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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
What does c wave in JVP represent?
mitral/tricuspid close causes small pressure rise --> mitral/tricuspid valve bulging into atrium
26
What does x descent in JVP represent?
atrial relaxation and downward displacement of tricuspid/mitral during ventricular contraction
27
What does v wave in JVP represent?
increase right atrial pressure/filling against closed tricuspid/mitral
28
What does y descent in JVP represent?
blood flow from RA to RV
29
What does JVP represent?
right atrial pressure
30
What does high JVP mean?
high right atrial pressure = right sided heart failure
31
What is difference LA and RA wave forms?
same wave form LA just slightly higher pressure
32
What does pulmonary capillary wedge pressure represent?
left atrial pressure = left ventricle diastolic pressure
33
What is pressure difference pulm artery, RV, RA?
all have similar diastolic pressure but | RA < RV < pulmonary artery
34
If you see right atrium pressure bigger than RV in diastole what should you think?
tricuspid stenosis
35
If you see tall v wave in RA and looks closer to RV pressure what should you think?
tricuspid regurgitation
36
If pressure LA ~20 and pressure LV = 120/10 what should you think?
mitral stenosis the diastolic pressure should be the same
37
If LV systolic pressure = 140 and aorta = 140/40 what should you think?
aortic regurgitation very low diastolic pressure in aorta b/c blood pumped back into LV
38
What should you think if wide pulse pressure but normal systolic BP?
aortic regurgitation
39
What should you think if there is a systolic gradient between LV and aorta?
aortic stenosis
40
Compare LA vs LV or RA vs RV in systole or diastole?
compare in diastole = when the mitral/tricuspid are open so atria and ventricles should have same pressure
41
If LA v wave elevated and looks like LV what should you think?
mitral regurgitation
42
If LV = 200 in systole and aorta = 120 what should you think?
aortic stenosis
43
How do you compare just AR to AS + AR?
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
What is difference aortic stenosis vs mitral regurgitation?
AS = have initial gap then ejection sound and crescendo-decrescendo systolic murmur MR = have holosystolic murmur
45
If you have a diastolic pressure gradient what does it mean?
stenosis of some valve!
46
If you have a systolic gradient LV and aorta what does it mean?
aortic stenosis
47
If you have loss of LV/aorta gradient in diastole what does it mean?
aortic regurgitation
48
If you have 140/40 BP and early diastolic murmur what should you think?
aortic regurgitation
49
What heart sounds in mitral stenosis?
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
What does it mean if there is no loud S1 and you have mitral stenosis?
valve degenerated/calcified/immobile
51
What causes exaggerated mitral stenosis?
- in exercise - in expiration - left lateral position - if shorter diastolic filling time - if squat
52
Why does mitral stenosis murmur increase with short filling interval?
less time for LA pressure to reduce, increase pressure gradient
53
Why use beta blocker in mitral stenosis?
to decrease HR, increase diastolic time, decrease pulmonary symptoms
54
What are signs of more severe mitral stenosis?
decreased interval S2 and O2
55
What position do you put someone in to increase sound of mitral stenosis?
put them in left lateral position
56
Where do you hear mitral stenosis murmur?
left 5th inter
57
Left 5th intercostal space at midclavicular line is which valve?
mitral
58
Lower left sternal border is which valve?
tricuspid
59
Upper left sternal border is which valve?
pulmonic
60
Upper right sternal border is which valve?
aortic
61
Which valve issues systolic murmurs?
``` MRS = mitral regurgitation systolic ASS = aortic stenosis systole ```
62
Which valve issues diastolic murmurs?
MSD = mitral stenosis diastolic | hARD =
63
What is mnemonic valve diseases and whether they are heard systole or diastole?
``` MRS = mitral regurgitation systole MSD = mitral stenosis diastole hARD = aortic regurgitation diastole ASS = aortic stenosis systole ```
64
Which murmurs increase with inspiration vs expiration?
RiLe = right inspiration, left expiration
65
Why do right sided heart sounds increase on inspiration?
during inspiration blood increased to heart [less intrathoracic P], more blood flow through right heart --> louder sounds
66
Why do left sided heart sounds increase on expiration?
during expiration --> push blood into systemic circulation [more intrathoracic P], more blood flow through left heart --> louder heart sounds
67
Whats common cause of mitral prolapse?
marfans, adult polycystic kidney disease
68
If tricuspid murmur what should you think?
IV drug user
69
If mitral murmur what should you think?
rheumatic fever
70
What part of atrial wave on pressure figure is S4?
S4 = peak of a wave = atrial contraction
71
What is measure of LV preload?
left ventricular end-diastolic pressure
72
What does high LVEDP mean? low LVEDP?
high LVEDP --> heart failure | low LVEDUP --> dehydration or hemorrhage
73
What is another pressure equivalent to LVEDP?
mean left atrial pressure
74
What is equation for CO?
CO = HR * SV
75
What is equation for SV?
SV = EDV - ESV = width of PV loop
76
What are the determinants of SV?
- preload - contractility - afterload
77
What is preload?
degree ventricle is distended before systole | bigger preload [aka bigger EDV] --> bigger SV
78
What kind of heart failure if ejection fraction < 50% normal?
systolic HF diastolic HF = normal ejection fraction

Cardio Exam 1 (16 decks)

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