly--> you hear a
QUICK SNAP OF THE MITRAL VALVE CLOSING / "CATCHING UP"
What are some reasons for a diminished S1? - ANSWER1st Degree Heart Block
LBBB
MI d/t weak ventricular contraction
Aortic Regurgitation
Early mitral valve closure occuring before ventricular contration, ventricle is weak and it's taking
longer to contract, mitral valve doesn't snap shut as forcefully
What are some reasons for a varying intensity of S1? - ANSWERComplete Heart Block (dissociated
beating of atria and ventricles)
Atrial Fibrillation
,Different Mitral Valve Closing times
Delayed closure of the tricuspid valve can lead to what abnormal sound? - ANSWERSplit S1
Best heard at LLSB
Occurs when RV contraction is delayed d/t RBBB, Left premature contractions
May be heard at apex, need to distinguish from S4, aortic ejection sounds, or early systolic clicks
DELAYED CLOSURE OF TRICUSPID AT BEGINNING OF SYSTOLE d/t DELAYED RV CONTRACTION
A physiologic split of S2 is heard best in which interspace? What accentuates the splitting? -
ANSWERHeard best at the 2nd or 3rd Left interspace in the pulmonic area
S2 is usually from the sound of the aortic valve closing because the closure of the pulmonic valve is
too faint
A split S2 is accentuated by inspiration, which increass the space between A2 and P2 so individual
sounds are now more audible
Deep breath decreases the pressure in the chest and causes an increase in venous return, causes RA
and ventricle to fill more so it takes the RV slightly longer to eject blood than the LV through the
aortic valve so the pulmonic valve stays open a little longer
A splitting of S2 is pathologic when: ------. - ANSWERsplitting is heard during expiration rather than
inspiration (physiologic)
There are 3 types of pathologic S2 splitting: what are they? - ANSWERWide splitting of S2
Fixed splitting of S2
Paradoxical/Reversed Splitting of S2
What causes wide splitting of S2 (pathologic)? - ANSWERDelayed closure of the pulmonic valve
Pulmonic Stenosis
, RBBB
Early closure of the aortic valve
Mitral Regurgitation
Wide splitting with inspiration, may have accentuated P2 (louder)
Wide splitting that does not vary with respiration. What kind of pathologic S2? - ANSWERFixed
Splitting of S2
Prolonged ventricular systole
Atrial septal defect
RVHF
Splitting appears during expiration and splitting disappears during inspiration is what kind of
pathologic S2? - ANSWERParadoxical or Reversed S2
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