During change-of-shift report, the off-going nurse tells
you that she heard abnormal sounds while obtaining apical
pulses on an elderly female patient, who has had a long history
of coronary artery disease and heart failure. She is recovering
from a recent myocardial infarction and is being
treated now for new-onset atrial fibrillation. Name five types
of abnormal heart sounds and explain the pathophysiology
of each sound. Describe the quality of these sounds and their
timing in relation to the cardiac cycle. If you suspect a murmur,
what six characteristics do you identify to determine
the underlying cause? Given this patient’s medical history,
what do you think caused those abnormal heart sounds?