Cardiology

Question 1

used for Mid to high pitched sounds
* Mitral Regurgitation
* Aortic Stenosis

Answer 1

Diaphragm

Question 2

used for low tones such as S3, S4

Answer 2

Bell

Question 3

Closure of the mitral and tricuspid valve (AV
valves).
* Best heard 5th intercostal space, L side.

Answer 3

S1 (systole) ”lub”

Question 4

Closure of the aortic and pulmonic valves
(semilunar valves).
* Best heard 2nd intercostal space, L side.
* Normal during inspiration, abnormal if heard
on expiration.

Answer 4

S2 (diastole) “dub”

Question 5

Fluid overload: CHF, pregnancy.
* Normal: children, athletes, pregnancy.
* Best heard 5th intercostal space, L side

Answer 5

S3

Question 6

Stiff L ventricle: LVH.
* Normal: elderly due to atherosclerotic vessels.
* Best heard 5th intercostal space, L side.

Answer 6

S4

Question 7

Cause: failure of the heart’s function as a pump.
* Symptoms: acute or gradual dyspnea, fatigue, dry cough, lower extremity
edema, pulmonary edema, ascites. S3 sound. SOB worse with exercise or
while laying dow

Answer 7

CHF

Left-sided failure: blood backs up into the lungs (L for LUNGS).
Right-sided failure: lower extremity edema, jugular venous distention

Risk factors: coronary artery disease, hx MI, HTN, DM, heart valve disease.
* Treatment: stop smoking, physical exercise, limit NA, diuretics, BP meds.

Question 8

Cause: bacterial infection of the heart lining/valves.
* Symptoms: fever, chills, malaise, new murmur, splinter hemorrhages on nail
beds, petechia on palate.
* Osler nodes: tender, purple-pink nodules found on distal fingers/toes.
* Janeway lesions: irregular, non-tender, erythematous macules or papules on hands and soles.
* Risk factors: older age, artificial valves, IV use, poor dental hygiene.
* Treatment: antibiotics, surgery.

Answer 8

Ineffective Endocarditis (IE)

Question 9

irregular, non-tender, erythematous macules or papules on hands and soles.

Answer 9

Janeway lesions- assc. with infective endocarditis

Question 10

tender, purple-pink nodules found on distal fingers/toes.

Answer 10

osler nodes- assc. with ineffective endocarditis

Question 11

• Prophylaxis tx before dental procedure for eneffective endocarditis

Answer 11

Amox 2g (adult), 50mg/kg (children)

Question 12

A bulge or swelling in the aorta. Dissecting: tear in the inner layer of
the aorta.
* Cause: tear in the inner layer of the aorta.
* Symptoms: AAA can be asymptomatic. With a tear: sudden onset of
severe, sharp, excruciating pain on abdomen, flank, or back, hypotension, abdominal distension.
* Risk factors: older age, smokers, HTN.
* Treatment: surgery, meds.

Answer 12

Dissecting Abdominal Aortic Aneurysm (AAA)

Question 13

• Cause: abnormal heart rhythm. Short circuit in the heart causes atria to pump rapidly. Can cause clot to form, leading to stroke or death.
• Symptoms: sudden SOB, fatigue, angina, palpitations, lightheadedness, syncope,
  fluid retention. Pulse >110bpm with hypotension.
• Risk factors: HTN, CAD, ACS, caffeine, nicotine, alcoholism, heart failure, LVH, PE,
  COPD, sleep apnea.
• Treatment: BB (metoprolol), CCB (diltiazem), digoxin, warfarin.
• Patient education: avoid stimulants (caffeine, nicotine, decongestants).

Answer 13

Atrial Flutter/Atrial Fibrillation

Question 14

Atrial Fibrillation INR goal

what if Synthetic/Prosthetic Valves?

Answer 14

INR 2-3
Synthetic/Prosthetic Valves= INR 2.5-3.5