Cardio6 Flashcards
Splitting
What are the different types of splitting?
Normal
Wide
Fixed
Pardoxical
Physiology of Normal Splitting:
Inspiration -> Drop in ___________ -> INcrease return to the _____ -> INcreased RV _________ -> INcreased RV __________ -> Delayed closure of _____________.
Intrathoracic pressure Right Ventricle Stroke Volume Ejection time Pulmonic Valve
What also contributes to the delayed closure of the pulmonic valve during Inspiration (causing Normal splitting)?
DEcreased Pulmonary Impedance
INcreased capacity of Pulmonary circulation
In what conditions do you hear Wide splitting?
Delayed RV emptying:
- Pulmonic stenosis
- Right bundle branch block
*Delayed RV emptying causes delayed pulmonic sound (regardless of breath). An exaggeration of normal splitting
What condition do you hear Fixed Splitting?
Atrial Septal Defect (ASD)
*ASD -> left-to-right shunt -> INreased RA & RV volumes -> INcreased flow through pulmonic valve
What conditions do you hear Paradoxical splitting?
Delayed Left Ventricle Emptying:
- Aortic stenosis
- Left bundle branch block
*normal order of valve closure is reveresed so that P2 sound occurs before delayed A2 sound. Therefore, on inspiration, P2 closes later and moves closer to A2, thereby “paradoxically” eliminating the split
What are the 4 areas of heart ausculatation?
“APT M”
Aortic area
Pulmonic area
Tricuspid area
Mitral area
What type of murmur do you hear at the Aortic area?
Systolic murmur:
- Aortic stenosis
- Flow murmur
- Aortic valve sclerosis
What type of murmur do you hear at the Pulmonic area?
Systolic ejection murmur:
- Pulmonic stenosis
- Flow murmer
What type of murmur do you hear at the Tricuspid area?
Pansystolic murmur: - Tricuspid regurgitation - Ventricular septal defect Diastolic murmur: - Tricuspid stenosis - Atrial septal defect
What type of murmur do you hear best at the mitral area?
Systolic murmur:
- Mitral regurgitation
Diastolic murmur:
- Mitral stenosis
What murmurs are best heard at the Left Sternal Border?
Diastolic murmur: - Aortic regurgitation - Pulmonic regurgitation Systolic murmur: - Hypertrophic cardiomyopathy
Bedside maneuver: Inspiration
INcrease intensity of Right Heart sounds
Bedside maneuver: Expiration
INcrease intensity of Left Heart sounds
Bedside maneuver: Hand Grip
INcrease Intensity:
- Mitral Regurgitation
- Aortic Regurgitation
- Ventricular Septal Defect
- Mitral Valve Prolapse
DEcrease intensity:
- Aortic Stenosis
- Hypertrophic cardiomyopathy
What does the Hand Grip maneuver do?
INcreases Systemic Vascular Resistance
Bedside maneuver: Valsalva
DEcreases intensity of most murmurs
INcreases intensity:
- Mitral valve prolapse (MVP)
- Hypertrophic cardiomyopathy murmurs
Bedside maneuver: Rapid Squatting
DEcrease intensity of:
- MVP
- Hypertrophic cardiomyopathy murmurs
What does rapid squatting do?
INcreases Venous return
INcreases Preload
INcreases Afterload with prolonged squatting
Systolic heart sounds include:
Aortic/Pulmonic Stenosis
Mitral/Tricuspid Regurgitation
Ventricular septal defect
Diastolic heart sounds include:
Aortic/Pulmonic Regurgitation
Mitral/Tricuspid Stenosis