Cardiovascular Part B

Question 1

What is MI?

Answer 1

myocardial infarction- heart attack

Question 2

How is S3 best heard?

Answer 2

at the apex in L lateral with bell

Question 3

What is S3

Answer 3

A third heart sound, a ventricular filling sound, which may be normal (physiologic) or abnormal (pathologic)

Question 4

Physiologic S3 is common in…

Answer 4

children, young adults (40 and under) and usually disappears upon sitting up.

Question 5

In adults, S3 is…

Answer 5

usually abnormal (pathologic) and called a ventricular gallop or S3 gallop. The sound persists when sitting up.

Question 6

The third heart sound can be seen…

Answer 6

in heart failure or volume overload conditions such as mitral regurgitation.

Question 7

The gallop will disappear when…

Answer 7

you correct the primary condition.

Question 8

Describe the S4 sounds

Answer 8

• ventricular filling sound, very soft, low pitch sound
• heard just before the S1 with bell at apex in left lateral position
• may be physiologic or pathologic

Question 9

When does S4 occur?

Answer 9

when atria contract late in diastole

Question 10

When is S4 physiologic?

Answer 10

in adults 40-50, no heart disease, especially after exercise

Question 11

What are four causes of pathologic S4?

Answer 11

• Decreased compliance of ventricles (CAD, cardiomyopathy)
• Systolic overload (afterload)
• Outflow obstruction of ventricle (aortic sensations)
• Systemic hypertension

Question 12

What’s another name for S4?

Answer 12

atrial gallop or S4 gallop

Question 13

Describe the Murmur Grading System: I-VI

Answer 13

Grade I- barely audible
Grade II- clearly audible
Grade III- moderately loud
Grade IV- loud with thrill
Grade V- very loud with thrill. can hear with one corner of stethoscope lifted.
Grade VI- heard with stethoscope of chest. thrill palpable and visible

Question 14

What do systolic murmurs generally indicate?

Answer 14

May NOT indicate disease.

Question 15

What are the 2 types of systolic and diastolic murmurs?

Answer 15

Aortic Stenosis (abnormal narrowing of the aortic valve) & Mitral Regurgitation (mitral valve does not close properly when the heart pumps out blood)

Question 16

What do diastolic murmurs usually indicate?

Answer 16

Almost ALWAYS indicate pathology and need referral.

Question 17

Describe the sound of diastolic murmurs.

Answer 17

Softer, more difficult to hear than systolic.

Question 18

What is Homan’s sign?

Answer 18

pain in the calf of the leg upon dorsiflexion of the foot with the leg extended that is diagnostic of thrombosis in the deep veins of the area

Question 19

What is the Edema Grading Scale?

Answer 19

+1 Mild - slight indentation, no perceptible swelling
of leg.
+2 Moderate - pitting, but indentation subsides
rapidly.
+3 Deep - indentation remains for a short time, leg
appears swollen.
+4 Very Deep - indentation lasts a long time, leg is
very swollen.

Question 20

Describe Arterial insufficiency.

Answer 20

Decreases/absent pulse.
Bruits.
Pain w/ activity.
\_\_\_\_\_ with increase - Rubor with decrease.
Delayed capillary refill.

Question 21

Describe Venous insufficiency.

Answer 21

Normal pulse.
Brown pigmentation.
Edema.
Aching increase throughout day.
Stasis ulcers at ankle.