Cardiovascular Flashcards
PMI is usually heard where?
5th ICS mid-clavicular line
What conditions commonly cause displaced PMI?
Heart failure, cardiomyopathy, and pregnancy
How is PMI displacement different between cardiomyopathy and pregnancy?
In cardiomyopathy, it is usually displaced laterally >3cm
In pregnancy, usually displaced upward towards the left side
Deoxygenated blood enters the heart through what vessels and travels through which structures?
Inferior/Superior vena cava into the RA, tricuspid valve, RV, pulmonic valve, pulmonic artery, lungs and alveoli
Oxygenated blood exits the lungs and enters the heart through what vessel and travels through which structures?
Pulmonary veins, LA, mitral valve, LV, aortic valve, aorta, and general circulation
Which valves produce the S1 heart sounds heart during systole?
Atrioventricular valves (AV): Mitral, Tricuspid
Closure of the mitral and tricuspid valves produce which heart sound?
S1
Which valves produce the S2 heart sounds heart during diastole?
Semilunar valves: Aortic & Pulmonic
Closure of the aortic & pulmonic valves produce which heart sound?
S2
An extra sound, S3 is usually heard at what point in cardiac cycle and may indicate what condition(s)?
Just after S2, sounds like a faint whooshing. Generally due to ventricular filling such as HF, although can be normal in healthy children & adults <40yrs.
An extra sound, S4 is usually heard at what point and may indicate what condition(s)?
Just before S1 and is related to stiff, noncompliant ventricles. Usually indicated L. Ventricular Hypertrophy (LVH).
Can be normal in advanced age due to normal physiological stiffening of the ventricles.
High-pitched sounds such as mitral stenosis are best heard with what part of the stethoscope?
Bell
T/F, the diaphragm of the stethoscope is best to hear high pitched sounds?
False, is best for low-pitched sounds such as lung sounds, mitral regurgitation and aortic stenosis
A physiological S2 split is always a concerning finding, T/F?
False- it is a benign variant. It occurs during inspiration and disappears during expiration
Using the pneumonic, MR. ASS helps the examiner to remember which murmurs?
MR- Mitral Regurgitation
AS- Aortic Stenosis
SYSTOLIC
Using the pneumonic, ARMS helps the examiner to remember which murmurs?
Diastolic:
Aortic Regurgitation
Mitral stenosis
What are the murmur point landmarks?
2nd ICS RSB: Aortic 2nd ICS LSB: Pulmonic 3rd ICS LSB: Erb’s point 5th ICS LSB: Tricuspid 5th MCL: Mitral (Bicuspid) also PMI
When assessing murmur features, the pneumonic SCRIPT is used to organize what information?
S-Site heard C-character (soft, blowing, crescendo, descreshendo) R-Radiation I-Intensity (Grade 1-6) P-Pitch, low or high T-Timing, Systolic or Diastolic
A grade 3 murmur is found to be?
Loud, easily heard once stethoscope is placed on chest
A murmur that also has a palpable thrill is defined as what grade?
Grade 4
Grade 5 Murmur is defined as?
Very loud, will a thrill and audible with the edge of the stethoscope just off the chest
T/F a grade 1 murmur is very soft, barely audible and only under the best circumstances?
True
Which grade murmur is mild to moderately loud?
Grade 2
This murmur is called pansystolic (holosystolic). Sounds loud or blowing, best with the diaphragm. It heard at the apex of the heart (5th ICS/MCL) and may radiate into the axila.
Mitral Regurgitation (systolic)
A midsystolic ejection murmur that is harsh and loud, it is heard best with the diaphram over the 2nd ICS RSB with possible radiation into the neck is which murmur?
Aortic Stenosis (Systolic)
Patients with Aortic Stenosis should be advised about what risk?
To avoid physical exertion because of the risk of sudden death. Should be followed by a cardiologist.
Mitral Valve stenosis is what type of murmur?
Diastolic
This murmur is a low-pitched rumbling murmur heard during diastole (S2) at 5th ICS MCL with a sharp opening snap heard best w/ the bell?
Mitral Stenosis
A high-pitched diastolic murmur heard best at 2nd or 3rd ICS RSB or Erb’s point is indicative of?
Aortic Regurgitation
T/F benign murmurs may have a thrill?
False
The apex of the heart is also defined as this location?
5th ICS MCL
An apical murmur that occurs during S1 (systole) is what?
Mitral Regurgitation
An apical murmur that occurs during S2 (diastole) is what?
Mitral stenosis
A patient with S3 is suggestive of what disorder?
HF
A patient with S4 is suggestive of what disorder?
LVH
Where is the best place to hear a physiological split?
pulmonic area
New onset of murmur, chest pain, general malaise and fever, what condition must be suspected?
Bacterial endocarditis