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0. Step Ib > Cardio Murmurs et EKGs > Flashcards

Cardio Murmurs et EKGs Flashcards

1
Q

S1 heart sound

A

mitral and tricuspid valves close

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2
Q

S2 heart sound

A

aortic and pulmonary valves close

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3
Q

S3 heart sound causes?

A

early diastolic, occurs with increased filling pressures

cause: CHF, MR, pregnancy, children, dilated cardiomyopathy

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4
Q

S4 heart sound causes?

A

late diastolic, occurs with elevated atrial pressures

cause: ventricular hypertrophy

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5
Q

physiologic splitting of heart sounds

A

occurs during inspiration

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6
Q

when does fixed splitting of heart sounds occur?

A

ASD

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7
Q

paradoxical splitting of heart sounds causes?

A

LBBB, AS

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8
Q

wide splitting of heart sounds

A

RBBB, pulmonic stenosis

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9
Q

sound of patent ductus arteriosus? causes?

A

continuous machine-like murmur

congenital heart disease, congenital rubella

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10
Q

sound of ventricular septal defect?

A

holosystolic, harsh murmur at left sternal border

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11
Q

sound of mitral stenosis? causes?

A

sound: opening click w/ delayed diastolic rumbling (interval btwn S2 and click is inversely correlated w/ severity)
cause: rheumatic fever

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12
Q

sound of mitral valve prolapse? causes?

A

sound: mid systolic click followed by systolic crescendo murmur
cause: myxomatous dgeneration, rheumatic fever (almost always), or chordae rupture

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13
Q

sound of mitral regurgitation? causes?

A

sound: holosystolic at apex with radiation to axilla (best heard in L decubitus position)
cause: MVP, LV dilation, ischemic heart disease, or rupture of chordae tendinae

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14
Q

sound of tricuspid regurgitation? causes?

A

holosytolic, radiates to R sternal border

cause: rheumatic fever, infective endocarditis, or things that cause RV dilation

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15
Q

sound of aortic stenosis? physical findings? causes?

A

sound: crescendo-descendo systolic ejection murmur (ejection click may be heard); loudest at 2nd right intercostal space (base) with radiation to carotids

parvus et tardus - pulses are weak w/ a delayed peak

cause: aortic sclerosis (age-related), bicuspid aortic valve

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16
Q

sound of aortic regurgitation? physical findings? causes?

A

sound: diastolic decrescendo murmur

PE: bounding pulses and head bobbing

causes: bicuspid aortic valve, aortic root dilation, endocarditis, rheumatic fever, SLE, syphilis

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17
Q

purpose of hand grip?

A

increase TPR (more remains in LV)

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18
Q

purpose of valsalva and standing?

A

decrease VR (less blood in heart’s circuit)

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19
Q

purpose of inspiration vs expiration?

A

Inspiration - increase VR (more enters RA/RV)

Expiration - increase flow to LA from pulmonary circuit

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20
Q

purpose of rapid squatting vs prolonged squatting?

A

rapid: increase VR, increase preload
prolonged: increase afterload

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21
Q

what increases intensity of AS? decreases?

A

increase: rapid squatting
decrease: hand grip, valsalva

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22
Q

what increases intensity of MR? decreases?

A

increases: anything that increases TPR: hand grip, squatting
decreases: valsalva

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23
Q

what increases intensity of MS? decreases?

A

increase: expiration (increase LA return from pulmonic circulation)
decrease: valsalva

24
Q

what increases intensity of VSD

A

increase: hand grip (to increase afterload)
decrease: valsalva

25
Q

what increases intensity of AR? decreases?

A

increase: **hand grip **
decrease: vasodilators, valsalva

26
Q

what increases intensity of MVP? decrease?

A

increase: handgrip, squatting (increase TPR; later onset of click/murmur)
decrease: valsalva, standing (decrease VR; earlier onset of click/murmur)

27
Q

what increases the intensity of R heart sounds?

A

inspiration

28
Q

what increases intensity of tricuspid regurgitation? decreases?

A

increase: inspiration (maneuvers that increase RA return)
decrease: valsalva

29
Q

type of arrhythmia?

at risk for?

trmt?

A

a-fib

  • Irregularly irregular
  • Ø P waves in between irregularly spaced QRS complexes

At risk of: Atrial stasis, thromboembolic stroke

Trmt:

  • Rate control
  • Anti-coagulation
  • Pharmacological or electrical cardioversion
30
Q

type of arrhythmia?

trmt?

A

a-flutter

Rapid succession of identical back-to-back atrial depolarization waves

Trmt:

  • Class IA, IC, or III (slows down atrial contraction so that the waves can collide and cancel out, and the SA node can take over)
  • ß blockers or Ca channel blockres
  • catheter ablation
31
Q

type of arrhythmia?

A

v-fib

Ø identifiable waves

at risk for: death - fatal

trmt: CPR and defibrillation

32
Q

type of arrhythmia?

A

AV - 1st degree

PR interval is prolonged

33
Q

type of arrhythmia?

A

AV - 2nd deg block - mobitz I

Progressive lengthening of the PR interval until a beat is dropped (P wave not followed by a QRS complex)

34
Q

type of arrhythmia?

At risk for?

Treatment?

A

AV block - 2nd degree mobitz II

Dropped beats not preceded by a change in the length of the PR interval (2:1 block)

At risk for: progression to a 3rd degree block

Trmt: Pacemaker

35
Q

type of arrhythmia?

trmt?

A

AV block - 3rd deg

Atria and ventricles beat independently of one another (no relationship between P waves and QRS complexes; atrial rate >> ventricular rate)

Trmt: Pacemaker

36
Q

ventricular depolarization

phase 0

phase 1

phase 2

phase 3

phase 4

A

ventricular depolarization

phase 0 = rapid upstroke = VG Na open -> influx

phase 1 = VG K open -> efflux

phase 2 = plateau = VG Ca open -> influx (balances K efflux)

phase 3 = repolarization = more VG K open; VG Ca close

phase 4 = resting potential (due to high K permeability)

37
Q

SA depolarization

phase 0

phase 1

phase 2

phase 3

phase 4

A

phase 0 = upstroke = VG Ca open -> influx; VG Na inactivate

phase 1 = does not exist

phase 2 = does not exist

phase 3 = repolarziation = VG K open, VG Ca close

phase 4 = If Na open -> Na conductance increases = determines HR

38
Q

P wave

A

atrial depolarization

39
Q

PR interval

A

conduction through AV node

40
Q

QRS complex

A

ventricular depolarization

41
Q

QT interval

A

mechnical contraction of the ventricles

42
Q

T wave

inverted T wave?

A

ventricular repolarization

Inversion may indicate recent MI

43
Q

ST segment

A

isoelectric; ventricles depolarizsed

44
Q

U wave

A

hypokalemia, bradycardia

45
Q

Some Risky Meds Can Prolong QT

what are they?

A

Some Risky Meds Can Prolong QT

Sotalol

Risperidone

Macrolides

Chloroquine

Protease inhibitors (-navir)

Quinidine (Class Ia, III)

Thiazides

46
Q

Romano-Ward Syndrome

A

AD, congenital QT syndrome - K channel defect

risk of sudden death due to torsades (otherwise healthy young individual)

ø deafness

47
Q

Jervell and Lange-Nielsen Syndrome

A

AR, congenital QT syndrome - K channel defect

risk of sudden death due to torsades (otherwise healthy young individual)

Sensorineural deafness

did you HEAR about the Nielsen Ratings for Jekell & hyde?

48
Q

3 holosystolic heart mumurs

what would accentuate these mumurs?

A
  • TR - increase in intensity during inspiration (more VR to R heart)
  • MR - increase in tensity with squatting/handgrip (more fluid remains in LV)
  • VSD (more fluid remains in LV)
49
Q

type of murmur heard with hypertrophic cardiomyopathy

A

almost always associated w/ mitral regurg 2˚ to impaired mitral valve closure, therefore one would hear a systolic mumur

50
Q

diastolic mumur best heard at the R sternal border is indicative of…

diastolic mumur best heard at the L sternal border is indicative of…

A

both are aortic regurgitation

R = due to aortic root dilation

L = bicuspid aortic valve?? not sure..but it is a common site to be heard

51
Q
A
52
Q

delta wave

A

Woff-Parkinson White Syndrome

caused by an abnormal fast accessory conduction pathway from A -> V, thereby passing the pace-determining step (AV node)

ventricles begin to depolarize earlier -> delta wave w/ shortened PR interval on ECG

may result in a reentry circuit -> supraventricular tachycardia

53
Q

STEMI in I, aVL leads

A

lateral wall - LCX

54
Q

STEMI in V1-V4 leads

A

anterior wall (LAD)

55
Q

STEMI in II, III aVF leads

A

inferior wall (RCA)

may cause sinus node dysfunction

56
Q

STEMI in V1, V2 leads

A

anteroseptal (LAD)

infranodal Mobitz type II second deg or third deg block would be possible

57
Q

STEMI in V4-V6 leads

A

anterolateral wall (LAD or LCX)

0. Step Ib (19 decks)

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