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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
what increases intensity of AR? decreases?
increase: **hand grip ** decrease: **vasodilators, valsalva**
26
what increases intensity of MVP? decrease?
increase: **handgrip, squatting** (increase TPR; later onset of click/murmur) decrease: **valsalva, standing** (decrease VR; earlier onset of click/murmur)
27
what increases the intensity of R heart sounds?
inspiration
28
what increases intensity of tricuspid regurgitation? decreases?
increase: **inspiration** (maneuvers that increase RA return) decrease: **valsalva**
29
type of arrhythmia? at risk for? trmt?
**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
type of arrhythmia? trmt?
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
type of arrhythmia?
v-fib Ø identifiable waves at risk for: **death - fatal** trmt: **CPR and defibrillation**
32
type of arrhythmia?
AV - 1st degree PR interval is prolonged
33
type of arrhythmia?
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
type of arrhythmia? At risk for? Treatment?
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
type of arrhythmia? trmt?
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
ventricular depolarization phase 0 phase 1 phase 2 phase 3 phase 4
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
SA depolarization phase 0 phase 1 phase 2 phase 3 phase 4
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
P wave
atrial depolarization
39
PR interval
conduction through AV node
40
QRS complex
ventricular depolarization
41
QT interval
mechnical contraction of the ventricles
42
T wave inverted T wave?
ventricular repolarization Inversion may indicate recent MI
43
ST segment
isoelectric; ventricles depolarizsed
44
U wave
hypokalemia, bradycardia
45
Some Risky Meds Can Prolong QT what are they?
Some Risky Meds Can Prolong QT Sotalol Risperidone Macrolides Chloroquine Protease inhibitors (-navir) **Quinidine (Class Ia, III)** **Thiazides**
46
Romano-Ward Syndrome
AD, congenital QT syndrome - K channel defect risk of sudden death due to torsades (otherwise healthy young individual) ø deafness
47
Jervell and Lange-Nielsen Syndrome
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
3 holosystolic heart mumurs what would accentuate these mumurs?
* **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
type of murmur heard with hypertrophic cardiomyopathy
almost always associated w/ mitral regurg 2˚ to impaired mitral valve closure, therefore one would hear a **systolic** mumur
50
diastolic mumur best heard at the R sternal border is indicative of... diastolic mumur best heard at the L sternal border is indicative of...
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
52
delta wave
**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
STEMI in I, aVL leads
lateral wall - LCX
54
STEMI in V1-V4 leads
anterior wall (LAD)
55
STEMI in II, III aVF leads
inferior wall (RCA) may cause sinus node dysfunction
56
STEMI in V1, V2 leads
anteroseptal (LAD) infranodal Mobitz type II second deg or third deg block would be possible
57
STEMI in V4-V6 leads
anterolateral wall (LAD or LCX)

0. Step Ib (19 decks)

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