Cardio6

Question 1

What are the different types of splitting?

Answer 1

Normal
Wide
Fixed
Pardoxical

Question 2

Physiology of Normal Splitting:
Inspiration -> Drop in ___________ -> INcrease return to the _____ -> INcreased RV _________ -> INcreased RV __________ -> Delayed closure of _____________.

Answer 2

Intrathoracic pressure
Right Ventricle
Stroke Volume
Ejection time
Pulmonic Valve

Question 3

What also contributes to the delayed closure of the pulmonic valve during Inspiration (causing Normal splitting)?

Answer 3

DEcreased Pulmonary Impedance

INcreased capacity of Pulmonary circulation

Question 4

In what conditions do you hear Wide splitting?

Answer 4

Delayed RV emptying:

• Pulmonic stenosis
• Right bundle branch block

*Delayed RV emptying causes delayed pulmonic sound (regardless of breath). An exaggeration of normal splitting

Question 5

What condition do you hear Fixed Splitting?

Answer 5

Atrial Septal Defect (ASD)

*ASD -> left-to-right shunt -> INreased RA & RV volumes -> INcreased flow through pulmonic valve

Question 6

What conditions do you hear Paradoxical splitting?

Answer 6

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

Question 7

What are the 4 areas of heart ausculatation?

Answer 7

“APT M”

Aortic area
Pulmonic area
Tricuspid area
Mitral area

Question 8

What type of murmur do you hear at the Aortic area?

Answer 8

Systolic murmur:

• Aortic stenosis
• Flow murmur
• Aortic valve sclerosis

Question 9

What type of murmur do you hear at the Pulmonic area?

Answer 9

Systolic ejection murmur:

• Pulmonic stenosis
• Flow murmer

Question 10

What type of murmur do you hear at the Tricuspid area?

Answer 10

Pansystolic murmur:
 - Tricuspid regurgitation
 - Ventricular septal defect
Diastolic murmur:
 - Tricuspid stenosis
 - Atrial septal defect

Question 11

What type of murmur do you hear best at the mitral area?

Answer 11

Systolic murmur:
- Mitral regurgitation
Diastolic murmur:
- Mitral stenosis

Question 12

What murmurs are best heard at the Left Sternal Border?

Answer 12

Diastolic murmur:
 - Aortic regurgitation
 - Pulmonic regurgitation
Systolic murmur:
 - Hypertrophic cardiomyopathy

Question 13

Bedside maneuver: Inspiration

Answer 13

INcrease intensity of Right Heart sounds

Question 14

Bedside maneuver: Expiration

Answer 14

INcrease intensity of Left Heart sounds

Question 15

Bedside maneuver: Hand Grip

Answer 15

INcrease Intensity:

• Mitral Regurgitation
• Aortic Regurgitation
• Ventricular Septal Defect
• Mitral Valve Prolapse

DEcrease intensity:

• Aortic Stenosis
• Hypertrophic cardiomyopathy

Question 16

What does the Hand Grip maneuver do?

Answer 16

INcreases Systemic Vascular Resistance

Question 17

Bedside maneuver: Valsalva

Answer 17

DEcreases intensity of most murmurs

INcreases intensity:

• Mitral valve prolapse (MVP)
• Hypertrophic cardiomyopathy murmurs

Question 18

Bedside maneuver: Rapid Squatting

Answer 18

DEcrease intensity of:

• MVP
• Hypertrophic cardiomyopathy murmurs

Question 19

What does rapid squatting do?

Answer 19

INcreases Venous return
INcreases Preload
INcreases Afterload with prolonged squatting

Question 20

Systolic heart sounds include:

Answer 20

Aortic/Pulmonic Stenosis
Mitral/Tricuspid Regurgitation
Ventricular septal defect

Question 21

Diastolic heart sounds include:

Answer 21

Aortic/Pulmonic Regurgitation

Mitral/Tricuspid Stenosis