1. Heart Tones and Assessment By: Diana Blum MSN Metropolitan Community College

2. OBJECTIVE 1 EVENTS THAT CREATE NORMAL SOUND EVENTS THAT CREATE NORMAL SOUND

3. Cardiac Cycle Contraction and relaxation of the heart: lub dub or 1 heart beat Contraction and relaxation of the heart: lub dub or 1 heart beat Diastole: ventricles at rest and filling up with blood coming from the atria (Dub) Diastole: ventricles at rest and filling up with blood coming from the atria (Dub) Systole: Once the Ventricle is filled with blood and the electrical impulse has reached the terminal fibers of the conduction system, the Ventricle contract and eject blood into the pulmonary artery from the RV and into the aorta from the LV (Lub) Systole: Once the Ventricle is filled with blood and the electrical impulse has reached the terminal fibers of the conduction system, the Ventricle contract and eject blood into the pulmonary artery from the RV and into the aorta from the LV (Lub)

4. Autonomic Nervous System Built in control center of the body Built in control center of the body Regulates functions not under conscious control Regulates functions not under conscious control Blood vessels innervated by sympathetic system Blood vessels innervated by sympathetic system –Fight or flight  Nerve endings are adrenergic and nuerotransmitter is norepinephrine –Increases HR and BP Parasympathetic is responsible for rest and digest Parasympathetic is responsible for rest and digest –Cholinergics are the nerve endings and acetylcholine is the neurotransmitter  Decreases HR and BP Parasympathetic and sympathetic innervates heart Parasympathetic and sympathetic innervates heart 4

5. Video http://www.blinkx.com/video/heart- system/ALAjmSD19aWwdVJNyeOLjA http://www.blinkx.com/video/heart- system/ALAjmSD19aWwdVJNyeOLjA http://www.blinkx.com/video/heart- system/ALAjmSD19aWwdVJNyeOLjA http://www.blinkx.com/video/heart- system/ALAjmSD19aWwdVJNyeOLjA

6. OBJECTIVE 2 ABNORMAL HEART TONES ABNORMAL HEART TONES

7. Heart Tones –Murmur: Produced by turbulent sounds across valves –Gallop: extra heart beat –Click: sounds like a clicking sound from a valve that is metal –Rub: inflamed pericardium-best heart along left sternal border –S3 murmur: sounds like “Kentucky” –S4 murmur: sounds like “Mississippi ” http://www.blaufuss.org/ http://www.med.ucla.edu/wilkes/Rubintro.htm

8. Innocent Heart Murmurs Innocent Heart Murmurs Normal heart murmurs Normal heart murmurs Benign heart murmurs Benign heart murmurs Functional heart murmurs Functional heart murmurs Physiologic heart murmurs Physiologic heart murmurs Still’s murmurs Still’s murmurs Flow murmurs Flow murmurs

9. Pathologic heart murmurs Pathologic heart murmurs –Related to valve problems and produce symptoms

11. Evaluation of murmurs When evaluating a heart murmur, your doctor pays attention to many things, such as: When evaluating a heart murmur, your doctor pays attention to many things, such as: –How faint or loud the sound is. Your doctor will grade the murmur on a scale of 1 to 6 (1 is very faint and 6 is very loud). –When the sound occurs in the cycle of the heartbeat. –Exactly where the sound is heard in the chest and whether it also can be heard in the neck or back. –Whether the sound has a high, medium, or low pitch. –How long the sound lasts. –How breathing, physical activity, or change of body position affects the sound.

12. OBJECTIVE 3 SYSTOLIC VS DIASTOLIC MURMURS SYSTOLIC VS DIASTOLIC MURMURS

13. systolic murmur is heard when the heart is squeezing and pumping blood out of the heart. is heard when the heart is squeezing and pumping blood out of the heart.

14. diastolic murmur is heard when the heart is relaxing and filling with blood. is heard when the heart is relaxing and filling with blood. often are a sign of a heart defect or heart disease, and further checking is likely needed. often are a sign of a heart defect or heart disease, and further checking is likely needed.

15. Continous Murmur is heard during the entire heartbeat. These murmurs often are a sign of a heart defect or heart disease, and further checking is likely needed. is heard during the entire heartbeat. These murmurs often are a sign of a heart defect or heart disease, and further checking is likely needed.

16. Inspection and palpation http://www.youtube.com/watch?v=WbBIHR Plyj8&feature=related http://www.youtube.com/watch?v=WbBIHR Plyj8&feature=related USE MY NURSING LAB also

17. OBJECTIVE 4 DEMONSTRATION DEMONSTRATION