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Cardio Exam 1 > Exam Review > Flashcards

Exam Review Flashcards

1
Q

Which valve lesions increase with hand grip?

A

mitral regurgitation

aortic regurgitation

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2
Q

Which valve lesions decrease with hand grip?

A

aortic stenosis

hypertrophic cardiomyopathy murmur

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3
Q

What kind of murmur mitral regurgitation?

A

holo-systolic blowing murmur
soft S1

in acute = can be shorter

increases with expiration, hand grip

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4
Q

What kind of murmur tricuspid regurgitation?

A

holo-systolic blowing murmur

increases with inspiration

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5
Q

What kind of murmur aortic stenosis?

A

ejection sound
systolic crescendo-decrescendo murmur

no splitting S2 or paradoxical split [more split on expiration] = more severe
later peaking murmur = more severe

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6
Q

What kind of murmur mitral valve prolapse?

A

mid-systolic click then last systolic crescendo murmur

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7
Q

What kind of murmur aortic regurgitation?

A

early diastolic blowing murmur decrescendo
can also have mid systolic ejection murmur

in acute = can be shorter

increase with hand grip and expiration

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8
Q

What kind of murmur mitral stenosis?

A

loud S1
loud P2
opening snap then mid diastolic murmur with pre-systolic accentuation

shorter interval between S2 and OS

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9
Q

What kind of murmur hypertrophic obstructive cardiomyopathy?

A

ejection systolic murmur at left border

may have mitral regurgitation as well

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10
Q

What kind of murmurs increase with valsalva/standing?

A

hypertrophic obstructive cardiomyopathy

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11
Q

What kind of murmurs decrease with valsalva/standing?

A

almost all include AS [except hypertrophic cardiomyopathy]

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12
Q

What kind of murmurs increase with squatting?

A

AS and MVP

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13
Q

What kind of murmurs decrease with squatting?

A

hypertrophic obstructive cardiomyopathy

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14
Q

What is difference pressure R and L sides?

A

R pressure = 1/4 of L pressures

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15
Q

When are lungs [PCWP], pulmonary veins, LA and LV same pressure?

A

in diastole

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16
Q

What is pressure difference LV and aorta?

A

aorta>LV diastole

same in systole

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17
Q

When are central venous pressure, RA and RVEDP same?

A

in diastole

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18
Q

What is pressure difference RV and pulmonary artery?

A

pulmonary artery > RV diastole

same in systole

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19
Q

What differentiates systole from diastole [electric + valve]?

A 
systole = starts at WRS and ends at aortic valve closure
diastole = from aortic closure to R
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20
Q

What is S1 sound?

A

mitral valve closure

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21
Q

What is S2 sound?

A

aortic and pulmonary valves close [A2 then P2]

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22
Q

What is S3 sound?

A

rapid early diastolic flow into ventricle

associated with mitral regurg, CHF, dilated ventricles

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23
Q

What is S4 sound?

A

atrial contraction = atrial kick in late diastole

sign of high atrial pressure
associated with ventricular hypertrophy

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24
Q

What does a wave in JVP represent?

A

atrial contraction

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25
Q

What does c wave in JVP represent?

A

mitral/tricuspid close causes small pressure rise –> mitral/tricuspid valve bulging into atrium

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26
Q

What does x descent in JVP represent?

A

atrial relaxation and downward displacement of tricuspid/mitral during ventricular contraction

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27
Q

What does v wave in JVP represent?

A

increase right atrial pressure/filling against closed tricuspid/mitral

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28
Q

What does y descent in JVP represent?

A

blood flow from RA to RV

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29
Q

What does JVP represent?

A

right atrial pressure

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30
Q

What does high JVP mean?

A

high right atrial pressure = right sided heart failure

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31
Q

What is difference LA and RA wave forms?

A

same wave form LA just slightly higher pressure

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32
Q

What does pulmonary capillary wedge pressure represent?

A

left atrial pressure = left ventricle diastolic pressure

33
Q

What is pressure difference pulm artery, RV, RA?

A

all have similar diastolic pressure but

RA < RV < pulmonary artery

34
Q

If you see right atrium pressure bigger than RV in diastole what should you think?

A

tricuspid stenosis

35
Q

If you see tall v wave in RA and looks closer to RV pressure what should you think?

A

tricuspid regurgitation

36
Q

If pressure LA ~20 and pressure LV = 120/10 what should you think?

A

mitral stenosis

the diastolic pressure should be the same

37
Q

If LV systolic pressure = 140 and aorta = 140/40 what should you think?

A

aortic regurgitation

very low diastolic pressure in aorta b/c blood pumped back into LV

38
Q

What should you think if wide pulse pressure but normal systolic BP?

A

aortic regurgitation

39
Q

What should you think if there is a systolic gradient between LV and aorta?

A

aortic stenosis

40
Q

Compare LA vs LV or RA vs RV in systole or diastole?

A

compare in diastole = when the mitral/tricuspid are open so atria and ventricles should have same pressure

41
Q

If LA v wave elevated and looks like LV what should you think?

A

mitral regurgitation

42
Q

If LV = 200 in systole and aorta = 120 what should you think?

A

aortic stenosis

43
Q

How do you compare just AR to AS + AR?

A

AR = have diastolic murmur and can also have systolic ejection murmur

AS + AR = have diastolic murmur from AR and delayed peaking crescendo-decrescendo from AS + paradoxical splitting of S2 [more split in expiration] from AS

44
Q

What is difference aortic stenosis vs mitral regurgitation?

A

AS = have initial gap then ejection sound and crescendo-decrescendo systolic murmur

MR = have holosystolic murmur

45
Q

If you have a diastolic pressure gradient what does it mean?

A

stenosis of some valve!

46
Q

If you have a systolic gradient LV and aorta what does it mean?

A

aortic stenosis

47
Q

If you have loss of LV/aorta gradient in diastole what does it mean?

A

aortic regurgitation

48
Q

If you have 140/40 BP and early diastolic murmur what should you think?

A

aortic regurgitation

49
Q

What heart sounds in mitral stenosis?

A

loud S1 = rapid closure of mitral
loud P2 = pt has pulmonary HTN
diastolic opening snap [OS] then mid-diastolic murmur with pre-systolic accentuation

50
Q

What does it mean if there is no loud S1 and you have mitral stenosis?

A

valve degenerated/calcified/immobile

51
Q

What causes exaggerated mitral stenosis?

A
  • in exercise
  • in expiration
  • left lateral position
  • if shorter diastolic filling time
  • if squat
52
Q

Why does mitral stenosis murmur increase with short filling interval?

A

less time for LA pressure to reduce, increase pressure gradient

53
Q

Why use beta blocker in mitral stenosis?

A

to decrease HR, increase diastolic time, decrease pulmonary symptoms

54
Q

What are signs of more severe mitral stenosis?

A

decreased interval S2 and O2

55
Q

What position do you put someone in to increase sound of mitral stenosis?

A

put them in left lateral position

56
Q

Where do you hear mitral stenosis murmur?

A

left 5th inter

57
Q

Left 5th intercostal space at midclavicular line is which valve?

A

mitral

58
Q

Lower left sternal border is which valve?

A

tricuspid

59
Q

Upper left sternal border is which valve?

A

pulmonic

60
Q

Upper right sternal border is which valve?

A

aortic

61
Q

Which valve issues systolic murmurs?

A 
MRS = mitral regurgitation systolic
ASS = aortic stenosis systole
62
Q

Which valve issues diastolic murmurs?

A

MSD = mitral stenosis diastolic

hARD =

63
Q

What is mnemonic valve diseases and whether they are heard systole or diastole?

A 
MRS = mitral regurgitation systole
MSD = mitral stenosis diastole
hARD = aortic regurgitation diastole
ASS = aortic stenosis systole
64
Q

Which murmurs increase with inspiration vs expiration?

A

RiLe = right inspiration, left expiration

65
Q

Why do right sided heart sounds increase on inspiration?

A

during inspiration blood increased to heart [less intrathoracic P], more blood flow through right heart –> louder sounds

66
Q

Why do left sided heart sounds increase on expiration?

A

during expiration –> push blood into systemic circulation [more intrathoracic P], more blood flow through left heart –> louder heart sounds

67
Q

Whats common cause of mitral prolapse?

A

marfans, adult polycystic kidney disease

68
Q

If tricuspid murmur what should you think?

A

IV drug user

69
Q

If mitral murmur what should you think?

A

rheumatic fever

70
Q

What part of atrial wave on pressure figure is S4?

A

S4 = peak of a wave = atrial contraction

71
Q

What is measure of LV preload?

A

left ventricular end-diastolic pressure

72
Q

What does high LVEDP mean? low LVEDP?

A

high LVEDP –> heart failure

low LVEDUP –> dehydration or hemorrhage

73
Q

What is another pressure equivalent to LVEDP?

A

mean left atrial pressure

74
Q

What is equation for CO?

A

CO = HR * SV

75
Q

What is equation for SV?

A

SV = EDV - ESV = width of PV loop

76
Q

What are the determinants of SV?

A
  • preload
  • contractility
  • afterload
77
Q

What is preload?

A

degree ventricle is distended before systole

bigger preload [aka bigger EDV] –> bigger SV

78
Q

What kind of heart failure if ejection fraction < 50% normal?

A

systolic HF

diastolic HF = normal ejection fraction

Cardio Exam 1 (16 decks)

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