Cardiovascular

Question 1

S1

Answer 1

• Lub
• Closure of AV (mitral, tricuspid) valves
• Loudest at APEX of heart
• Marks end of diastole, beginning of systole

Question 2

S2

Answer 2

• Dub
• Caused by closure of semilunar valves (aortic, pulmonic)
• Loudest at base
• End of systole, beginning of diastole
• Splits on inspiration
• Wide fixed split caused by RBBB
• S2 louder with PE

Question 3

Aortic Value Ascultation Point

Answer 3

2nd Intercostal space, R sternal boarder

Question 4

Pulmonic Valve Auscultation Point

Answer 4

2nd Intercostal Space, L Sternal Border

Question 5

Tricuspid Auscultation Area

Answer 5

Fifth intercostal space, L sternal boarder

Question 6

Mitral/Apical Auscultation point

Answer 6

5th intercostal space, midclavicular

Question 7

S3

Answer 7

• Rapid rush of blood into dilated ventricle
• occurs early in diastole
• Apex, using bell
• HF, heard before crackles
• Ventricular gallop, “kentucky”

Question 8

S3 - Additional Causes

Answer 8

• Pulm HTN
• Cor pulmonale
• Mitral, aortic, tricuspid insufficiency

Question 9

S4

Answer 9

• Atrial contraction of blood into noncompliant ventricle
• Occurs before S1
• Apex with bell
• Atrial gallop “tennessee”

Question 10

S4 Causes

Answer 10

• MI
• Infarction
• HTN
• Ventricular hypertrophy
• Aortic Stenosis

Question 11

Pericardial Friction Rub

Answer 11

• Pericarditis
• Deep pain on inspiration
• May be positional

Question 12

Pulse Pressure

Answer 12

=Systolic-diastolic

Question 13

Normal Pulse Pressure

Answer 13

40-60 mmHg

Question 14

Narrow Pulse Pressure

Answer 14

• Drop in Cardiac Output

- Severe Hypovolemia

Question 15

Widened Pulse Pressure

Answer 15

• Decrease in SVR (systemic vascular resistance)
• Vasodilation
• Sepsis

Question 16

When do coronary arteries perfuse?

Answer 16

Diastole

Question 17

Two Types of Valvular Disease

Answer 17

• Insufficiency

- Stenosis

Question 18

Is Systole or Diastole longer?

Answer 18

Diastole is 1/3 longer

Question 19

Causes of valvular Heart Disease

Answer 19

• Coronary Artery Disease
• Ischemia
• MI
• Dilated Cardiomyopathy
• Degeneration
• Rheumatic Fever
• Infection
• Connective Tissue Disease

Question 20

This type of murmur occurs when valve is closed…

Answer 20

Insufficiency, acute or chronic

Question 21

This type of murmur occurs when valve is open…

Answer 21

Stenosis, chronic only

Question 22

Systolic Murmur Sound

Answer 22

Lub - shhhh - dub

Question 23

Systolic Murmurs

Answer 23

Semilunar Stenosis
-Aortic stenosis
-Pulmonic Stenosis
AV Insufficiency
-Mitral Insufficiency
-Tricuspid Insufficiency

Question 24

Diastolic Murmur Sound

Answer 24

Lub - Dub - Shhhh

Question 25

Types of Diastolic Murmurs

Answer 25

Semilunar Insufficiency
-Aortic Insufficiency
-Pulmonic Insufficiency
AV Stenosis
-Mitral Stenosis
-Tricuspid Stenosis

Question 26

Unstable Angina

Answer 26

• Chest pain at rest
• Unpredictable
• Nitro may work
• Trops-
• ST Depression/T wave inversion

Question 27

NSTEMI

Answer 27

• Trops+
• ST Depression
• T Wave inversion
• Unrelenting Chest Pain

Question 28

STEMI

Answer 28

• Trop+
• ST elevation in 2 or more contiguous leads
• Unrelenting Chest Pain

Question 29

Variant or Prinzmetal’s Angina

Answer 29

• Unstable Angina
• Associated w/ transient ST elevation
• Coronary Artery Spasm
• At rest
• May be cyclic
• Nicotine, ETOH, Cocaine may be involved
• Trops-
• Nitro works

Question 30

Anticoags for MI

Answer 30

Heparin

Lovenox

Question 31

Antiplatelets for MI

Answer 31

• Plavix
• Abciximab (Reopro)
• Eptifibatide (Integrilin)
• Tirofiban (Aggrastat)

Question 32

Contraindications for Beta Blockers in MI

Answer 32

• Hypotension
• Bradycardia
• Phosphodiesterase-inhibitor drugs (viagra)

Question 33

How to Treat Pain in MI

Answer 33

-Nitro

Morphine

Question 34

Fibrinolytic Therapy Time Frame

Answer 34

Door to drug < 30 Minutes

Question 35

Percutaneous Coronary Intervention Time Frame

Answer 35

Door to balloon in 90 minutes