Cardiac Function: Examining The Heart

Question 1

Used for high frequency sounds such as valve closures, systolic events, and regurgitation murmurs

Answer 1

Diaphragm

Question 2

Used for low frequency sounds (S3, S4) like a diastolic murmur of mitral stenosis

Answer 2

Bell

Question 3

Can only hear with patient seated and leaning forward

Answer 3

Aortic regurgitation

Question 4

MArks the onset of systole with the closure of the AV valves

Answer 4

First heart sound (S1)

Question 5

Marks the onset of diastole with the closure of the semilunar valves

Answer 5

Second Heart sound (S2)

Question 6

If the HR is slow, the shorter period is

Answer 6

Systole

Question 7

To identify S1 vs S2, we want to check the

-Palpable impulse occurs just after S1

Answer 7

Carotid pulse

Question 8

Found in the right second (or third) intercoastal space

Answer 8

S2

Question 9

Will be louder, shorter, and sharper

-Higher frequency sound

Answer 9

S2

Question 10

Heard well across the entire precordium

-coincides with closure of mitral and tricuspid valves

Answer 10

S1

Question 11

S1 is loudest at the

Answer 11

Apex

Question 12

S1 should be louder than S2 at the

Answer 12

Apex

Question 13

S2 should be louder than S1 at the

Answer 13

RICS

Question 14

The intensity of S1 increases with the strength of

Answer 14

Ventricular contraction

Question 15

The position of the AV leaflets at the onset of systole affects the intensity of S1, the wider they are apart, the

Answer 15

Louder S1 (indicator of valve disease)

Question 16

The position of the AV leaflets at the onset of systole depends on the

Answer 16

PR interval

Question 17

When ventricular systole immediately follows atrial systole, so valve leaflets are wide open and S1 is loud

Answer 17

Short PR interval

Question 18

Gives more time for leaflets to float together so S is not as loud

Answer 18

Long PR interval

Question 19

The most important characteristic of S1 is

Answer 19

Intensity

Question 20

Vigorous ventricular contraction, short PR interval, or delayed closure of valve gives a

Answer 20

Loud S1

Question 21

If pulse is regular and S1 intensity varies beat-to-beat, consider

Answer 21

AV dissociation (complete heart block)

Question 22

A loud unexplained S1 can mean

Answer 22

Mitral Stenosis

Question 23

A faint or absent S1 can mean

Answer 23

Acute aortic regurgitation

Question 24

The S2 sound has 2 components caused by closure of the

Answer 24

Semilunar valves

Question 25

We hear a single S2 sound during

Answer 25

Expiration

Question 26

Normally, for our S2 sound, which closes first

Answer 26

AV closes before PV

Question 27

Pulmonary circulation is a low pressure system so there is less back pressure in the pulmonary artery and the

Answer 27

P2 is heard later than A2

Question 28

During inspiration, the interval separating A2 and P2

Answer 28

Increases (A2 first then P2)

Question 29

In greater than 90% of normal people, A2 and P2 are perceived as a single sound during expiration. In those with splitting, it disappears when they

Answer 29

Sit up

Question 30

Wide physiologic splitting of S2 can be caused by a

Answer 30

Conduction problem or hemodynamics problem

Question 31

A Right Bundle Branch Block (RBBB) or left ventricular preexcitation are two types of

Answer 31

Conduction problems leading to physiologic splitting of S2

Question 32

Prolongation of RV systole, pulmonic stenosis, or pulmonary hypertension w/ RV failure are examples of

Answer 32

Hemodynamics causes of physiologic splitting

Question 33

A wide and fixed splitting of S2 is caused by an

Answer 33

Atrial Septal Defect

Question 34

The presence of physiologic splitting of S2 decreases the likelihood of an

Answer 34

Atrial Septal Defect

Question 35

A low frequency sound that requires the bell to hear

Answer 35

Ventricular or S3 gallop

Question 36

As a general rule, if there is an S3 gallop than the heart is

Answer 36

Dilated

Question 37

An atrial or S4 gallop is also a low frequency sound that needs the

Answer 37

Bell

Question 38

An “opening snap” is indicative of

Answer 38

Mitral stenosis

Question 39

An “early ejection click” is indicative of

Answer 39

Aortic stenosis

Question 40

A “midsystolic click” is indicative of

Answer 40

Mitral valve prolapse

Question 41

Audible vibrations due to increased turbulence

-Defined by timing within the cardiac cycle

Answer 41

Heart Murmurs

Question 42

Begin with or after S1 and end at or before S2

Answer 42

Systolic Murmurs

Question 43

Begin with or after S2 and end at or before S1

Answer 43

Diastolic murmurs

Question 44

Any murmur with a grade of 4/6 or above will also have an accompanying

Answer 44

Thrill