Cardiovascular PD

Question 1

aortic stenosis

Answer 1

harsh
systolic
crescendo-decrescendo
aortic area (R 2nd intercostal)
radiates to carotid area

Question 2

aortic regurgitation

Answer 2

blowing 
diastolic
decrescendo
Erb's point
heard best leaning forward

Question 3

mitral regurgitation

Answer 3

harsh 
systolic
holosystolic (plateau)
heard at apex (mitral)
radiates to left axilla

Question 4

mitral stenosis

Answer 4

loud S1 w opening snap
rumbling mid diastolic
heard best on expiration
at apex
L lateral decubitus

Question 5

pericardial friction rub

Answer 5

High frequency scratching noise.
Mainly in L precordial area.
Exacerbated by inspiration, leaning forward, left lateral decubitus position.
Inflammation of pericardium causes friction in walls which generates noise

Question 6

pulse amplitude scale

Answer 6

0: no palpable pulse
1+: diminished (weak, thready)
2+: normal, brisk, expected
3+: bounding, hyperdynamic

Question 7

dicrotic notch forms from

Answer 7

aortic valve closing

Question 8

a wave

Answer 8

increase in R atrial pressure produced by R atrial contraction

less robust (unless pathologic)

Question 9

c wave

Answer 9

start of systole.

Tricuspid closes and bulges into atrium.

Question 10

x descent

Answer 10

decrease in R atrial pressure.

Caused by R atrial relaxation

Question 11

v wave

Answer 11

Increase in R atrial pressure.

Due to filling with blood from IVC during ventricular systole (tricuspid closed)

Question 12

y descent

Answer 12

Decrease in R atrial pressure due to opening of tricuspid valve at end of ventricular systole

Question 13

diaphragm

Answer 13

High Pitched.

S1, S2, some murmurs, friction rubs.

Question 14

bell

Answer 14

Low Pitch.

SD3, S4, some murmurs

Question 15

S1 sound

Answer 15

start of ventricular contraction.

Closure of AV valves (T, M)

Question 16

S2 sound

Answer 16

End of ventricular contraction.

Closure of semilunar valves (aortic, pulmonic)

Question 17

S3 sound

Answer 17

Low pitched sound in early diastole.
Follows S2.
Rapid filling of dilated ventricle causing AV apparatus to tense and vibrate.
May be normal in young adults.

VOLUME OVERLOAD TO VENTRICLE

Question 18

S4 sound

Answer 18

Low pitched sound in late diastole.
Precedes S1.
Aorta contracting forcefully against a STIFF VENTRICLE

Question 19

intensity scale of cardiac murmurs

Answer 19

1: very faint, may not be heard in all positions
2: quiet but recognizable
3: moderately loud
4: loud murmur with palpable thrill
5: loud with palpable thrill, heard w only rim of stethoscope on chest
6: very loud, heard with stethoscope off chest

Question 20

hepatojugular reflex

Answer 20

For volume overload.

Pressure on RUQ –> blood flows up jugular vein

Question 21

resonant percussion sound

Answer 21

Air.

Ex: over lung

Question 22

dull percussion sound

Answer 22

solid

ex: over heart

Question 23

how can you enhance a murmur?

Answer 23

have patient do valsalva maneuver

Question 24

Symptoms of cardiac disease (ask these questions to anyone complaining of chest pain)

Answer 24

Palpitations.
Dyspneas (SOB: resting or exertional).
Syncope.
Fatigue.
Dependent edema.
Cyanosis.

Question 25

Korotkoff Sounds

Answer 25

I: 2 consectutive beats (systolic BP)
II: soft, longer sounds
III: loud, crisp sounds
IV: begins to muffle
V: sounds disappear (diastolic BP)