Download Innocent Heart Murmurs - Metropolitan Community College

Heart Tones and
Assessment
By: Diana Blum MSN
Metropolitan Community College
OBJECTIVE 1
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EVENTS THAT CREATE NORMAL SOUND
Cardiac Cycle

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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)
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)
Autonomic Nervous System
Built in control center of the body
 Regulates functions not under conscious control
 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
– Cholinergics are the nerve endings and acetylcholine
is the neurotransmitter
 Decreases HR and BP

Parasympathetic and sympathetic innervates heart
4
Video
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http://www.blinkx.com/video/heartsystem/ALAjmSD19aWwdVJNyeOLjA
OBJECTIVE 2

ABNORMAL HEART TONES
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
Innocent Heart Murmurs
 Normal heart murmurs
 Benign heart murmurs
 Functional heart murmurs
 Physiologic heart murmurs
 Still’s murmurs
 Flow murmurs

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Pathologic heart murmurs
– Related to valve problems and produce
symptoms
Evaluation of murmurs

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.
OBJECTIVE 3

SYSTOLIC VS DIASTOLIC MURMURS
systolic murmur

is heard when the heart is squeezing and
pumping blood out of the heart.
diastolic murmur
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.

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.
Inspection and palpation
http://www.youtube.com/watch?v=WbBIHR
Plyj8&feature=related
USE MY NURSING LAB also
OBJECTIVE 4
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DEMONSTRATION