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Step One R&M > Heart sounds, EKGs, murmurs > Flashcards

Heart sounds, EKGs, murmurs Flashcards

1
Q

Missed beat not preceeded by prolonged PR intervals

A

2nd degree heart block, Mobitz type II

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2
Q

y descent

A

Blood flow from RA to RV

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2
Q

EKG of 2nd degree heart block, Mobitz type II

A

No change in PR interval with dropped beats, usually in a 2:1 P:QRS ratio

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3
Q

Effect of expiration

A

Increase LA return = increase mitral stenosis

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3
Q

Continuous machine-like murmur

A

PDA

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4
Q

Flow murmur with diastolic rumble

A

ASD

(rumble = increased flow across tricuspid valve)

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4
Q

Blowing holosystolic murmur loudest at left sternal border

A

TR

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5
Q

Which maneuvers increase the intensity of MR?

A

Squatting, hand grip

(anything that increases TPR)

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5
Q

U wave

A

Hypokalemia, bradycardia

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6
Q

What effect does hand grip have?

A

Increased systemic vascular resistance

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7
Q

a wave

A

RA contraction

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8
Q

No identifiable waves

A

V fib

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9
Q

Radiates to right sternal border

A

TR

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10
Q

What would you hear in a patient with pulmonic stenosis?

A

Wide splitting of S2

(increases on inspiration)

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11
Q

What correlates with severity of MS?

A

Increased severity = decreased duration between S2 and OS

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11
Q

Irregularly spaced QRS complexes

A

A fib

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11
Q

Leads V1-V2

A

Anterior septum (LAD)

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12
Q

Anterolateral (LAD or LCX) leads

A

V4-V6

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13
Q

Hand grip decreases the intensity of which murmurs?

A

Hypertrophic cardiomyopathy

AS

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14
Q

What would you hear in a patient with left bundle branch block (LAD occlusion)?

A

Paradoxical splitting

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14
Q

Wide pulse pressure

A

Chronic AR

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14
Q

EKG of 2nd degree heart block, Mobitz type 1

A

Progressive lengthening of PR interval followed by a missed beat (no QRS)

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15
Q

Leads V4-V6

A

Anterolateral (LAD, LCX)

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16
Q

What would you hear in a patient with aortic stenosis?

A

Crescendo-decrescendo murmur with paradoxical splitting

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17
Q

List 3 causes of MVP

A

Rheumatic fever, myxomatous degeneration (too much dermatan sulfate), chordae rupture

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18
Q

Leads V1-V4

A

Anterior wall (LAD)

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20
Q

What causes paradoxical splitting?

A

Delayed empyting of the LV

Aortic stenosis, left bundle branch block

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21
Q

c wave

A

Tricuspid valve bulging into RA during RV contraction

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21
Q

Wide splitting vs fixed splitting

A

Wide = increases even more on inspiration

Fixed = widended with no change with breathing

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21
Q

What causes WPW?

A

Increased conduction through accessory pathway from atria to ventricles (Bundle of Kent) so ventricles begin to depolarize earlier

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22
Q

MVP predisposes to:

A

IE

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23
Q

Describe Jervell and Lange-Nielson syndrome

A

Long QT + sensorineural deafness

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23
Q

Leads II, III, aVF

A

Inferior wall (RCA)

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24
Q

JV wave that’s absent in TR

A

X descent

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25
Q

Describe paradoxical splitting

A

A2 occurs after P2 and on inspiration P2 moves closer to A2, paradoxically eliminating the split

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26
Q

Atria and ventricles beat independently of each other

A

3rd degree heart block

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27
Q

When and where is a VSD best heard?

A

Left sternal border, 5th interspace

Pansystolic

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28
Q

Speed of pacemakers

A

SA > AV > Purkinje/bundles/ventricles

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29
Q

What cause pulsus parvus et tardus?

A

AS

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30
Q

Characteristic finding in WPW

A

Delta wave, shortened PR interval

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31
Q

Radiates to carotids

A

AS

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31
Q
A

A fib

(No P waves - irregularly spaced QRS’s)

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31
Q

Progressive increase in PR interval followed by dropped beat (QRS)

A

2nd degree heart block, Mobitz type I

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33
Q

x descent

A

Tricupsid valve going down into RV during atrial relaxation

Absent in TR

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35
Q

Which diastolic murmurs are heard best at left sternal border?

A

Aortic and pulmonic regurg

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35
Q

OS

A

MS

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35
Q

Delay through AV node

A

P interval

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37
Q

Decreases the intensity of AS and hypertrophic cardiomyopathy

A

Hand gripping

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38
Q

Long QT + deaf

A

Jervell and Lange-Nielson syndrome (AR)

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39
Q

Loudest at left infraclavicular area

A

PDA

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40
Q

Late systolic crescendo murmur

A

MVP

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41
Q

EKG of atrial flutter

A

Sawtooth appearance = identical back-to-back atrial depolarization waves

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42
Q

Sawtooth EKG

A

A flutter

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43
Q

Prognosis of 1st degree heart block

A

Benign and asymptomatic

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44
Q

Which maneuver accentuates VSD?

A

Hand grip

(increase TPR = increase LV pressure = increase left-to-right shunt)

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45
Q

Two causes of PDA

A

Prematurity

Congenital rubella

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46
Q

Which occurs first: pulmonic or aortic valve closure?

A

Aortic (A before P)

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46
Q

EKG of A fib

A

Absent P wave, irregularly spaced QRS complexes

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47
Q

What would decrease the intensity of AR?

A

Vasodilators (hydralazine)

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48
Q

What causes wide fixed splitting?

A

ASD

(increases volume in RA and RV = delayed closure of pulmonic valve regardless of breathing)

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48
Q

Absent P wave

A

A fib

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49
Q

Which systolic murmurs are heard best at the left sternal border?

A

Hypertrophic cardiomyopathy

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50
Q

What “splits” on inspiration? Why?

A

S2 heart sound (A2 and P2)

Decreased intrathoracic pressure = increased RV volume = delayed closure of pulmonic valve

Also, pulmonary compliance increases during inspiration, contributing to the prolonged S2

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51
Q

Effect of standing

A

Decrease venous return

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52
Q

When is MVP loudest?

A

Just before S2

53
Q

What would you expect to hear in a patient with MR?

A

Blowing holosystolic murmur loudest at apex and radiating to axilla

54
Q

Delayed rumbling late diastolic murmur

55
Q

Completely erratic rhythm

55
Q

Leads I, aVL

A

Lateral wall (LCX)

57
Q

Decreases intensity of most murmurs

A

Valsalva, standing

58
Q

What is pulsus parvus et tardus?

A

Delayed, weak pulses due to AS

58
Q

Bounding pulses

58
Q

What causes the opening snap?

A

Abrupt halt of mitral valve leaflets

59
Q

P waves and QRS complexes bear no relation

A

3rd degree heart block

60
Q

ST depression

A

Subendothelial infarct

62
Q

What would you expect to hear in a patient with MVP?

A

Late systolic crescendo murmur with mid-systolic click heard best at apex

64
Q

Which murmurs are loudest at right sternal border?

A

Aortic stenosis

Flow murmur

Aortic valve sclerosis

66
Q

When and where is an ASD best heard?

A

Left sternal border, 5th interspace

Diastole

67
Q

Describe Romano-Ward syndrome

A

Long QT only (AD)

69
Q

Effect of Valsalva

A

Decrease venous return

69
Q

Only murmur intensified by Valsalva/standing

A

Hypertrophic cardiomyopathy

70
Q

Holosystolic murmurs

A

MR, TR, VSD

71
Q

Effects of rapid squatting

A

Increased preload/venous return, increased afterload

71
Q

What would you expect to hear in a patient with TR?

A

Blowing holosystolic murmur loudest at left sternal border that radiates to right sternal border

72
Q

Syncope, dyspnea, and angina on exertion

74
Q

Head bobbing

75
Q

What would you hear in a patient with right bundle branch block (LAD occlusion)?

A

Wide splitting

76
Q

Shortened PR interval

78
Q

Radiates toward axilla

79
Q

Drugs that prolong QT interval

A

Sotalol

Risperidone

Macrolides

Cholorquine

Protease inhibitors

Quinidine

81
Q

Increases sytemic vascular resistance

81
Q

What are the two congenital long QT syndromes?

A

Romano-Ward syndrome

Jervell and Lange-Nielsen syndrome

82
Q

What would you expect to hear in a patient with VSD?

A

Harsh holosystolic murmur loudest at tricuspid area

83
Q

Treatment of torsades

84
Q

Normal in children but pathologic in adults

86
Q

What would you expect to hear in a patient with MS?

A

S2 followed by OS and late diastolic rumbling murmur

87
Q

Which maneuver would increase AR?

A

Hand grip (increased TPR)

88
Q
A

Atrial flutter (sawtooth)

89
Q

List 3 causes of MR

A

Ischemic heart disease, LV dilation, MVP

90
Q

Symptoms of 2nd degree heart block, Mobitz type I

A

Asymptomatic

91
Q

Mechanical contraction of ventricles

A

QT interval

92
Q

Where is murmur of aortic stenosis heard best?

A

Right sternal border

93
Q
A

2nd degree heart block, Mobitz type 1

(progessively long PR intervals with a missed beat)

94
Q

Patients with congenital long QT syndrome are at increased risk for:

A

Torsades/sudden cardiac death

96
Q

Which maneuver would enhance MS?

A

Expiration

(increases LA return)

97
Q

Back-to-back atrial depolarization

A

Atrial flutter

98
Q

Identical back-to-back waves

A

Atrial flutter

(creates the sawtooth appearance)

100
Q

Stiff left ventricle

101
Q

Irregularly spaced QRS complexes + no P waves

103
Q

What murmur is common in Turner’s patients?

A

Crescendo-decrescendo radiating to carotids (AS)

Due to bicuspid aortic valve

104
Q

Increases intensity of MR, AR, VSD, MVP

A

Hand gripping (increase TPR)

105
Q

Leads for inferior wall (RCA)

A

II, III, aVF

107
Q

S4

A

Stiff left ventricle (“atrial kick”)

107
Q

Which maneuver would increase TR?

A

Inspiration

108
Q

Speed of conduction

A

Purkinje > atria > ventricles > AV node

110
Q

What maneuvers can be done to manipulate MVP?

A

Standing/Valsalva (decrease preload) –> earlier murmur

111
Q
A

2nd degree heart block, Mobitz type II

(Normal PR intervals, dropped beat)

112
Q

Delta wave

113
Q

Which maneuver increases MS?

A

Expiration

114
Q

Leads of anterior septum (LAD)

115
Q

Requires immediate CPR/defibrillation

116
Q

ST elevation

A

Transmural infarct

118
Q

Which murmur increases with squatting?

120
Q

Enhanced by expiration

121
Q

2:1 P:QRS

A

2nd degree heart block, Mobitz type II

122
Q

EKG of V fib

A

Completely erratic rhythm, no identifiable waves

123
Q

ST segment

A

Isoelectric, ventricles depolarized

124
Q

Prolonged PR interval with no dropped beat

A

First degree AV block

126
Q

When is PDA murmur loudest?

127
Q

Which murmurs are heard best at the left sternal border, 5th intercostal space?

A

Tricupsid regurg (pansystolic)

VSD (pansystolic)

Tricuspid stenosis (diastolic)

ASD (diastolic)

129
Q

What would you expect to hear in a patient with AR?

A

Blowing early diastolic decrescendo murmur

131
Q

Increased filling pressure

132
Q

WPW patients are at increased risk for:

A

Re-entry/SVT

133
Q

Which is the only maneuver that decreases the intensity of hypertrophic cardiomyopathy?

134
Q

Blowing holosystolic murmur loudest at apex

135
Q

Leads for anterior wall (LAD)

136
Q

Harsh holosystolic murmur loudest at tricuspid area

137
Q

Lateral wall (LCX) leads

138
Q

Symptoms suggesting AS

A

Syncope, dyspnea, angina on exertion

139
Q

Split S2 - physiologic

A

Inspiration

141
Q

What are two causes of AS?

A

Age-related calcification, Turner’s/bicupsid aortic valve

142
Q

Predisposes to torsades

A

Long QT interval

143
Q

Classic cause of 3rd degree heart block?

A

Lyme disease

144
Q

PR interval

A

Delay through AV node

145
Q

What can cause MR or TR?

A

Endocarditis or rheumatic heart disease

146
Q

QT interval

A

Mechanical contraction of ventricles

148
Q

What causes congenital long QT syndromes?

A

Channelopathies resulting in disordered myocardial repolarization

149
Q

Increase intensity of right heart sounds

A

Inspiration

150
Q

Fhx sudden cardiac death + long QT + normal hearing

A

Romano-Ward syndrome

151
Q

Which murmurs are accentuated by hand gripping?

A

MR, AR, VSD, MVP (later onset of click)

152
Q

EKG of first degree heart block

A

Prolonged PR interval with no dropped beats

153
Q

Blowing early diastolic decrescendo murmur

154
Q

Long QT interval predisposes to:

155
Q

Q wave

A

Old/evolving transmural infarct present

156
Q

What would you hear in a patient with an ASD?

A

Wide fixed splitting

157
Q

v wave

A

Increased RA pressure during filling

158
Q

What causes wide splitting?

A

Delayed RV emptying

(pulmonic stenosis, right bundle branch block)

159
Q
A

Atrial flutter (sawtooth)

160
Q

S3

A

Increased filling pressure (MR, CHF)

Normal in pregnancy and childhood

Step One R&M (38 decks)

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