Lecture 2: Physical examination

Question 1

Widely split S2

Answer 1

severe MR
Pulmonary stenosis/ HTN
RBBB
Pulmonary embolism

Question 2

Fixed split S2

Answer 2

ASD (ostium secundum)

Question 3

Paradoxically split S2

Answer 3

LBB

Question 4

Reasons for fix ASD

Answer 4

1. RV enlargement
2. > 2:1 L-R shunt
3. Symptoms

Question 5

ECG finding in ASD

Answer 5

Right axis deviation

RBBB

Question 6

S3?

Answer 6

sudden termination of early rapid diastolic filling into stiff ventricle 
LV apex - HFrEF
< 40 - hyperdynamic states 
HYPER FAT HIPP
F-ever
A-nemia
AV fistula
thiamine
Hyperthyroidism
Infection
Paget
Pregnancy

Question 7

valsalva increases **

Answer 7

HOCM
MVP

decreases preload mechancims

Question 8

what other two methods can you do to replicate valsalva

Answer 8

amyl nitrate

Standing

Question 9

Hand-grip increases ***

Answer 9

MAV grips hard

MR/MVP
AR
VSD

Question 10

cannon-A waves

Answer 10

ventricular tachycardia
complete heart block
ventricular pacing

AV dissociation

Question 11

pulsus paradoxus

Answer 11

CAT

Cardiac tompanode
constrictive pericarditis
asthma/pneumothorax
Tension pneumoia

inspiration fall 10 in systolic pressure

Question 12

reason for AV valve replacement in Aortic regurgitation

Answer 12

1. symptoms
2. LEVF < 50
3. LVSD > 55 or LVDD < 75 mm

Question 13

tracking of aortic regurgitation

Answer 13

repeat echo 6-12 months

Question 14

rapid x descent

Answer 14

cardiac tamponade