14. Cardiac Cycle and Heart Sounds

Question 1

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Stands for what and what intercostal spaces ?

Answer 1

Aortic : Right 2nd ICS along sternum
Pulmonic: Left 2nd ICS along sternum
Erbs Point: (S1S2) Left 3rd ICS
Tricuspid: Lower left sternal border/4th ICS
Mitral: Left 5th ICS, medial to mid clavicular line

Question 2

Atrial systole occurs during?

Answer 2

P wave

Question 3

Atrial diastole occurs during?

Answer 3

PR interval

Question 4

Ventricular Systole occurs during?

Answer 4

QRS complex

Question 5

Late ventricular systole occurs during?

Answer 5

ST segment

Question 6

Ventricular diastole occurs during?

Answer 6

T wave

Question 7

The lub sound or S1 comes from?

Answer 7

AV valves closing

Question 8

The dub sound or S2 comes from?

Answer 8

Semilunar valves closing

Question 9

S3 sounds, which can sounds like Ken-tuckee occurs from?

Answer 9

blood filling the relaxed and empty ventricle

Question 10

S4 sounds, which present as Tenness-ee occur from?

Answer 10

atrial filling from high pressure in SVC ( before S1)

Question 11

How are heart murmurs graded?

Answer 11

On a scale of 1-6
1 being soft murmur in quiet room
2. soft murmur in loud room
3. prominent heard murmur
4 being loud murmur with a thrill
5. loud heard with edge of steth tilted against chest
6 being loud murmur heard from far away

Question 12

What is considered a pathologic murmur?

Answer 12

Any murmur that is great or equal to 3/6

Question 13

What does RINspiration and LEXpiration mean?

Answer 13

RIN: inspiration makes RIGHT murmurs in tricuspid and pulmonic valves louder
LEX: expiration makes LEFT murmurs in mitral and aortic valves louder

Question 14

Preload is the volume of blood sent to the heart. What happens to the murmur when preload is increased or decreased?

Answer 14

Increased = louder
Decreased = softer

Question 15

Why is HOCM (hypertrophic obstructive cardiomyopathy) one of the two exceptions for the rules of preload?

Answer 15

An increase in preload imporves aortic murmur by pushing the septum away from aortic outflow
A decrease worsens aortic murmur because the aortic outflow is more blocked

Question 16

Why is MVP (mitral valve prolapse) the second exception for the rules of preload?

Answer 16

IN MVP: leaflets of mitral valve prolapse into left atria under normal pressure and blood flow. Increase in preload improves murmur by allowing the prolapsed leaflets to return to their normal orientation

Question 17

Afterload is the pressure the ventricles have to generate to move blood forward into the arterial system (PVR). What happens to the murmur when afterload is increased or decreased?

Answer 17

Increased afterload= louder
Decreased afterload=softer

Opposite for HOCM and MVP

Question 18

Aortic stenosis has a crescendo-decrescendo (increasing then decreasing) murmur between S1 and S2. What are the 3 common presentations associated?

Answer 18

1. Old- SAD: Syncopy, Angina, Dyspnea
2. Calcified aortic valve
3. Radiates UP to carotids

Question 19

Mitral regurgitation (Rheu-mitral) is a constant/steady murmur between S1 and S2. Where is it best heard and where does it radiate?

Answer 19

Radiates to axillla best heard at apex of heart

Question 20

Tricuspid regurgitation is usually due to IV drug abuse (dirty needles used = bacteria to heart= first valve takes hit = tricuspid). Where can this be heard?

Answer 20

Constant murmur between s1/s2

Question 21

Aortic regurgitation presents with CT disorder, marfans syndrome, head bobbing, water hammer pulse and femoral bruits. What is a mneumonic to remember the sound of the murmur and where does it occur?

Answer 21

AR, thar she BLOWS

early blowing diastolic murmur between S2 and S1

Question 22

Mitral stenosis (Rheu mitral) history of rheumatic fever. Mnemonic and where is it heard?

Answer 22

before S1
The OS is the MS
os = opening snap = mitral stenosis

Question 23

HOCM is associated with sudden cardiac death at a young age. What is different during preload and after load as discussed earlier?

Answer 23

Decreased pre/afterload= louder murmur

Increased pre/afterload = softer murmur

Question 24

Mitral valve prolapse is characterized by a midsystolic click and is usually seen with?

Answer 24

Myxomatous valvular disease or young woman with psychiatric history