Cardiac Concepts Part 1

Question 1

S1

Answer 1

“lub”, the first heart sound,

heard when the atrioventricular (mitral and tricuspid) valves close

Question 2

S1 marks the end of ____________ and the beginning of _____________, and is loudest at the ________.

Answer 2

diastole,

systole,

apex of the heart

Question 3

S2

Answer 3

dub,

closure of aortic and pulmonary (semilunar) valves

Question 4

S2 marks the end of ________ and the beginning of _______, and is loudest at the ______.

Answer 4

systole,

diastole,

base of the heart (right sternal border, 2nd intercostal space)

Question 5

S2 is louder with what condition?

Answer 5

pulmonary embolism

Question 6

Wide fixed splitting of S2 is caused by what?

Answer 6

RBBB (right bundle branch block)

Question 7

S3

Answer 7

an abnormal heart sound detected early in diastole as resistance is met to blood entering either ventricle; most often due to volume overload associated with heart failure

“Kentucky” right after S2

heard best at the apex with the bell of stethoscope

Question 8

S3 is associated with

Answer 8

heart failure,

pulmonary hypertension, cor pulmonale, mitral, aortic, or tricuspid insufficiency

Question 9

S4

Answer 9

an abnormal heart sound detected late in diastole as resistance is met to blood entering either ventricle during atrial contraction; most often caused by hypertrophy of the ventricle

“Tennessee” right before S1

heard best at the apex with the bell of stethoscope

Question 10

S4 is associated with

Answer 10

myocardial ischemia, infarction, htn, ventricular hypertrophy, and AORTIC STENOSIS

Question 11

pericardial friction rub

Answer 11

scraping or grating noise heard on auscultation of the heart; suggestive of pericarditis; may be positional

Question 12

pulse pressure

Answer 12

systolic pressure - diastolic pressure

normal 40-60 mmHg

Question 13

Systolic Blood Pressure (SBP) is an indirect measurement of ____

Answer 13

cardiac output and stroke volume

Question 14

Diastolic Blood Pressure (DBP) is an indirect measurement of ____.

Answer 14

systemic vascular resistance (SVR)

Question 15

Coronary arteries are perfused during ____.

Answer 15

diastole

Question 16

narrowed pulse pressure, think ___.

Answer 16

cardiac tamponade

Question 17

Widened pulse pressure think

Answer 17

vasodilation; often seen in sepsis, septic shock

Question 18

systole

Answer 18

ejection, hight pressure

Question 19

diastole

Answer 19

filling, low pressure

Question 20

Why do the cardiac output and bp drop with extreme tachyarrhythmias?

Answer 20

no time for filling = less output

Question 21

murmur of insufficiency/regurgitation

Answer 21

occurs when the valve is closed

(acute or chronic)

Question 22

Murmur of stenosis

Answer 22

occur when valve is open

(chronic, NOT acute)

Question 23

Systolic murmurs

Answer 23

aortic stenosis and mitral regurgitation; occur between s1 and s2 (lub…shhhb…dub)

Semilunar valves are OPEN during systole - aortic and pulmonic stenosis

AV valves are CLOSED during systole - mitral and tricuspid insufficiency

Ventricular septal defect (most common with acute MI) may result in a systolic murmur

Question 24

Diastolic murmurs

Answer 24

aortic regurgitation/insufficiency and mitral stenosis; occur after s2 (lub…dub…shhb)

Semilunar valves are CLOSED during diastole- aortic and pulmonic insufficiency (AI)

AV valves are OPEN during diastole - mitral and tricuspid stenosis

Mitral stenosis is associated with AFIB d/t atrial enlargement that occurs over time

Question 25

Mitral insufficiency/regurgitation occurs when the mitral valve is _____.

Answer 25

closed, during Systole!

Question 26

Mitral stenosis occurs when the mitral valve is _____.

Answer 26

open, during Diastole!

Question 27

Aortic insufficiency/regurgitation occurs when the aortic valve is _____.

Answer 27

closed, during Diastole!

Question 28

Aortic stenosis occurs when the aortic valve is _____.

Answer 28

open, during Systole!

Question 29

Nitoprusside

Answer 29

Drug of choice in a hypertensive emergency. A continuous infusion that reduces preload and afterload.

Assess for cyanide toxicity after a few hours - days on the drip. Signs of cyanide toxicity include change in mental status, tachycardia, seizure, and metabolic acidosis.

Question 30

Ankle brachial index

Answer 30

Normal is > 1

To get this divide the ankle pressure by the brachial pressure on the same side of the body. This test for arterial flow and PAD