Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Cardiology Exam 4 > Cardiac Auscultation > Flashcards

Cardiac Auscultation Flashcards

1
Q

a wave

A
  • in late diastole, atrial contraction propels a final bolus of blood into each ventricle
  • produces a brief further rise in atrial and ventricular pressures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

c wave

A
  • small rise in atrial pressure as tricuspid and mitral valves close and bulge into respective atria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

v wave

A
  • result of passive filling of the atria from the pulmonary and systemic veins during systole during which blood accumulates because the tricuspid and mitral valves are closed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

causes of prominent a wave

A
  • RVH or tricuspid stenosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

cause of prominent v wave

A
  • tricuspid regurgitation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

cause of prominent y wave

A
  • constrictive pericarditis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

S1

A
  • produced by the closure of the mitral and tricuspid valves in early systole
  • loudest near the apex
  • high frequency sound - listen with diaphragm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

S2

A
  • results from closure of the aortic and pulmonic valves

- high frequency - listen with diaphragm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

physiologic splitting of S2

A
  • normally A2 and P2 are fused as one sound during expiration
  • A2 and P2 are audibly separated during inspiration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

physiologic mechanism behind physiologic splitting of S2

A
  • inspiration causes an intrathoracic pressure to become more negative
  • transient increase in capacitance and reduced resistance resulting in a temporary delay in the diastolic back pressure of the pulmonary artery responsible for pulmonic valve closure
  • P2 is delay
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

description and common causes of paradoxical splitting of S2

A
  • audible separation of A2 and P2 during expiration and fusion upon inspiration
  • most common cause is LBBB, aortic stenosis, HCM, right ventricular pacemaker, right ventricular ectopic beat
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

description and common causes of fixed splitting of S2

A
  • widened interval between A2 and P2 that persists unchanged through the respiratory cycle
  • most common cause is atrial septal defect
  • mid systolic murmur almost clinches the diagnosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

S3

A
  • occurs in early diastole following opening of the AV valves
  • dull, low pitched sound best heard with the bell
  • left sided S3 heard at the apex, right sided at LLSB
  • results from tensing of the chordae tendinae during rapid filling and expansion of the ventricle
  • “Kentucky”
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

S4

A
  • occurs in late diastole and coincides with the contraction of the atria
  • sound generated by atria vigorously contracting against a stiffened ventricle
  • dull, low pitched sound best heard with bell
  • left sided S4 best heard at the apex, right sided S4 best heard at the LLSB
  • “Tennessee”
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

pathology associated with an S4 sound

A
  • decreased ventricular compliance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

quadruple rhythm

A
  • presence of all 4 heart sounds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

summation gallop

A
  • quadruple rhythm with tachycardia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

dynamic ausculatory changes that occur with inspiration

A
  • increase in venous return and flow to the right side of the heart
  • all right sided pathological findings will increase in intensity during inspiration except the pulmonic ejection click
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

actions that decrease venous return

A
  • squatting to standing

- valsalva

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

systolic murmur grading system

A
  • 1: very faint, usually not heard at first
  • 2: faint, but heard immediately
  • 3: easily heard
  • 4: easily heard with palpable thrill
  • 5: very loud, stethoscope slightly off chest
  • 6: very loud, stethoscope completely off chest
21
Q

diastolic murmur grading system

A
  • 1: very faint, usually not heard at first
  • 2: faint, but heard immediately
  • 3: easily heard
  • 4: very loud
  • no palpable thrills associated with diastolic murmurs
22
Q

timing of a systolic murmur

A
  • begins with or after S1 and ends at or before S2
23
Q

timing a diastolic murmur

A
  • begins with or after S2 and ends before the next S1
24
Q

4 types of systolic murmurs

A
  • aortic and pulmonic stenosis

- mitral and tricuspid regurg

25
Q

4 types of diastolic murmurs

A
  • aortic and pulmonic regurn

- mitral and tricuspid stenosis

26
Q

2 major categories of systolic murmurs

A
  • systolic ejection murmurs: AS, PS, HCM, most “innocent murmurs”
  • holosystolic murmurs: TR, MR (except acute MR and MVP), VSD
27
Q

characteristics of chronic MR

A
  • holosystolic murmur
  • does not get louder with inspiration
  • best heard at apex, radiating to axilla
  • gets louder with isometric grip and squatting or vasopressor agents (decreased venous return)
28
Q

characteristics of acute MR

A
  • early systolic decrescendo murmur
29
Q

characteristics of MVP

A
  • midsystolic click, late systolic murmur
  • maneuvers that increase the volume of the LV (sudden squatting) delay the occurrence of prolapse in systole and cause the click and murmur to occur later and shorter
  • if volume of blood in the LV is decreased (sudden standing), prolapse occurs more readily and the click and murmur occur earlier in systole
30
Q

characteristics of TR

A
  • holosytolic murmur

- gets louder during inspiration (Carvallo’s sign)

31
Q

classic triad of severe TR

A
  • Carvallo’s sign - louder during inspiration
  • pulsatile JVD - prominent v waves
  • pulsatile liver - regurgitant blood gets backed up into systemic veins
32
Q

characteristics of VSD

A
  • holosytolic murmur
  • does not get louder with inspiration
  • best heard at LLSB
  • often harsh in quality
33
Q

characteristics of AS

A
  • aortic ejection click is hallmark for bicuspid aortic valve
  • crescendo-decrescendo murmur
  • radiates to the carotids
  • pulsus parvus et tardus: delayed carotid upstroke
  • gets louder with increased preload (squatting, amyl nitrate)
  • gets softer with decreased preload (standing, Valsalva, isometric grip)
34
Q

differentiating AS from MR

A
  • AS gets louder after a PVC

- MR does not change intensity after PVCs

35
Q

characteristics of HCM murmur

A
  • crescendo-decrescendo
  • louder with reduced preload (Valsalva, standing, amyl nitrate)
  • softer with increased preload (isometric grip, squatting)
36
Q

characteristics of pulmonic stenosis

A
  • crescendo-decrescendo
  • increases during inspiration
  • does not radiate to carotids
37
Q

4 causes of diastolic murmurs

A
  • AR, PR

- MS, TS

38
Q

characteristics of AR

A
  • early diastolic murmur
  • decrescendo
  • high pitched
  • “blowing”
  • best heard with patient leaning forward
39
Q

associated murmurs with AR

A
  • systolic ejection murmur: high flow across valve

- Austin Flint murmur: diastolic rumble

40
Q

Duroziez sign of AR

A
  • systolic murmur heard over femoral artery when stethoscope is compressed proximally and a diastolic murmur over femoral artery when stethoscope is compressed distally
  • most specific sign of severe AR
41
Q

other signs of AR that are associated with high stroke volume

A
  • wide pulse pressure
  • Quincke’s pulse - phasic blanching of the nails
  • Hill sign - popliteal SBP exceeds brachial SBP by > 60 mmHg
  • Corrigan (water hammer) pulse - palpable abrupt upstroke and rapid fall of arterial pulsation
  • Traube sign - pistol shot sound over femoral artery
  • Mueller sign - pulsating uvula
42
Q

characteristics of PR

A
  • Graham Steel murmur
  • early diastolic
  • decrescendo
  • high pitched, blowing
  • louder with inspiration
  • murmur due to deformity
  • mid diastolic
  • crescendo-decrescendo
  • low pitched
43
Q

characteristics of MS

A
  • mid diastolic
  • low pitched rumble
  • best heard in left lateral decubitus position
  • may have opening snap or accentuated S1
44
Q

characteristics of TS

A
  • sounds like MS except: gets louder during inspiration, best heard at LLSB
45
Q

common cause of continuous murmurs

A
  • PDA
46
Q
  • Beck’s triad
A
  • hypotension
  • JVD
  • muffled or distant heart sounds
47
Q

Virchow’s triad

A
  • vascular injury
  • hypercoagulability
  • venous stasis
  • high risk for DVTs
48
Q

Kussmaul sign

A
  • increase in JVD during inspiration

- often seen in restrictive pericarditis

Cardiology Exam 4 (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions