Cardio: Anatomy and Physiology Flashcards
What structures are contained within the mediastinum?
Heart and great vessels
Esophagus, trachea, thoracic duct and thoracic lymph nodes
Where is the point of maximal impulse (PMI) located and what is the diameter in healthy patients?
5th intercostal space, 1-2.5 in healthy patients
What does a PMI of > 2.5 cm indicate?
Cardiomegaly
LVH (left ventricular hypertrophy)
Dilated cardiomyopathy
What are the atrioventricular valves?
- Tricuspid
- Mitral
What are the semilunar valves?
- Pulmonic
- Aortic
How many leaflets does a bicuspid aortic valve have?
two, most common congenital heart defect.
What are the auscultation landmarks (refer to slide 10)
” All physicians earn too much”
A- aortic
P-pulmonic
E- erbs point (left sternal border)
T- tricuspid area
M- mitral area
During systole, the ______ and _____ valves are open, allowing for blood to flow from the
aortic, pulmonic
LV to the aorta and RV to pulmonary artery
During systole, the ________ and _________ valves are closed, allows for
mitral, tricuspid
allows for the atrium to fill with blood
S1
beginning of systole the mitral valve and tricuspid valve close
S2
end of systole the aortic valve and pulmonic closes
Diastole is ventricular _______
relaxation
During diastole, the ________ and ________ valves are closed allowing for what
aortic and pulmonic
allowing for the ventricles to relax and fill with blood
During diastole, the _______ and ________ valves are open and the atria________
mitral and tricuspid, atria contracts to fill the ventricles with blood
What occurs during the beginning of diastole
The aortic valve closes (S2) and the mitral valve opens, LV fills
What occurs during the end of diastole
Mitral valve closes (S1)
What are the classifications of heart sounds?
First heart sound (S1)
Second heart sound (S2)
Opening Snap
Third heart sound (S3)
Fourth heart sound (S4)
Physiologic and pathologic split S2
What is S1?
“LUB”
Closing of the atrioventricular valves (mitral and tricuspid)
Marks the onset of systole
Occurs just before the upstroke of the carotid pulse
Typically louder than S2, heart best over the apex (mitral area) and the lower left sternal border
What is S2?
“DUB”
Closing of the semilunar valves (aortic and pulmonary)
Marks the onset of diastole
Occurs after peak carotid pulse
Typically quieter than S1, best heard over the left 2nd interspace (aortic area), close to sternal border
What is the opening snap?
-pathologic sound
Generated from a calcified mitral valve (mitral stenosis)
The rapid opening of the calcified mitral valve leaflets to its maximal open position causes the opening snap
Mitral stenosis
Where is the opening snap best heard at?
Heard at best the apex with the diaphragm of the stethoscope, left 2nd intercostal space
High frequency
S3 is rapid deceleration of blood as it hits the ______ wall
LV
-ventricular gallop
S4 is an audible ____________ just before _______
atrial contraction, systole
atrial gallop
Which heart sound can be physiologic or pathologic?
S3
physiologic in young adults
Often pathologic if age > 40 years
Rapid deceleration of blood as it hits the LV wall = Ventricular gallop
What is the clinical significance of S3?
Dilated, volume overloaded LV
Heart failure
Aortic valve disease
Severe mitral regurgitation
Which heart sound is ALWAYS considered pathologic however not uncommon after age >40 due to lower ventricular compliance
S4
In S4, the LV is ____ and ____
stiff, less compliant
What is the clinical significance of S4?
Hypertension
HCOM
Aortic stenosis
Acute MI
In Ten-Ne-See, the _____ is S4
TEN
In Ken-Tuck-Y the ______ is S3
Y
Split S2=
A2(aortic valve closing) + P2(pulmonic valve closing)
What does a split S2 mean?
that you can hear both components (A2 and P2) rather that one combined sound
What is A2?
the aortic valve closing
Louder, reflecting higher aortic pressure c/w pulmonary artery pressure
Heard throughout the precordium, heard best at right 2nd intercostal space (aortic area)
Because of higher pressure system, typically closes first
What is P2?
pulmonic valve closing
In normal anatomy, relatively soft sound
Heard best at 2nd and 3rd intercostal space near the sternal border (pulmonic area)
A2 with increased intensity
Systemic HTN: louder due to increased pressure load
Aortic root dilated due to increased proximity of aortic root to the chest wall
A2 decreased or absent
Severe aortic stenosis due to valve immobility, no closure sound is heard
P2 with increased intensity
When P2 is louder than A2, suspect pulmonary hypertension, dilated pulmonary artery or atrial septal defect
P2 with decreased intensity or absent
Occurs with increased AP diameter of the chest (aging)
Also in pulmonary stenosis due to valve immobility, no closure sound is heart
Physiologic split S2
A2 precedes P2 during inspiration only
Wide splitting
Split S2 has further delay with inspiration
Pulmonary stenosis or RBBB
Fixed splitting
No change in wide split S2 with inspiration OR expiration
Atrial septal defect, fixed split because of prolonged right ventricular systole
Paradoxical splitting
P2 precedes A2 in expiration when closure of aortic valve is abnormally delayed
The split disappears during inspiration (P2 is normally delayed during inspiration) causing the split to disappear
Aortic stenosis, LBBB
Systolic (ejection) click
Typically mid or late systole
Apex or left sternal border
Common finding in mitral valve prolapse
The mitral valve has redundant or elongated chordae tendineae causing an abnormal ballooning of the mitral valve leaflets during systole
Which of the following is NOT occurring during diastole?
A) Pulmonic valve is closed
B) Aortic valve is open
C) Right ventricle is relaxed
D) Left atrium is contracting
Aortic valve is open
The ___________ artery is the only artery in the body that carries deoxygenated blood
pulmonary
S1 marks the onset of ________________.
systole
In a paradoxical split S2:
A) The pulmonic valve closes before aortic valve during expiration
B) The aortic valve is stenosed
C) The pulmonic valve closes after aortic valve during expiration
D) A and B
D
What is the most lateral aspect of the cardiac silouhette on a CXR?
A) Pulmonary artery
B) Right ventricle
C) Left atrium
D) Left ventricle
D
Which of the following is NOT true of S3:
A) Can be physiologic (normal) in children/young adults
B) Is considered an atrial gallop
C) Indicative of reduced ventricular compliance, or left ventricular hypertrophy
D) Heard just after S2, early in diastole
B
Name the two atrioventricular valves:
A) Tricuspid
B) Pulmonic
C) Mitral
D) Aortic
A, C
What does an opening snap suggest?
A) Mitral stenosis
B)Heart failure
C) Pulmonic stenosis
D) Atrial septal defect
Mitral stenosis
