Final: Concepts in Cardiac and Heart Sounds DSA

Question 1

What can cause a fixed split S2?

Answer 1

Usually an ASD, but R HF can cause it too

Question 2

What is the most common cause of a delayed A2 that moves closer to P2 on inspiration?

Answer 2

LBBB is the main cause of paradoxical splitting

Question 3

When is an S3 sound heard?

Answer 3

Normal in children, in adults its due to volume overload and dilated cardiomyopathy

D=S3

Question 4

What does an S4 sound mean?

Answer 4

Atrial contraction against a non-compliant ventricle

Question 5

When would you hear an S4?

Answer 5

Ventricular hypertrophy in:

• Aortic stenosis
• HTN
• Hypertrophic cardiomyopathy
• CAD

Question 6

What pathology would cause an opening snap followed by a diastolic rumble?

Answer 6

Mitral stenosis

-usually due to rheumatic heart disease

Question 7

Mid systolic click followed by a late systolic murmur?

Answer 7

Mitral valve prolapse

-common in younger women and Marfans

Question 8

What grade of murmur: a very faint murmur, that youd have to listen for 5-6 beats while being tuned it?

Answer 8

Grade 1

Question 9

What grade of murmur: Quite, but still heard after a few beats?

Answer 9

Grade 2

Question 10

What grade of murmur: moderately loud, no thrill

Answer 10

Grade 3

Question 11

What grade of murmur: moderately loud, with thrill

Answer 11

Grade 4

Question 12

What grade of murmur: loud, thrill, heard with stethoscope partly off chest

Answer 12

Grade 5

Question 13

What grade of murmur: very loud, heard without stethoscope

Answer 13

Grade 6

Question 14

This pathology is the most common murmur in elderly. Due to abnormal calcification. Presents as cresendo-decresendo systolic murmur that radiates to the neck. You may also hear an S4 gallop.

Answer 14

Aortic stenosis

Question 15

What can cause aortic stenosis in those less than 50?

Answer 15

Bicuspid aortic valve

Question 16

What is the classic triad of aortic stenosis?

Answer 16

HF, angina, and syncope

Question 17

What is an Austin-Flint murmur?

Answer 17

It is due to rheumatic heart disease where you have both an AS and MS murmur

Question 18

Can you treat AS with vasodilators?

Answer 18

No, actually can make it worse. Usually valve replacement is the first choice

Question 19

This murmur is an early diastolic decresendo murmur. Heard best at the left sternal boarder (3rd space)

Answer 19

Aortic regurge

Question 20

What are some common causes of aortic regurge?

Answer 20

Endocarditis (valve deformity) and Type A dissection
-expect cardiogenic shock symptoms!

Also syphilis

Question 21

What can chronic AR cause?

Answer 21

LV hypertrophy and volume overload, leading to left heart failure

Question 22

What is treatment of choice for aortic regurge?

Answer 22

ACEi/ARBs + diuretics

Question 23

This murmur is a holosystolic murmur that radiates to R sternal boarder that increases in intensity with inspiration.

Answer 23

Tricuspid regurge.

Question 24

What are 2 common causes of tricuspid regurge?

Answer 24

1. RV dilatation due to pulmonary HTN** or Left HF
2. Acute endocarditis (staph aureus and IVDU)

also look out for carcinoid syndrome and ebstein anomaly

Question 25

What conduction abnormality is common with mitral stenosis?

Answer 25

A-fib

Question 26

How does the duration of time b/t S2 and the opening snap of MS compare to the severity of disease?

Answer 26

They are inversely related! | -the more severe the disease, the higher the LA pressure, the early the opening snap will be heard

Question 27

What would a chest x-ray show on someone with a MS show?

Answer 27

1. Prominent pulmonary artery vascularity 2. An enlarged LA 3. Normal sized LV

Question 28

What is the most common congenital heart disease diagnosed in adulthood (after bicuspid aortic valve)?

Answer 28

An Atrial septal defect

Question 29

If I said a systolic ejection murmur at LSB that causes a fixed split between P2 and A2, and can lead to A-fib?

Answer 29

ASD

Question 30

What is the most common congenital defect in kids?

Answer 30

VSD

Question 31

Do smaller or larger VSDs produce murmurs?

Answer 31

Smaller ones | -have to force the blood through a smaller hole

Question 32

If I said a continuous, machine-like murmur that is heard at the LUSB and causes cyanosis of the LE and Pulmonary HTN, what would you say?

Answer 32

PDA

Question 33

What is a rapid rise and fall with an elevated systolic and low diastolic pressure found in radial or brachial pressures a sign of?

Answer 33

Chronic aortic regurge