Harvey

Question 1

S1 is caused by (2)

Answer 1

Closure of mitral and tricuspid valves

Indicates beginning of systole

Question 2

S2 is caused by (2)

Answer 2

Closure of aortic and pulmonary valves

Indicates beginning of diastole

Question 3

Systolic murmurs concide with

Answer 3

Carotid pulse

Question 4

Do diastolic murmurs coincide with the carotid pulse

Answer 4

NO

Question 5

Physiological splitting of S2 (5)

Answer 5

Occurs during inspiration
Intrathoracic pressure decreases increasing venous return to right side of heart
the increased right ventricular volume increases right ventricular ejection time
The aortic component is louder than the pulmonary component
Heard at left 2nd intercostal space at sternal border

Question 6

When is splitting of S2 pathological

Answer 6

When it happens in both inspiration and expiration

Question 7

3rd heart sound (3)

Answer 7

Is both physiological and pathological depending on patient
Common cause of S3 is Left ventricular systolic dysfunction
Patients should get echocardiography done to assess left ventricle performance

Question 8

4th heart sound (6)

Answer 8

Occurs in late diastolic before S1
It is a low frequency sound
Always pathological
Due to atrial contraction causing blood flow into stiff ventricle
Common causes are Myocardial ischaemia, hypertension and aortic stenosis
Patients should get echocardiography to assess LVH or aortic stenosis

Question 9

Cause of murmurs

Answer 9

Turbulent blood flow

Question 10

Description of murmur (5)

Answer 10

Intensity (grading)
Character and pitch
Timing
Location
Radiation

Question 11

Innocent murmur (2)

Answer 11

Occurs during systole
of turbulent flow in right ventricular outflow tract
Loudest in hyperdynamic - Fever, pregnancy, anaemia

Question 12

Innocent murmur characteristics (4)

Answer 12

Soft mid systolic
Heard in pulmonary area
Localized in one ausculatory area
No radiation or cardiac abnormalities

Question 13

Pathological murmur (2)

Answer 13

Caused by turbulent blood flow from cardiac abnormality

Can be during systole or diastole

Question 14

Pathological murmur characteristics (4)

Answer 14

Ejection systolic late peaking and pan systolic murmurs are pathological
Not localized - More than 1 ausculatatory area
Radiates to neck in aortic stenosis or axilla in mitral regurgitation
Associated with low volume pulse, thrills,palpable heaves and displaced apex)