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PCMI Exam 2 > Heart Sounds and the Cardiac Cycle > Flashcards

Heart Sounds and the Cardiac Cycle Flashcards

1
Q
  • What is systolic blood pressure?
A
  • The pressure exerted upon the artery during heart contraction
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2
Q
  • What is diastolic blood pressure?
A
  • The pressure exerted upon the artery wall during rest
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3
Q
  • What are the cardiac phases? How are each of these phases represented on an ECG?
A
  • Atrial Systole= P wave (also represents late ventricular diastole)
  • Atrial diastole=PR interval (slow conduction thru AV node)
  • Ventricular systole=QRS complex (atrial diastole/repolarization)
  • Late ventricular systole=ST segment
  • Ventricular diastole=T wave (ventricular repolarization)
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4
Q
  • What is represented by S1?
A
  • Closing of the AV valves (tricuspid and bicuspid)
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5
Q
  • What is represented by S2 (dub)?
A
  • Closure of the semilunar valves (aortic and pulmonary)
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6
Q
  • What is represented by S3 (Kentucky)?
  • When does it occur?
  • In which population is it commonly heard?
A
  • Blood filling relaxed and empty ventricle
  • after S2
  • Children; pathologically in adults
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7
Q
  • What is represented by S4 (tenessee)?
  • When does this sound occur?
A
  • Atrial filling from high pressure of SVC/IVC and pulmonary venous return
  • Before 1st heart sound (s1)
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8
Q
  • What can cause abnormal valvular heart sounds?
  • How are they identified?
A
  • Regurgitation
    • Blood going in opposite direction that it should
  • Stenosis
    • Turbulent flow when blood is moving thru a stiff damaged valve
  • Identified based off of when they occur in the cardiac cycle?
    • Systolic murmur=ventricular systole
    • Diastolic murmur=ventricular diastole
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9
Q
  • Where are the ascultation locations on the chest?
A
  • APTM (All Physicians Take Money)
  • Aortic R 2nd ICS
  • Pulmonic L 2nd ICS
  • Tricuspid L 4th ICS
  • Mitral L 5th ICS Mid clavicular line*
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10
Q
  • How are heart murmurs graded?
A

1 is lowest grade and 6 is the highest

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11
Q
  • What are the characteristics of a grade 1 murmur?
A
  • Soft
  • Heard in quiet surroundings
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12
Q
  • What are the characteristics of a grade 2 murmur?
A
  • Soft
  • Heard in noisy surroundings
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13
Q
  • What are the characteristics of a grade 3 murmur?
A
  • Prominent heard murmurs
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14
Q
  • What are the characteristics of a grade 4 murmur?
A
  • Loud
  • With Thrill
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15
Q
  • What are the characteristics of a grade 5 murmur?
A
  • Loud
  • Heard against edge of stethescope when tilted against chest
  • Thrill present
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16
Q
  • What are the characteristics of a grade 6 murmur?
A
  • Loud
  • Heard 5-10 mm from chest
  • Has thrill
17
Q
  • What types of valvular stenosis can be detected during ventricular systole?
A
  • Aortic stenosis
  • Pulmonic stenosis
18
Q
  • What types of valvular stenosis can be heard during atrial systole?
A
  • Tricuspid stenosis
  • Mitral stenosis
19
Q
  • What are the two key points when trying to identify a murmur?
A
  • Location
  • Is the sound occurring during systole or diastole
20
Q
  • What side of the heart is louder during inspiration?
  • What positions on chest ascultation is reflected here?
A
  • RINspiration (right side louder during inspiration)
  • T and P
21
Q
  • Which side of the heart is louder during expiration?
  • Which areas of ascultation does this coincide with?
A
  • LEXpiration (left side of the heart is louder during expiration)
  • M and A (mitral and aortic)
22
Q
  • Does an increase in preload cause a softer or louder heart sound?
A
  • Trick question**
  • Depends on case
  • With normal individual, increase in preload is normally louder than a decrease in preload
  • Exception: HOCM and MVP
23
Q
  • Does a decrease in preload cause a softer or louder heart sound?
A
  • Trick question
  • In a normal individual, a decrease in pre-load will lead to softer heart sounds
  • OPPOSITE is true for HOCM and MVP*
24
Q
  • How come increases in preload creates a softer heard murmur in HOCM?
  • How come decreases in preload cause a louder heard murmur in HOCM?
A
  • Increases make softer sound (improve murmur) b/c septum is pushed from outflow tract and blood can flow more easily
  • Decreases make louder sound (more prominent murmur) becasue less blood can pass over enlarged interventricular septum and be ejected out of the aorta (obstruction and disruption of blood flow)
25
Q
  • Why are MVP murmurs quieter with an increase in pre-load? Opposite of what you would expect in a normal murmur
A
  • Increase in pre-load improves mid-systolic click heard w. MVP by allowing prolapsed leaflets to return to their normal orientation
26
Q
  • What are the effects of afterload on murmurs? (NORMAL NOT EXCEPTION)
A
  • Increased afterload=LOUDER
  • Decreased afterload=SOFTER
  • Exceptions (HOCM and MVP)
27
Q

BOARDS Q!!

  • What is the most likely case presentation of Aortic stenosis?
  • What is the murmur ?
A
  • OLD-SAD (syncope, angina, dyspnea); calcified aortic valve; radiates up into carotids
  • Crescendo-Decrescendo murmur
28
Q
  • What is mitral regurgitation commonly caused by?
  • Where is it heard?
  • Where does it radiate?
  • What type of murmur is it?
A
  • Rheumatic fever (Rheu-mitral)
  • Apex (5th intercostal space)
  • Axilla
  • Holosystolic murmur
29
Q
  • What is the common case presentation in a patient with tricuspid regurgitation?
  • What type of murmur is this?
A
  • IVDA (Want to TRI some drugs?)
  • Holosystolic murmur
30
Q
  • What are the common case presentations for patients with aortic regurgitation?
  • What type of murmur is it?
A
  • Connective tissue disorders, Marfan’s
  • Head bobbing, Water-Hammer pulse, Femoral bruits
  • early blowing diastolic murmur (AR there she BLOWS)
31
Q
  • What is the common case presentation in an individual with mitral stenosis?
  • What is a key characteristic of this murmur?
A
  • Rheu-mitral (history of rheumatic fever)
  • Opening Snap is Mitral Stenosis (OS is MS-The operating system is microsoft)
32
Q
  • What is important about HOCM?
  • What maneuvers can you use to identify it?
A
  • Genetic; family history of individual with sudden death at a young age
  • Maneuvers used to identify
    • Louder with decreased preload
    • Louder with decreased afterload
    • Softer with increased preload
    • Softer with increased afterload
33
Q
  • What is unique about mitral valve prolapse?
  • What is the commmon case presentation?
A
  • Midsystolic click common in those affected with myxomatous valvular disease (See the MVP to be the MVP and everything will click)
  • Young women with psychiatric history (anxiety and depression)
34
Q

What embryological defects can cause murmurs? (TRIGGERED)

A
  • ASD
  • PDA
  • VSD

PCMI Exam 2 (11 decks)

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