Cardiovascular PD

Question 1

aortic stenosis

Answer 1

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

severe findings: late-peaking murmur, soft/lost S2, pulsus parvus et tardus (weak/small carotid upstroke)

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 
diastolic
heard best on expiration
at apex
L lateral decubitus

time to opening snap=associated w/ severity

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 - HF

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

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

Answer 23

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

Question 24

Korotkoff Sounds

Answer 24

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

Question 25

systolic murmurs

Answer 25

``` aortic stenosis mitral regurgitation pulmonic stenosis tricuspid regurgitation hypertrophic cardiomyopathy ventricular septal defect ```

Question 26

diastolic murmurs

Answer 26

aortic regurg mitral stenosis pulmonic regurg tricuspid stenosis

Question 27

continuous

Answer 27

PDA

Question 28

holosystolic

Answer 28

mitral regurg tricuspid regurg VSD

Question 29

how to differentiate aortic stenosis and HCM

Answer 29

valsalva inc HCM, dec aortic stenosis

Question 30

VSD

Answer 30

holosystolic (sim to MR)

Question 31

holosystolic murmurs

Answer 31

mitral regurg tricuspid regurgitation VSD

Question 32

young otherwise healthy female

Answer 32

MVP

Question 33

Marfan's

Answer 33

MVP

Question 34

immigrant | pregnant

Answer 34

mitral stenosis

Question 35

IV drug abuser

Answer 35

tricuspid regurg

Question 36

Turner syndrome or aortic coarctation

Answer 36

bicuspid AV early stenosis aortic regurgitation

Question 37

how to differentiate systolic click and opening snal

Answer 37

mitral valve disorders - proCLICK - stenoSNAP

Question 38

PDA murmur

Answer 38

continuous, machine-like

Question 39

small VSD murmur

Answer 39

loud, holosystolic | left lower sternal border

Question 40

loud S2

Answer 40

pulmonary HTN

Question 41

continuous murmur over back between scapula

Answer 41

coarctation of aorta

Question 42

fixed split S2

Answer 42

ASD | inc blood In R heart --> delayed closure of pulmonary valve

Question 43

ASD murmur

Answer 43

systolic murmur heard best over the left upper systolic border poss RV heave

Question 44

systolic ejection click

Answer 44

MR (bicuspid aortic valve)

Question 45

electrical wave that repetitively goes around a physical structure in the atrium (e.g. tricuspid valve annulus)

Answer 45

atrial flutter

Question 46

large "V-Waves" on a pulmonary artery wedge tracing

Answer 46

severe mitral regurgitation

Question 47

inspiration | mechanism/effect on heart sounds

Answer 47

inc VR to RA inc R heart sounds

Question 48

``` hand grip (mechanism/effect on heart sounds) ```

Answer 48

inc afterload inc of MR, AR, VSD dec HCM, AS later onset of MVP click/murmur

Question 49

valsalva or standing up | mechanism/effect on heart sounds

Answer 49

dec preload dec most murmurs (AS) inc HCM earlier onset of MCP click/murmur

Question 50

squatting or raising legs | mechanism/effect on heart sounds

Answer 50

inc VR, inc preload, inc afterload dec HCM inc AS, MR, VSD later onset of MVP click/murmur