Cardio6 Flashcards

Splitting

1
Q

What are the different types of splitting?

A

Normal
Wide
Fixed
Pardoxical

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2
Q

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

A
Intrathoracic pressure
Right Ventricle
Stroke Volume
Ejection time
Pulmonic Valve
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3
Q

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

A

DEcreased Pulmonary Impedance

INcreased capacity of Pulmonary circulation

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4
Q

In what conditions do you hear Wide splitting?

A

Delayed RV emptying:

  • Pulmonic stenosis
  • Right bundle branch block

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

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5
Q

What condition do you hear Fixed Splitting?

A

Atrial Septal Defect (ASD)

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

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6
Q

What conditions do you hear Paradoxical splitting?

A

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

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7
Q

What are the 4 areas of heart ausculatation?

A

“APT M”

Aortic area
Pulmonic area
Tricuspid area
Mitral area

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8
Q

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

A

Systolic murmur:

  • Aortic stenosis
  • Flow murmur
  • Aortic valve sclerosis
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9
Q

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

A

Systolic ejection murmur:

  • Pulmonic stenosis
  • Flow murmer
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10
Q

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

A
Pansystolic murmur:
 - Tricuspid regurgitation
 - Ventricular septal defect
Diastolic murmur:
 - Tricuspid stenosis
 - Atrial septal defect
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11
Q

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

A

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

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12
Q

What murmurs are best heard at the Left Sternal Border?

A
Diastolic murmur:
 - Aortic regurgitation
 - Pulmonic regurgitation
Systolic murmur:
 - Hypertrophic cardiomyopathy
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13
Q

Bedside maneuver: Inspiration

A

INcrease intensity of Right Heart sounds

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14
Q

Bedside maneuver: Expiration

A

INcrease intensity of Left Heart sounds

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15
Q

Bedside maneuver: Hand Grip

A

INcrease Intensity:

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

DEcrease intensity:

  • Aortic Stenosis
  • Hypertrophic cardiomyopathy
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16
Q

What does the Hand Grip maneuver do?

A

INcreases Systemic Vascular Resistance

17
Q

Bedside maneuver: Valsalva

A

DEcreases intensity of most murmurs

INcreases intensity:

  • Mitral valve prolapse (MVP)
  • Hypertrophic cardiomyopathy murmurs
18
Q

Bedside maneuver: Rapid Squatting

A

DEcrease intensity of:

  • MVP
  • Hypertrophic cardiomyopathy murmurs
19
Q

What does rapid squatting do?

A

INcreases Venous return
INcreases Preload
INcreases Afterload with prolonged squatting

20
Q

Systolic heart sounds include:

A

Aortic/Pulmonic Stenosis
Mitral/Tricuspid Regurgitation
Ventricular septal defect

21
Q

Diastolic heart sounds include:

A

Aortic/Pulmonic Regurgitation

Mitral/Tricuspid Stenosis