CCRN Cardiovascular Concepts_Assessment and Valvular Disease

Question 1

S2 sound is caused by the closure of which valves?

Answer 1

Aortic and Pulmonic (semilunar)

Question 2

Where is the S2 sound loudest?

Answer 2

The Base (right sternal border, 2nd ICS); base of the heart is the aortic area, where S2 (dub) is loudest.

Question 3

S2 marks the beginning of diaystole or systole?

Answer 3

Diastole

Question 4

S2 is louder with what type of embolism?

Answer 4

Pulmonary

Question 5

Anatomically, where is S1 (lub) the loudest?

Answer 5

The apex of the heart is the mitral area, where S1 (lub) is loudest. Anatomically it is at the 5th ICS, midclavicular

Question 6

S3 is an abnormal heart sound. What is it caused by?

Answer 6

S3 is caused by a rapid rush of blood into a dilated ventricle.

Question 7

S3 is associated with heart failure. What other conditions may cause it?

Answer 7

Pulmonary Hypertension, Cor Pulmonale, mitral, aortic, or tricuspid insufficiency

Question 8

Where would you hear S3 the best?

Answer 8

Apex of the heart (5th ICS), using the BELL because it is low frequency.

Question 9

What causes S4 sound?

Answer 9

Atrial contraction of blood into a non-compliant ventricle

Question 10

What conditions are S4 associated with?

Answer 10

Myocardial ischemia, infarction, hypertension, ventricular hypertrophy, aortic stenosis

Question 11

Why is S4 not heard in the presence of afib?

Answer 11

There is no atrial contraction

Question 12

What is the range for normal pulse pressure?

Answer 12

40 - 60 mmHg

Question 13

Which blood pressure is an indirect measurement of cardiac output and stroke volume?

Answer 13

Systolic

Question 14

What is a narrowing pulse pressure?

Answer 14

A decrease in systolic pressure with little change or an increase in diastolic pressure

Question 15

What type of pulse pressure is typically seen with severe hypovolemia or severe drop in cardiac output?

Answer 15

Narrow Pulse Pressure

Question 16

What type of blood pressure is an indirect measurement of systemic vascular resistence (SVR)?

Answer 16

Diastolic

Question 17

What type of pulse pressure is typically associated with vasodilation, a drop in SVR; often seen in sepsis, septic shock?

Answer 17

Wide pulse pressure

Question 18

The coronary arteries are perfused during systole or diastole?

Answer 18

Diastole

Question 19

Ejection, high pressure is associated with which phase of the cardiac cycle?

Answer 19

Systole

Question 20

Filling, low pressure is associated with which phase of the cardiac cycle?

Answer 20

Diastole

Question 21

Why do cardiac output and blood pressure drop with extreme tachyarrhythmias?

Answer 21

No time for filling, therefore less output

Question 22

What are some causes of valvular heart disease?

Answer 22

CAD, ischemia, acute MI, dilated cardiomyopathy, degeneration, Bicuspid aortic valve (genetic), Rheumatic fever, infection, connective tissue diseases

Question 23

A murmur of insufficiency is also called _______

Answer 23

Regurgitation

Question 24

Regurgitation occurs when the valves are open or closed?

Answer 24

CLOSED. Can be acute or chronic.

Question 25

Stenosis occurs when the valve is open or closed?

Answer 25

OPEN. It is a chronic problem that develops over time and is NOT ACUTE.

Question 26

What type of stenosis is associated with Afib d/t atrial enlargement that occurs over time?

Answer 26

Mitral Stenosis

Question 27

Ventricular Septal Defect (VSD), is most common with an acute MI. What type of murmur may results because of this?

Answer 27

Systolic

Heard at the left sternal border, 5th ICS

Question 28

What is Hypertensive Emergency or CRISIS?

Answer 28

elevated BP with EVIDENCE of end organ damage (brain, heart, kidneys, retina) that can be related to acute hypertensionW

Question 29

What is Hypertensive URGENCY?

Answer 29

elevated BP without evidence of end organ damage–usually no need for critical care admission.

Question 30

What 2 drugs are used in Hypertensive CRISIS or EMERGENCY

Answer 30

Nitroprusside (reduces both preload and afterload)

Labetalol (intermittent IV doses; effective 4-6 hours after dose is dc’d)

Question 31

What is the greatest risk associated with Hypertensive CRISIS/EMERGENCY?

Answer 31

Stroke