Cardiac Cycle

Question 1

What elicits the S1 heart sound?

Answer 1

closure of the AV valves

Question 2

What elicits the S2 heart sound?

Answer 2

Closure of the semilunar valves

Question 3

What elicits the S3 heart sound?

Answer 3

It is a normal sound in children but can indicate heart pathology in an adult (e.g. CHF)

Occurs from blood filling the relaxed and empty ventricle

Question 4

What elicits the S4 heart sound?

Answer 4

Atrial filling from high pressure SVC/IVC and pulmonary venous return

Question 5

What are the heart sounds if S3 is present?

Answer 5

Ken-tuckee

Question 6

What is the heart sound if S4 is present?

Answer 6

Tenness-ee

Question 7

What is a 6/6 heart murmur?

Answer 7

Loud murmur heart 5-10mm from the chest with thrill (w/o the stethoscope)

Question 8

What is a 5/6 heart murmur?

Answer 8

Loud murmur heard with edge of the stethoscope tilted against the chest with thrill

Question 9

What is a 4/6 heart murmur?

Answer 9

Loud murmur with a thrill

Question 10

What is a 3/6 heart murmur?

Answer 10

Prominent heard murmurs

Question 11

What is a 2/6 heart murmur?

Answer 11

Soft murmur heard in noisy surroundings

Question 12

What is a 1/6 heart murmur?

Answer 12

Soft murmur heard in quiet surroundings

Question 13

Which murmurs are louder with inspiration?

Answer 13

Tricuspid and pulmonic valve murmurs (right side of the heart= RINspiration)

Question 14

What murmurs are louder with expiration?

Answer 14

Mitral and aortic valves (left side of the heart; LEXpiration)

Question 15

What are the two exceptions to the general rules of preload (increase preload, louder murmur)?

Answer 15

Hypertrophic obstructive cardiomyopathy (HOCM) and Mitral Valve Prolapse (MVP)

Question 16

What occurs with increased preload in a patient with HOCM?

Answer 16

It improves the aortic murmur by pushing the septum away from the aortic outflow tract, allowing blood to be ejected more easily

Decreased preload makes the murmur worse and louder (because of obstruction of blood flow)

Question 17

What occurs with increased preload in a patient with MVP?

Answer 17

Improves the mid-systolic click heard with MVP by allowing the prolapsed leaflets to return to their normal orientation

Question 18

What is afterload?

Answer 18

Pressure the ventricles have to generate to move blood forward into the arterial system (PVR too)

Question 19

Does a murmur get louder or softer with increased afterload?

Answer 19

Louder

Question 20

What occurs to murmurs in patients with HOCM or MVP that have increased afterload?

Answer 20

They become softer

Question 21

How is aortic stenosis presented?

Answer 21

Crescendo-decrescendo

Old-SAD (syncope, angina, dyspnea)
Calcified aortic valve
Radiates up to the carotids

Question 22

What can lead to mitral regurgitation?

Answer 22

Rheumatic fever

Radiates to the axilla

Best heard at the apex

Holosystolic murmur (steady)

And presents with a decreased s1 sound

Question 23

What is associated with tricuspid regurg?

Answer 23

It is holosystolic and people who have a h/o IVDA

Question 24

What is associated with aortic regurg?

Answer 24

Early BLOWING diastolic murmur

Connective tissue disorders
Marfan’s
Head-bobbing
Water-hammer pulse 
Femoral bruits 

“AR, thar she BLOWS”

Question 25

What is associated with Mitral stenosis?

Answer 25

Opening “snap” Rheumatic fever “The OS is MS”

Question 26

Where is the best place to feel for the point of maximal impulse (PMI)?

Answer 26

Supine: 45 degrees or left lateral decubitus Upright: 5th ICS, 1 cm medial to MCL Normal: 4th-5th ICS at the mid-clavicular line

Question 27

Where does mitral regurg radiate to?

Answer 27

The left axilla

Question 28

Where does aortic stenosis radiate to?

Answer 28

Into the sternal notch

Question 29

What are the systolic murmurs and where are they typically heard?

Answer 29

Heard between s1 and s2 Mitral and Tricuspid regurg Aortic and pulmonic stenosis

Question 30

What are the diastolic murmurs and when are they typically heard?

Answer 30

Heard between s2 and s1 Mitral and tricuspid stenosis Aortic and pulmonic regurg

Question 31

What do jugular veins reflect?

Answer 31

The activity of the right side of the heart

Question 32

How do you measure JVP?

Answer 32

Recline pt to 45 degrees supine Put ruler on sternal angle to measure to external jugular (top level of venous pulsation) and then add 5cm

Question 33

What does an increased v wave indicate?

Answer 33

Tricuspid regurgitation

Question 34

What if the a wave is increased in a jugular venous pressure graph?

Answer 34

Tricuspid stenosis (because blood cannot leave the atria)

Question 35

What is physiologic splitting of s2?

Answer 35

Occurs during inspiration becasue of increased venous return during inspiration and more time for RV to deliver blood to the lung