Heart Sounds Tutorial

Anatomy

Regarding the following statements mark whichever you think are true...

	a)	The mitral valve is between the right atrium and ventricle
	b)	The tricuspid valve is between the right atrium and ventricle
	c)	The left-heart pumps to the systemic circulation and is at higher pressure than the right side
	d)	All veins leading to the heart carry de-oxygenated blood
a) Correct the Mitral valve is on the Left side of the hearta) No, the mitral valve is on the Left side of the heartb) Correctb) No, the tricuspid valve is on the right side of the heartc) Correctc) No, the Left does pump to the systemic (body) circulation and the right to the pulmonary (lungs)d) Correct, the pulmonary veins carry oxygenated blood from the lungsd) No, the pulmonary veins carry oxygenated blood from the lungs

Looking at the diagram above, what condition(s) could it represent?

	a)	Aortic Stenosis
	b)	Aortic Regurgitation
	c)	Pulmonic Regurgitation
	d)	Co-arctation of the Aorta
a) Correcta) NO this is Systolicb) Correctb) No it could be ARc) Correctc) No, there is a chance this could be PRd) Correctd) No this would be systolic

Where to listen

Regarding the picture above mark whichever you think are true...

	a)	I'd listen for the pulmonary valve at 1
	b)	The valve I'd hear best at 1 radiates to the axilla
	c)	The apex beat is usually at 4
	d)	The valve I'd hear at 1 radiates to the carotids
	e)	"Practically All Medicines Taste" is a way of remembering the sequence of the valves
	f)	If I hear a murmur at position 3 it must be the Tricuspid Valve
a) Correct you'd listen to the Aortic Valve at 1a) No, remember APTM, it'd be the Aortic Valve at position 1b) Correct, it radiates to the carotids (if a loud enough murmur) b) No, Mitral radiates classically to the axilla the aortic valve to the carotids c) Correctc) No, this was true!d) Correct if the murmur is loud enoughd) No, this was true!e) Angry People Take Medicinese) No no no no no ... Angry People Take Medicinesf) YES, it does not HAVE to be the tricuspid valve, you might be hearing a loud murmur from somewhere else, only by looking at the whole clinical picture including a relevant history can you emphatically say which valve is the problemf) No, it does not HAVE to be the tricuspid valve, you might be hearing a loud murmur from somewhere else, only by looking at the whole clinical picture including a relevant history can you emphatically say which valve is the problem

Regarding the sound above

The sound above was heard on a patient, and was heard easiest when the patient sat up and exhaled, their was also radiation to the carotids. Which of the following is the most likely diagnosis? (this should be possible even without the sound-clip)

	a)	Mitral Stenosis
	b)	Mitral Regurgitation
	c)	Aortic Stenosis
	d)	Aortic Regurgitation
Well done, radiation to the carotids is important to rememberNo, have a think over what would radiate to the carotidsYour answer has been saved.

Hamman's Sign

Hamman's Sign is associated with...

	a)	A stenoitc valve
	b)	A musical quality to the sound of mitral regurgitation
	c)	Air in the mediastinum
	d)	Pulmonic Regurgitation
Well done, air from a spontaneous pneumothoraxNo, it's associated with air in the mediastinum usually from a spontaneous pneumothoraxYour answer has been saved.

Regarding the sound above

You hear this sound in a patient and also note that they have cyanosis in their lower limbs and clubbing in their toes but oddly enough there is no evidence of clubbing or cyanosis in their hands.

What do you think the problem is?

	a)	Hypoventilation
	b)	Aortic Stenosis
	c)	Eisenmenger's syndrome from a PDA
	d)	Eisenmenger's syndrome from a VSD
	e)	Co-arctation of the Aorta
	f)	Aortic Regurgitation
Yes, the question describes Eisenmenger's syndrome and the sound is of a PDANo, the question describes Eisenmenger's syndrome and the sound is of a PDAYour answer has been saved.