Cardiac cycle and heart sounds

Question 1

what causes a murmur

Answer 1

sound produced when the flow of blood through a valve is turbulent or disrupted

not always indicative of a problem

Question 2

Heart sounds: S1

Answer 2

lub (closure of A-V valves)

Question 3

Heart sounds: S2

Answer 3

dub (closure of semilunar valves)

Question 4

Heart sounds: S3

Answer 4

Ken-tuckee (from blood filling the ventricle)

Question 5

Heart sounds: S4

Answer 5

Tenness-ee (atrial filling from high pressure SVC/IVC and pulmonary venous return; occurs before S1)

Question 6

Regurgitation

Answer 6

turbulent flow sound when blood is moving in the wrong direction

Question 7

Stenosis

Answer 7

turbulent flow when blood is moving through a stiff, damaged valve

Question 8

auscultation location

Answer 8

APTM (All Physicians Take Money)

Aortic - R 2nd ICS
Pulmonary - L 2nd ICS
Tricuspid - L 4th ICS
Mitral - L 5th ICS mid clavicular line

Question 9

what makes murmurs louder

Answer 9

inspiration - right (T&P)
expiration - left (M&A)
increased preload (decreased makes it softer

Question 10

HOCM (hypertrophic obstructive cardiac myopathy)

Answer 10

thickened ventricular septum

exception to general rules of preload and afterload:
increased preload improves aortic murmur by pushing septum away from the aortic outflow track allowing blood to be ejected more easily

Question 11

MVP (Mitral Valve Prolapse)

Answer 11

“see the MVP to be the MVP and everything will CLICK”

exception to general rules of preload and afterload:
increase in preload improves the “mid-systolic click” heard with MVP by allowing prolapsed leaflets to return to their normal orientation

Question 12

Afterload effect on murmurs

Answer 12

Afterload: Pressure the ventricles have to generate to move blood forward into the arterial system (PVR)
increased - louder
decreased - softer

Question 13

Aortic stenosis

Answer 13

Crescendo-decrescendo murmur

radiates UP to the carotids

Question 14

Mitral regurgitation

Answer 14

“Rheu-mitral” (associated with rheumatoid fever”)
radiates to the axilla
best heard at apex
holosystolic murmur (plateau-shaped loud, blowing murmur)

Question 15

Tricuspid regurgitation

Answer 15

“want to TRI some drugs?”
holosystolic
history of IVDA (intravenous drug abuse)

Question 16

Aortic regurgitation

Answer 16

"AR thar she BLOWS"
early blowing diastolic murmur
presentations:
-CT disorders
-marfan's syndrome
-head-bobbing
-water-hammer pulse
-femoral bruits

Question 17

Mitral stenosis

Answer 17

“The OS is MS”
opening “snap”
“RHEUmitral”
hx of rheumatic fever