Cardiac Cycle/Murmurs Flashcards
During which phase (systole or diastole) are the AV valves closed to prevent the backflow of blood?
systole
True or False: AV valves open and close passively are are wimpy like Brainy from Hey Arnold.
True.
breathes breathes breathes
True or False: the papillary muscles help the AV valves close via the chordae tendinae.
FALSE. The AV valves are passive.
So what’s the fxn of the papillary muscles?
They pull the vanes of the valves inwards towards the ventricles to prevent their buldging too far backward into the atria.
What % of blood flows into the ventricles PASSIVELY from the atria?
80%
What causes the additional 20% of the ejected blood to flow from the atria to the ventricles?
atrial contraction
Rapid ventricular filling (passively) occurs how long in the filling phase?
first 1/3
What causes the “a” wave on the atrial pressures?
“a”trial contraction
What causes the “c” wave on the atrial pressures?
‘c”losure of the AV valves
What causes the “v” wave on the atrial pressures?
“v”entricular contraction
This is the period where the ventricles are actively contracting but there is no ejection.
Isovolumetric contraction
After the ventricles get a pressure higher than the aorta, blood is squirted into the aorta, leading to this phase.
Rapid ejection phase.
After the blood is squirted itno the aorta, the pressures are higher than the LV, closing the aortic valve, and leading to this phase of the cardiac cycle.
Isovolumetric relaxation
What causes the S1?
Closure of the AV valves
What electrical disordere can cause S1 to split?
RBBB
Conditions that shorten the PR interval (MS, high CO or tachycardia) can cause which one: accentuated or reduced S1?
Accentuated
Which conditions can prolong the PR interval, causing a reduced S1 sound?
1st degree AV block, MR, MS, stiff LV
What causes the late pulmonic closure to cause the splitting of S2?
expansion of the chest during inspiration creates a negative pressure in the chest –> increased capacitance of the pulmonary vessels –> delay in diastolic back pressure onto pulomary valve –> P2 delayed
What causes the early atrial valve closure to cause the splitting of S2?
increased capacity of intrahtoracic veins from neg pressure –> reduced venous return to LA and LV –> reduced LV filling –> shortened LV filling –> early A2 during inspiration
The intensity of S2 depends on what factor of the blood?
velocity
RBBB or PS can cause what abnormal splitting of S2?
Widened splitting
ASD can cause what abnormal splitting of S2?
Fixed splitting
LBBB or AS can cause what abnormal splitting of S2?
Paradoxical splitting
Where in the the cardiac cycle is S3 found?
Early diastole
“Ken——tuck–y”
Is S3 sharp or dull?
dull
What causes S3?
tensing of the chordae tendineae during rapid filling and expansion of the ventricle.
like plucking a guitar string… bongggggg
True or False: S3 is normal in kids and young adults cuz the ventricle is supple and capable of rapid expansion.
True
Contraction of the atria against a stiffened ventricle can cause what heart sound?
S4
Where in diastole does S4 occur?
Late diastole
What are the characteristics of a 1/6 grade murmur?
barely audible
What are the characteristics of a 2/6 grade murmur?
faint but immediately audible
What are the characteristics of a 3/6 grade murmur?
easily heard
What are the characteristics of a 4/6 grade murmur?
easily heard with palpable thrill
What are the characteristics of a 5/6 grade murmur?
very loud with stethoscope light on chest
What are the characteristics of a 6/6 grade murmur?
audible without the stethoscope on the chest
What are the 3 ways to decrease the preload to the heart?
valsalva, sitting–>stranding, amyl nitrate
What are the 5 ways to increase the preload to the heart?
standing–>squatting, passive leg elevation, Muller, isometric hand grip, vasopressors
What are the 3 systolic ejection murmurs?
- aortic/pulmonary stenosis
- HCM
- innocent murmurs
Where is the radiation in AS?
carotids
Does HCM murmurs get louder or quieter if you decrease preload?
Louder
Why are innocent murmurs “innocent?”
theyre just high-flow states like youth, pregnancy, fever, anemia, hyperthyroidism, etc.
What are the 3 pansystolic murmurs?
- MR
- TR
- VSD
Any murmur on the R side of the heart gets louder or softer during inspiration?
Louder
Do pansystolic murmurs change the intensity throughout S1-S2 or remain the same?
remain the same
Does MR get louder when u increase or decrease preload?
Increase
What is the sign called of TR where it gets louder during inspiration?
Carvallos sign
What is the triad for severe TR?
carvallos sign, pulsatile JVD, and pulsatile liver
Where is VSD best heard?
4-6th L intercostals
Does VSD increase with inspiration?
No
What is the 1 mid-to-late systolic murmur?
MVP
What causes MVP?
Bowing of abnormally redundant and elongated valve leaflets into the left atrium.
What happens mid-systolic which is indicative of MVP?
click
What are the 2 EARLY diastolic murmurs?
AR and PR
What is the shape of AR?
Decrescendo after A2
This is an assocation with AR that may happed due to high flow across the aortic valve.
Systolic ejection murmur
This is an assocaition with AR that is a diastolic rumble from a functional MS.
Austin Flint murmurs
most likely a test question lol. there were like 5 slides just on this 1 thing.
This is a sign of AR where theres a systolic murmur over femoral artery when steth is compressed proximally and a diastolic murmur when compressed distally.
Duroziez sign
What is the main cause of PR?
pulmonary arterial HTN
This is a type of murmur in PR from pulmonary HTN and has a loud component of S2.
Graham steel murmur
This is the cause of PR when u hear an afterpulmonic component of S2 with a crescendo-decrescendo pattern.
Deformity in the pulmonic valve.
What are the 2 mid-to-late diastolic murmurs?
- AV valve stenosis
2. increased flow across the AV valves
What happens after S2 in MS? give me the shape of the murmur
opening snap –> fade down –> re-appears when atria contract before S1
What is MS almost always a sequela of?
rheumatic fever
