Cardiac Cycle and Sounds (Stewart)

Question 1

What are the two heart sounds?

Answer 1

Lub (S1)

Dub (S2)

Question 2

Helpful menumonic to remember to assessment points for a CV exam?

Answer 2

All | Aortic Area (1)

Physicians | Pulmonic Area (2)

Take | Tricuspid Area (4)

Money | Mitral area/apex (5)

Question 3

What is the order of heart sounds?

Answer 3

S4 –> S1 –> S2 –> S3

Question 4

Describe what is occuring during:

S1

Answer 4

“lub”

Closure of A-V valves

Question 5

Describe what is occuring during:

S2

Answer 5

“dub”

Closure of semilunar valves

Question 6

Describe what is occuring during:

S3

Answer 6

“Ken-Tuckee”

A vibratory sound that occurs from blood filling the relaxed venticle. A normal sound in children but can indicate heart pathology in adult.

Question 7

Describe what is occuring during:

S4

Answer 7

“Tenness-ee”

Atrial filling from high pressure from SVC/IVC and pulmonary venous return. Occurs BEFORE S1 heart sound.

Pathologic heart sound

Question 8

Define:

Regurgitation

Answer 8

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

Question 9

Define:

Stenosis

Answer 9

Turbulent flow when blood is moving through a stiff damaged valve

Question 10

How are heart murmurs graded?

Answer 10

Question 11

What are the mneumonics to remember what makes murmurs loud or soft?

Answer 11

RINspiration : Inspiration, Right = louder

LEXpiration : Expiration, Left = louder

Question 12

What should you know about aortic stenosis?

Answer 12

Crescendo-Decrescendo murmur “whooshing” sound

Old-SAD (syncope, angina, dyspnea)

Radiates up into the carotids

Question 13

What is occuring during

Ventricular Systole?

Answer 13

OPEN semi lunar valves, Aortic and Pulmonic

CLOSED AV valves, Tricuspid and Mitral

Question 14

What is occuring during

Atrial Systole?

Answer 14

OPEN AV valves, Tricuspid and Mitral

CLOSED semilunar valves, Pulmonic and Aortic

Question 15

Exceptions to the general rules of preload?

Answer 15

HOCM (Hypertropic obstructive cardiomyopathy): heart is becoming really muscular –> increase preload, improves murmur, decrease preload –> worsens aortic murmur

MVP (mitral valve prolapse): leaflets of mitral valve prolapse. Increase in preload improves murmur

Question 16

Effect on murmurs?

Increased afterload =

Decreased afterload =

Answer 16

Increased afterload = LOUDER

Decreased afterload = SOFTER

*Exceptions: HOCM, MVP

Question 17

Mitral Regurgitation?

What do you need to know?

Answer 17

Question 18

What is the mneumonic associated with tricuspid regurgitation?

Answer 18

Want to TRI some drugs??

History of IV drug use, related to tricuspid regurgitation

Question 19

What is the mneumonic associated with aortic regurgitation?

Answer 19

AR, thar she blows!!!

Early blowing diastolic murmur

*HEAD BOBBING heavily associated

Question 20

What are the mneumonics for mitral stenosis?

Answer 20

The Operating System is MicroSoft

The OS is MS

Opening snap is Mitral stenosis

*RHEUmitral = rheumatic fever associated

Question 21

HOCM (hypertropic obstructive cardio myopathy)

Associated with?

Answer 21

Death at young age

*EXCEPTION TO THE RULE of loudness with preload/afterload

Question 22

What is the mneumonic for mitral valve prolapse?

Answer 22

See the MVP to be the MVP and everything will click

Midsystolic “click”

*closely associated with young women with psych hx