Harvey Flashcards
what generates heart sounds?
blood velocity changes / valve closure
what are the good and bad causes of a split heart sound?
good - larger volume
bad - slower contraction speed
S3 - when, sound, why
when - early-mid diastolic
sound - groaning
why - ventricular wall noise from resistance to filling
S4 - when, why
when - late diastolic, end of ventricular filling
why - ventricular wall resistance to atrial kick
what are the best ways to hear S3 and S4?
apex with the bell in left lateral recumbent position
RA pressure
0 - 5 mm Hg
RV pressure
30 / 5
pulmonary mean pressure
20
the pulmonary wedge pressure is equal to the pressure in what chamber? what is the pcwp?
LA
15
LV pressure
120/10
what is the order of naming convention for heart murmurs?
grade - cycle - intensity - radiation
what are the left sided systolic murmurs?
aortic stenosis
mitral regurgitation
hypertrophic cardiomyopathy
what are the right sided systolic murmurs?
pulmonic stenosis
tricuspid regurgitation
what are the causes of aortic stenosis?
age, calcification congenital disease (bicuspid valve) infective endocarditis
is aortic stenosis a left-sided or right-sided murmur? is it systolic or diastolic?
left sided
systolic
what is the cause of hypertrophic cardiomyopathy?
left ventricular outflow tract obstruction
is aortic regurg a left-sided or right-sided murmur? is it systolic or diastolic?
left sided
diastolic
what are the causes of aortic regurg?
endocarditis
root dilation
congenital (bicuspid valve)
CT disorder
is mitral stenosis a left-sided or right-sided murmur? is it systolic or diastolic?
left sided
diastolic
where does mitral stenosis radiate?
precordial area
what are the causes of mitral stenosis?
infectious endocarditis
calcific changes
does mitral regurg permit backward flow during systole or diastole?
systole
what are the causes of mitral regurg?
MVP from myxomatous degeneration endocarditis, rheumatic fever CT disease MI with papillary rupture pulmonary HTN
when is MV prolapse heard?
late systole
what is an austin flint murmur?
severe aortic regurgitation
is an austin flint murmur systolic or diastolic? where is it best heard?
mid-diastolic or pre-systolic
apex
what does an austin flint murmur sound like?
low pitched rumbling
what is the direction of flow in an austin flint murmur?
mixing of antegrade mitral valve blood and regurgitant blood from the aorta
what does a pericardial friction rub sound like? how is it heard best?
cabasa
leaning forward and exhaling
which condition is heard better upon doing a valsalva maneuver?
HCM
what does the hand squeeze do? which murmurs increase when doing a hand squeeze?
increases systolic gradient and intraventricular pressures
AR, MR, TR, VSD
what is the effect of hand squeezing on aortic stenosis?
decrease in intensity
what is the effect of hand squeezing on HCM?
decrease in intensity
the hand grip maneuver will decrease murmur intensity in what conditions?
aortic stenosis
HCM
mitral valve prolapse
the hand grip maneuver will increase murmur intensity in what conditions?
aortic regurg
mitral regurg
VSD
what is the effect of valsalva on blood return?
reduces return and LV volume
what is the effect of valsalva on stenoses?
increase
where / how is MR augmentation heard best?
left lateral recumbent
where / how is AS augmentation heard best?
reverse semi-fowler’s in exhalation (lean forward and exhale)
