14. Cardiac Cycle and Heart Sounds Flashcards
All People Enjoy Time Magazine Stands for what and what intercostal spaces ?
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
Atrial systole occurs during?
P wave
Atrial diastole occurs during?
PR interval
Ventricular Systole occurs during?
QRS complex
Late ventricular systole occurs during?
ST segment
Ventricular diastole occurs during?
T wave
The lub sound or S1 comes from?
AV valves closing
The dub sound or S2 comes from?
Semilunar valves closing
S3 sounds, which can sounds like Ken-tuckee occurs from?
blood filling the relaxed and empty ventricle
S4 sounds, which present as Tenness-ee occur from?
atrial filling from high pressure in SVC ( before S1)
How are heart murmurs graded?
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
What is considered a pathologic murmur?
Any murmur that is great or equal to 3/6
What does RINspiration and LEXpiration mean?
RIN: inspiration makes RIGHT murmurs in tricuspid and pulmonic valves louder
LEX: expiration makes LEFT murmurs in mitral and aortic valves louder
Preload is the volume of blood sent to the heart. What happens to the murmur when preload is increased or decreased?
Increased = louder Decreased = softer
Why is HOCM (hypertrophic obstructive cardiomyopathy) one of the two exceptions for the rules of preload?
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
Why is MVP (mitral valve prolapse) the second exception for the rules of preload?
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
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?
Increased afterload= louder
Decreased afterload=softer
Opposite for HOCM and MVP
Aortic stenosis has a crescendo-decrescendo (increasing then decreasing) murmur between S1 and S2. What are the 3 common presentations associated?
- Old- SAD: Syncopy, Angina, Dyspnea
- Calcified aortic valve
- Radiates UP to carotids
Mitral regurgitation (Rheu-mitral) is a constant/steady murmur between S1 and S2. Where is it best heard and where does it radiate?
Radiates to axillla best heard at apex of heart
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?
Constant murmur between s1/s2
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?
AR, thar she BLOWS
early blowing diastolic murmur between S2 and S1
Mitral stenosis (Rheu mitral) history of rheumatic fever. Mnemonic and where is it heard?
before S1
The OS is the MS
os = opening snap = mitral stenosis
HOCM is associated with sudden cardiac death at a young age. What is different during preload and after load as discussed earlier?
Decreased pre/afterload= louder murmur
Increased pre/afterload = softer murmur
Mitral valve prolapse is characterized by a midsystolic click and is usually seen with?
Myxomatous valvular disease or young woman with psychiatric history
