Lecture-Heart Lung Sounds 2015.PDF (Dr Simon Ong)

7/23/2019 Lecture-Heart Lung Sounds 2015.PDF (Dr Simon Ong)

http://slidepdf.com/reader/full/lecture-heart-lung-sounds-2015pdf-dr-simon-ong 1/48

SDPCN COURSE

PATIENT ASSESSMENT:

Modified Heart & Lung Sounds

26-8-15

2 – 5 pm (3 h)Simon Ong



Overview

• Lecture (1h)

– Heart Sounds & murmurs

– Breath Sounds & adventitious sounds

• Simulator (2h)

– Heart Sounds & murmurs

– Breath Sounds & adventitious sounds



Auscultatory Areas



S1S2



Carotid Pulse



S1 S1 S1 S1 S1S2 S2 S2 S2 S2

S1(Carotid Pulse)S2



S1 S1 S1 S1 S1S2 S2 S2 S2 S2

S1S2



S1

MitralValve

Closure

S2

AorticValve

Closure

Heart Sounds Due to Valve Slamming Shut



S1

MitralValve

Closure

“lub”

S2

AorticValve

Closure

“dub”



S1

“lub”

S2

“dub”

SYSTOLE

(ventricular

contraction)



S1

“lub”

S2

“dub”

SYSTOLE

(ventricular

contraction)

DIASTOLE

(ventricular

relaxation)

DIASTOLE

(ventricular

relaxation)



S1

“lub”

Split S2

“d-dub”

SYSTOLE

(ventricular

contraction)

DIASTOLE

(ventricular

relaxation)

DIASTOLE

(ventricular

relaxation)

A2 P2



S1

“lub”

Split S2

“d-dub”

SYSTOLE

(ventricular

contraction)

DIASTOLE

(ventricular

relaxation)

DIASTOLE

(ventricular

relaxation)

A2 P2

S3

“ta”

S3 = dilated left ventricle, e.g. heart failure



S1

“lub”

Split S2

“d-dub”

SYSTOLE

(ventricular

contraction)

DIASTOLE

(ventricular

relaxation)

DIASTOLE

(ventricular

relaxation)

A2 P2

S3

“ta”

S4

“ta”

S4 = non-compliant left ventricle, e.g. LVH or MI



Heart Sounds & Added Heart Sounds

• “lub, dub” (S1S2)

• “lub, d-dub” (S1, split S2)

•

“lub dub-ta” (S1S2 & S3) • “ta-lub dub” (S1S2 & S4)



Left Ventricle

LEFT

VENTRICLE

MITRAL

VALVE

AORTIC

VALVE



Normal Systole

LEFT

VENTRICLE

MITRAL

VALVE

AORTIC

VALVE



Normal Diastole

LEFT

VENTRICLE

MITRAL

VALVE

AORTIC

VALVE



Normal Diastole

LEFT

VENTRICLE

AORTIC

VALVE

MITRAL

VALVE



What Can Go Wrong During Systole?

LEFT

VENTRICLE

MITRAL

VALVE

AORTIC

VALVE



Systolic Murmurs

LEFT

VENTRICLE

MITRAL

REGURGITATION

AORTIC

STENOSIS

CANNOT

OPEN FULLY

CANNOT

CLOSE FULLY



What Can Go Wrong During Diastole?

LEFT

VENTRICLE

AORTIC

VALVE

MITRAL

VALVE



Diastolic Murmurs

LEFT

VENTRICLE

MITRAL

STENOSIS

AORTIC

REGURGITATION

CANNOT

CLOSE FULLY

CANNOT

OPEN FULLY



Classification of Murmurs

• Systolic murmurs

– Aortic Stenosis

– Mitral regurgitation

• Diastolic murmurs

– Aortic regurgitation

– Mitral stenosis



S1

“lub”

S2

“dub”

SYSTOLE

(ventricular

contraction)

DIASTOLE

(ventricular

relaxation)

DIASTOLE

(ventricular

relaxation)

SYSTOLIC

MURMURS



S1

“lub”

S2

“dub” SYSTOLE

(ventricular

contraction)

DIASTOLE

(ventricular

relaxation)

DIASTOLE

(ventricular

relaxation)

EJECTION

SYSTOLICMURMURS

Aortic Stenosis



S1

“lub”

S2

“dub” SYSTOLE

(ventricularcontraction)

DIASTOLE

(ventricularrelaxation)

DIASTOLE


PAN

SYSTOLICMURMURS

Mitral Regurgitation



S1

“lub”

S2

“dub” SYSTOLE


DIASTOLE


DIASTOLE


DIASTOLIC

MURMURS

DIASTOLIC

MURMURS



S1

“lub”

S2

“dub” SYSTOLE


DIASTOLE


DIASTOLE


DIASTOLIC

MURMURS

EARLY

DIASTOLICMURMURS

Aortic Regurgitation



S1

“lub”

S2

“dub” SYSTOLE


DIASTOLE


DIASTOLE


DIASTOLIC

MURMURS

MID

DIASTOLICRUMBLE

Mitral Stenosis



Classification of Murmurs


– Aortic Stenosis (ESM)

– Mitral regurgitation (PSM)


– Aortic regurgitation (EDM)

– Mitral stenosis (MDM)



ESM

• Aortic stenosis (AS)

• Crescendo-decrescendo

murmur midway between

S1 and S2

• Best heard at aortic area

• Radiates up the carotids



PSM

• Mitral regurgitation (MR) or

ventricular septal defect

(VSD)

• Uniform blowing sound

heard throughout S1 to S2

• MR best heard at mitral

• VSD best hear at LSE



EDM

• Aortic regurgitation (AR)

• High-pitched sighing sound

immediately past S2

• Best heard at left sternal

edge, sitting up and in full

expiration



MDM

• Mitral stenosis (MS)

• Low pitched rumbling

sound

• Best heard at mitral using

bell

• Occurs shortly after S2



Summary


– ESM @ aortic area,

radiation up carotids

(AS)

– PSM @ mitral area (MR)

– PSM @ LSE (VSD)


– MDM @ mitral area

(MS)

–

EDM @ LSE, sitting up, infull expiration (AR)



Breath Sounds



Classification of Breath Sounds

• Normal breath sounds

– Vesicular

– Bronchial

– Abnormal

• Vocal resonance (this is a transmitted soundrather than a breath sound)

•

Adventitious breath sounds – Continuous (rhonchi)

– Discontinuous (crackles)



Normal Breath Sounds

• Vesicular – Soft, blowing and low-

pitched sounds

– No pause

– Fade away about one third

of the way throughexpiration

• Bronchial – Loud, hollow and high-

pitched sounds

– A short pause – Expiratory sounds last

longer than inspiratorysounds



Normal Breath Sounds

• Vesicular

– Heard over normal lung

field

•

Bronchial – Heard over normal large

airway



Abnormal Breath Sounds

• Decreased breath

sounds

– Caused by decreased air

flow (e.g. pulmonary

collapse, airway

obstruction)

– Caused by masking (e.g.

pleural effusion,

pneumothorax)



Abnormal Breath Sounds

• Bronchial breath sounds

– Breath sounds become

better conducted when

air is replaced by “solid”

– Can be heard in

pneumonia due to

consolidation



Vocal Resonance

• Increased when there is

consolidation because

“solid” transmits sound

(patient’s voice) well • Decreased when there

is an insulation (pleural

effusion,

pneumothorax) to thetransmission of sound

(patient’s voice)



Continuous Adventitious Sounds

• Inspiratory rhonchi(stridor)

– Caused by narrowing oflarge airways

–Upper airway obstruction

• Expiratory rhonchi

– Caused by narrowing ofsmall airways

– Asthma, COPD, heartfailure, bronchiectasis,carcinomatosislymphangitis



Discontinuous Adventitious Sounds

• Fine crackles

– Caused by small airways

opening against a

resistance, hence

inspiratory

– Heart failure, COPD,

pulmonary fibrosis

• Coarse crackles

– Caused by secretions

– Bronchiectasis



Thank You

Lecture-Heart Lung Sounds 2015.PDF (Dr Simon Ong)

Documents

Transcript of Lecture-Heart Lung Sounds 2015.PDF (Dr Simon Ong)