Cardiovascular

Question 1

Systole events:

Answer 1

closing of the tricuspid and mitral valves
opening of the aortic and pulmonary valves
ventricular contraction (high pressure)
S1 sound (high-pitched)

Question 2

Diastole events:

Answer 2

closing of the aortic and pulmonary valves
opening of the tricuspid and mitral valves
ventricular relaxation/filling (low pressure)
S2 sound (low-pitched)

Question 3

NSR is?

Answer 3

Normal Sinus Rhythm - 60-100bpm

Question 4

What is the inherent rate of the SA node?

Answer 4

75bpm

Question 5

What is the inherent rate of the AV node?

Answer 5

60bpm

Question 6

What happens if both the SA & AV nodes fail? (escape rhythm)

Answer 6

There is still some inherent rhythm set by the Bundle of Hiss and bundle branches, but it is slow (30-40bpm) and doesn’t progress in the normal direction/coordination.

Question 7

Extreme tachycardia:

Answer 7

150-250bpm

Question 8

Extreme bradycardia:

Answer 8

<30bpm (escape rhythm)

Question 9

What are 5 important questions to ask in your cardio Hx?

Answer 9

1. Pain (chest, arm, back, neck, jaw - on exertion?)
2. Palpitations?
3. Syncope, dizziness, lightheaded?
4. SOB, DOE, PND, orthopnea?
5. Edema?

Question 10

Orthostatic hypotension is dx at:

Answer 10

> 20mm fall in systolic BP

Question 11

General appearance to look for in CV dz?

Answer 11

Acute distress, ease of breathing, cyanosis, alertness, mobility, weight loss.
Syndromes - Turners, Marfans, Downs.

Question 12

Assess peripheral pulses for:

Answer 12

rate & rhythm
intensity
symmetry
variations - beat to beat, with respiration

Question 13

Assess carotid pulse:

Answer 13

intensity
symmetry
auscultate for murmurs and carotid bruits

Question 14

What questions would you ask a pt with palpitations?

Answer 14

SOB
dizziness
syncope
weakness
(pain - but less likely in women)

Question 15

Variation of heart rate that occurs during respiration:

Answer 15

Respiratory Sinus Arrhythmia (RSA)

Question 16

Where would you auscultate the aortic valve?

Answer 16

2nd intercostal space RIGHT of the sternum

Question 17

Where would you auscultate the pulmonary valve?

Answer 17

2nd intercostal space LEFT of the sternum

Question 18

Where would you auscultate the tricuspid valve/RV?

Answer 18

lower left half of the sternum and parasternal area

Question 19

Where would you auscultate the mitral valve/LV?

Answer 19

5th intercostal space at/just medial to the midclavicular line

Question 20

What is Erb’s point?

Answer 20

point where S2 is best auscultated, located at 3rd intercostal space left of the sternum

Question 21

Are S3 and S4 heart sounds normal?

What does each signify?

Answer 21

Not in adults. S3 may be normal in kids.
S3 sound is d/t noncompliant, dilated ventricle, heard in early diastole.
S4 sound is d/t augmented ventricular filling caused by atrial filling, heard in late diastole.

Question 22

Turbulent blood flow through a valve or outflow tract:

Answer 22

Ejection murmur (systolic)

Question 23

Sound d/t retrograde or abnormal flow:

Answer 23

Regurgitant murmur (systolic)

Question 24

Sound d/t abnormal openings btw vessels/chambers:

Answer 24

Shunt murmur (systolic)

Question 25

Are diastolic murmurs ever normal?

Why might you hear one?

Answer 25

No! Never.

D/t aortic/pulmonary regurgitation w/relaxation, or mitral/tricuspid valve stenosis.

Question 26

What causes a pericardial friction rub?

Answer 26

Inflamed visceral and pericardial pleural friction, causes a high-pitched squeaking. “ziplock bag of mayonnaise”

Question 27

What are three additional things to check if you suspect cardiovascular issues?
(3 L’s)

Answer 27

Lungs
Liver (abdomen, spleen, abd aorta)
Legs (edema, veins, ulcers)