Cardiac Cycle and Valvular Heart Disease Flashcards
In young healthy individuals is atrial contraction a significant source of ventricular filling?
no
When is atrial contraction a significant source of ventricular filling?
when ventricular filling is reduced because of reduced compliance
What is the S1 sound produced by? (sound associated with it)
the “lub” sound
closure of mitral and tricuspid valves
What is the S2 sound produced by? (also sound associated with it)
the “dub” sound
closure of the aortic(A2) and pulmonic sounds (P2 component)
What is physiological splitting of S2?
during inspiration due to increased output of rt heart physiological splitting in which the pulmonic valve closes later than the aortic valve occurs
What is a widened split?
Upon inspiration, the natural physiological split, or delay in pulmonic valve closure is even more delayed
Meaning of a widened split?
pulmonic stenosis
right bundle branch block
What is a fixed split?
When you hear S2 split both upon inspiration and expiration
Meaning of a fixed split?
ASD; L-R shunt
What is paradoxical splitting?
When the pulmonary valve closes before the aortic valve; you are technically hearing P2 close first even though it has a natural delay so P2 upon inspiration gets closer to timing for aortic valve to close and now you hear 1 sound
You are hearing the aortic valve close later instead of sooner
What is the meaning of paradoxical splitting?
left bundle branch block
advanced aortic stenosis
What is the S3 sound?
It occurs just after the opening of the AV valves during rapid filling of the ventricle
Usually produced by expansion compliant ventricle
normal in children
in older adults signifies volume overload
What is S4 sound?
coincides with atrial contraction; is produced when atrium contracts against a stiff ventricle
What are examples of when you hear an S4 sound?
concentric hypertrophy, aortic stenosis, and myocardial infarction
Where is the aortic auscultation point?
second intercostal space on rt side, and mid-clavicular line
What is the pulmonic ausculatation point?
second intercostal space on the left side, about mid-clavicular line
What is the tricuspid auscultation point?
fifth ICS just at left sternal border
Where is the mitral ausculation point?
sixth ICS on the left side, about mid-clavicular line
Which venous wave has the highest deflection of the venous pulse and is produced by contraction of the right atrium?
a wave
What is the c wave of the venous pulse curve caused by mainly? What event does it begin at?
due to bulging of the tricuspid valve into the atrium (rise in atrial pressure)
occurs near beginning of ventricular contraction
What is x descent produced by on venous pulse curve?
produced by a decreasing atrial pressure during atrial relaxation
What is the v wave?
produced by filling of the atrium during ventricular systole when the tricuspid valve is closed
What is y descent?
produced by the rapid emptying of the right atrium immediate after the opening of tricuspid valve
Describe what each venous pressure curve represents and why?
From top to bottom:
A Normal
B A fib
C tricuspid regurgitation
D tricuspid stenosis
Formula for stroke volume
Stroke volume = end-diastolic volume – end-systolic volume
If increased contractility is the only variable that changes in a pressure volume loop; where will the loop shift?
to the left
What falls during excercise? preload, ESV, peak systolic pressure, or SV?
ESV
A stenotic valve is a resistor and therefore when can you hear the mumur?
when valve is open
A regurgitant valve allows back-flow of blood. When can you hear this type of murmur?
when the valve is normally closed
What type of murmur would you hear for aortic stenosis?
crescendo decrescendo
What valvular conditions is being seen here?
aortic stenosis
What valvular condition is being seen here?
aortic stenosis
What valvular condition is being seen here?
aortic regurgitation
retrograde flow from aorta to left ventricle produces a low aortic diastolic pressure
large aortic PP
What is being seen here?
Aortic regurgitation (insufficiency)
all volumes are increased (SV, ESV, EDV) though end diastolic pressure pretty much the same (eccentric hypertrophy)
No true isovolumetric relaxation
A short S2: OS (opening snap) interval is a reliable indicator of what valvular condition?
severe mitral stenosis
If you hear a click instead of an opening snap? What valvular condition may this indicate?
MVP
What condition can be seen here?
mitral stenosis
elevated atrial pressure and volume
What condition can be seen here?
mitral stenosis
What condition is being seen here? What type of murmur would you hear?
mitral insufficiency regurgitation
atrial volumes and pressures are increased
ventricular volumes and pressure are increased during diastole
pansystolic or holosystolic murmer
What condition is being seen here?
mitral insufficiency regurgitation
no true isovolumetric contraction
ventricular volumes are pressures are increased during diastole
What condition is being seen here?
mitral insufficiency regurgitation
no true isovolumetric contraction
ventricular volumes are pressures are increased during diastole
