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PCM 1 Final > Cardiac Cycle and Sounds > Flashcards

Cardiac Cycle and Sounds Flashcards

1
Q

Where is the aortic area?

A

second intercostal space, right sternal border

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2
Q

Where is the pulmonic area?

A

second intercostal space, left sternal border

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3
Q

Where is Erb’s point?

A

Third intercostal space, left sternal border

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4
Q

Where is tricuspid area?

A

fourth (or fifth) intercostal space, left sternal border

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5
Q

Where is mitral area or apex?

A

fifth intercostal space, left midclavicular line

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6
Q

What are the normal heart sounds for an adult?

A

S1 (lub), S2 (dub)

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7
Q

When is systole (in regards to the heart sounds)?

A

between S1 and S2

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8
Q

When is diastole (in regards to the heart sounds)?

A

between S2 and S1

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9
Q

When is a murmur heard?

A
  • flow of blood through a valve is turbulent

- valve is non-compliant, incompetent, stiff, or damaged

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10
Q

When is a murmur concerning?

A

it is associated with symptoms

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11
Q

Is there always a problem or underlying disease if there is a murmur?

A

NO, not always

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12
Q

How should a murmur be evaluated?

A

echocardiogram

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13
Q

What is SBP?

A

the pressure exerted upon the artery during heart contraction

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14
Q

What is DBP?

A

the pressure exerted upon the artery wall during heart rest

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15
Q

When does the mitral valve open?

A

during atrial contraction

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16
Q

What sound is associated with the mitral valve closing?

A

S1

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17
Q

What sound is associated with the aortic valve closing?

A

S2

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18
Q

What is the order of valves opening and closing during the cardiac cycle starting during atrial contraction?

A
  • atrial contraction = mitral valve opens
  • isovolumic ventricular contraction = mitral valve closes
  • isovolumic ventricular contraction = aortic valve opens
  • isovolumic ventricular relaxation = aortic valve closes
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19
Q

What is associated with the mechanical phenomenon of the cardiac cycle?

A

aortic pressure wave, ventricular pressure wave, atrial pressure wave, ventricular volume wave, jugular venous wave, heart sounds

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20
Q

What is associated with the electrical phenomenon of the cardiac cycle?

A

sino-atrial nodal firing, internodal pathway conduction, atrio-ventricular nodal activation, bundle of HIS, right bundle branch and left bundle branch, left anterior and posterior fascicle, purkinje fibers

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21
Q

What does the P wave indicate?

A

atrial systole (late ventricular diastole)

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22
Q

What does the PR interval indicate?

A

atrial diastole (slow conduction thru AV node)

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23
Q

What does the QRS complex indicate?

A

ventricular systole (atrial diastole/repolarization)

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24
Q

What does the ST segment indicate?

A

late ventricular systole

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25
Q

What does the T wave indicate?

A

ventricular diastole/repolarization

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26
Q

What is the AV valve on the right side of the heart? High or low pressure system?

A

tricuspid valve,

low pressure system

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27
Q

What is the AV valve on the left side of the heart? High or low pressure system?

A

bicuspid (mitral) valve,

high pressure system

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28
Q

What is the semilunar valve on the right side of the heart? High or low pressure system?

A

pulmonic valve,

low pressure system

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29
Q

What is the semilunar valve on the left side of the heart? High or low pressure system?

A

aortic valve,

high pressure system

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30
Q

What makes the S1 sound?

A

closure of AV valves

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31
Q

What makes the S2 sound?

A

closure of semilunar valves

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32
Q

What does S3 sound like?

A

“Ken-tuckee”

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33
Q

What makes the S3 sound? Who is it normal in?

A

a vibratory sound that occurs from blood filling the relaxed and empty ventricle. Heard when AV valves are open.
normal in children.

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34
Q

What pathology can the S3 sound indicate?

A

CHF, cardiomyopathy with stiff ventricular walls

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35
Q

What does S4 sound like?

A

“Tenness-ee”

36
Q

What makes the S4 sound?

A

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

37
Q

When does the S4 sound occur?

A

before the S1 sound

38
Q

What is regurgitation?

A

turbulent flow sound when blood is moving in an opposite direction from what it should

39
Q

What is stenosis?

A

turbulent flow when blood is moving through a stiff damaged valve

40
Q

When does a systolic murmur occur?

A

during ventricular systole (between S1 and S2)

41
Q

When can a diastolic murmur be heard?

A

ventricular diastole (between S2 and S1)

42
Q

What is the mneumonic for the 4 locations on the chest?

A

APTM (All Physicians Take Money)

43
Q

What murmur is heard at the aortic valve?

A

ejection murmur (aortic stenosis)

44
Q

What murmur is heard at the tricuspid valve?

A

pansystolic murmur - tricuspid regurgitation or ventricular septal defect
mid-to-late diastolic murmur - tricuspid stenosis or atrial septal defect

45
Q

What murmur is heard at the left sternal border?

A

early diastolic murmur - aortic regurgitation or pulmonic regurgitation

46
Q

What murmur is heard at the pulmonary valve?

A

ejection murmur - pulmonic stenosis

47
Q

What murmur is heard at the mitral valve?

A

pansystolic murmur - mitral regurgitation

mid-to-late diastolic murmur - mitral stenosis

48
Q

What would you grade a soft murmur heard in quiet surroundings?

A

1

49
Q

What would you grade a soft murmur heard in noisy surroundings?

A

2

50
Q

What would you grade a prominent heard murmur?

A

3

51
Q

What would you grade a loud murmur with a thrill?

A

4

52
Q

What would you grade a loud murmur heard with edge of the stethoscope tilted against the chest + thrill

A

5

53
Q

What would you grade a loud murmur heard 5-10 mm from the chest + thrill?

A

6

54
Q

What are the characteristics of pathologic murmurs?

A
  • > =grade 3
  • holosystolic timing
  • maximum intensity at left upper sternal border
  • harsh or blowing
  • abnormal second heart sound
  • systolic click
  • diastolic murmur
  • increased intensity with upright position
  • gallop rhythm (S3 or S4)
  • friction rub
55
Q

What are the characteristics of innocent murmurs?

A
  • <=grade 2
  • softer intensity when sitting compared to supine
  • short systolic duration
  • minimal radiation
  • musical or vibratory quality
56
Q

Which valves are open and which are closed during ventricular systole?

A

open: semilunar (aortic and pulmonic)
closed: AV (tricuspid and mitral)

57
Q

What is aortic stenosis?

A

crescendo-decrescendo murmur
Most likely presentation: Old-SAD - syncope, angina, dyspnea
calcified aortic valve
radiates UP to the carotids

58
Q

What is pulmonic stenosis?

A

restricted flow through stenotic pulmonary valve (heard during systole)

59
Q

Which valves are open and which are closed during atrial systole?

A

open: AV (tricuspid and mitral)
closed: semilunar (pulmonic and aortic)

60
Q

What is tricuspid stenosis?

A

restricted/disrupted flow through stenotic tricuspid valve (heard during diastole)

61
Q

What is mitral stenosis?

A

restricted/disrupted flow through stenotic mitral valve (heard during diastole)

62
Q

What murmurs are louder during inspiration?

A

tricuspid and pulmonic (RINspiration)

63
Q

What murmurs are louder during expiration?

A

mitral and aortic

LEXpiration

64
Q

In most cases, how does a changing preload change the the murmur?

A

increasing preload = louder murmur

decreasing preload = softer murmur

65
Q

What are the exceptions to the general rules of preload?

A
  • HOCM (hypertropic obstructive cardiomyopathy)

- MVP (mitral valve prolapse)

66
Q

How is HOCM an exception to the general rule of preload?

A

increase in preload improves aortic murmur by pushing the septum away from the aortic outflow track, allowing blood to be ejected more easily. A decrease in preload causes worsening aortic murmur due to less blood to push the outflow track open, obstructing and disrupting the blood flow.

67
Q

How is MVP an exception to the general rule of preload?

A

leaflests of mitral valve prolapse into the left atria under normal pressure and blood flow. increased preload improves the “mid-systolic click” heard with MVP by allowing the prolapsed leaflets to return to their normal orientation.

68
Q

What is afterload?

A

pressure the ventricles have to generate to move blood forward into the atrial system (PVR)

69
Q

What is the effect of a change in afterload? What are the exceptions?

A

increased afterload = louder
decreased afterload = softer
Exceptions: HOCM and MVP are opposite

70
Q

What murmur radiates to the carotids?

A

aortic stenosis

71
Q

What is the most likely murmur in an older patient with syncope, angina, and dyspnea?

A

aortic stenosis

72
Q

What murmur radiates to the axilla?

A

mitral regurgitation

73
Q

Where is mitral regurgitation best heard?

A

apex

74
Q

What is mitral regurgitation?

A

holosystolic murmur radiating to the axilla. best heard at apex. “Rheu-mitral”

75
Q

What is mitral regurgitation associated with?

A

history of rheumatic fever

76
Q

What is tricuspid regurgitation?

A

holosystolic murmur associated iwth IVDA. “Want to TRI some drugs?”

77
Q

What has a early blowing diastolic murmur?

A

aortic regurgitation. “AR thar she BLOWS”

78
Q

What is aortic regurgitation? Presentations?

A

early blowing diastolic murmur.

  • connective tissue disorders
  • Marfan’s syndrome
  • “head bobbing”
  • water hammer pulse
  • femoral bruits
79
Q

What murmur has an opening “snap”?

A

mitral stenosis

80
Q

What is mitral stenosis?

A

opening snap
RHEU mitral - history of rheumatic fever
“The OS is MS”

81
Q

When should you be concerned for HOCM?

A
  • family history of sudden cardiac death at a young age (20-30 yo)
  • Exception to the preload/afterload loudness general rule
82
Q

When should you think mitral valve prolapse?

A

-midsystolic “click”
-clinical presentation of a young woman with a psychiatric history
-myxomatous valvular disease in the question stem
“See the MVP to be the MVP and everything will click”

83
Q

What are some other murmurs?

A

atrial septal defect, ventricular septal defect, patent ductus arteriosus

84
Q

When do you use the diaphragm?

A

for general cardiac auscultation

85
Q

When do you use the bell?

A

identify low pitch heart sounds (S3 and S4 gallops)

PCM 1 Final (6 decks)

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