Lecture 3+4

Question 1

pericarditis

Answer 1

inflammation of the pericardium

cause:
infection, renal failure, MI, post-surgical

Question 2

pericardial friction rub

Answer 2

A resulting sound due to roughness of the parietal lining from inflammation

Question 3

pericardial effusion

Answer 3

the accumulation of excess fluid within the pericardial space

cause:
pericarditis
CT disease
hypothyroidism

Question 4

cardiac tamponade

Answer 4

rapid large fluid (blood) accumulation in the pericardial space that leads to compression which prevents adequate filling of the chambers

clinical signs: beck’s triad

1. hypotension
2. distant heart sounds
3. distended neck veins

causes:
Stab wound, MI, or Rupture of heart muscle

treatment: pericardiocentesis

paraxiphoid approach: tip of xiphoid, or between xiphoid and left costal margin, angles towards shoulder

apical approach: left 5th or 6th intercostal space

Question 5

where does the right atrium get blood from?

Answer 5

gets blood from the IVC, SVC, and coronary sinus

Question 6

left atrium

Answer 6

gets blood from 4 pulmonary arteries

Question 7

location of aortic valve and where to auscultate

Answer 7

location: posterior to left side of sternum at 3rd intercostal space

Auscultate: right sternal border at 2nd intercostal space

Question 8

location of pulmonary valve and where to auscultate?

Answer 8

location: left 3rd costal cartilage
auscultate: left costal border at 2nd intercostal space

Question 9

location of tricuspid valve and where to auscultate

Answer 9

location: behind sternum at 4/5 intercostal space
auscultate: left sternal border at 5th intercostal space

Question 10

mitral valve location and where to auscultate

Answer 10

location: behind sternum at 4th costal cartilage
auscultate: 5th left intercostal space in midclavicular line

Question 11

structures supplied by the right coronary A.

Answer 11

right atrium 
right ventricle 
SAN
AVN
interventricular septum

Question 12

structures supplied by the left coronary A

Answer 12

left atrium and left ventricle

interventricular septum

Question 13

What is S1 and S2?

Answer 13

S1 (Lub) is the closing of the mitral and tricuspid valve.. systole

S2 (Dub) is the closure of the aortic and pulmonary valve… diastole

Question 14

What is diastole and systole?

Answer 14

diastole is when the heart is filling with blood and is not contracting (S2 to S1)

systole is the period of contraction (S1 to S2)

Question 15

The 7 steps of the cardiac cycle

Answer 15

1. Arterial systole (diastole)
   (S1)
2. isovolumetric contraction (systole: mitral valve closure)
3. rapid ventricular ejection (systole: Aortic valve open)
4. reduced ventricular ejection (systole: aortic valve open)
   (S2)
5. isovolumetric ventricular relaxation (diastole: aortic valve closure)
6. rapid ventricular filling (diastole: mitral valve open)
7. reduced ventricular filling (diastole: mitral valve open)

Question 16

Electrocardiogram (electrical activity)

Answer 16

P = arterial depolarization

QRS = ventricular depolarization

T = ventricular repolarization

Question 17

Normal cardiac pressures for LA, LV, and aorta (mmHg)

Answer 17

LA: 12
LV: 130/10
Aorta: 130/90

Question 18

Normal cardiac pressures for RA, RV, pulmonary A. (mmHg)

Answer 18

RA: 5
RV: 25/5
pulmonary A: 25/10

have lower pressures compared to the left side because the pulmonary system is a low resistance circulation

Question 19

S1, S2, S3, and S4

origin and location? Normal/Abnormal?

Answer 19

S1: mitral and tricuspid valve closure
loudest at the mitral valve region
normally present

S2: aortic and pulmonary valve closure
loudest at left upper external border
normally present

S3: In early diastole during rapid ventricular filling phase
Can be found in children, young adults, and pregnant
women (can be normal; but not normally present)

Abnormal in adults: Dilated ventricles (more common), increased filling pressure: mitral regurgitation. May lead to heart failure (left ventricular failure)

S4: during late diastole (atrial kick)
best heard at the apex with patient in left lateral decubitus position

abnormal regardless of age: high atrial pressure, ventricular hypertrophy, stiff left ventricular wall

Question 20

splitting patterns of S2

Answer 20

1. wide-splitting: This is due to a delay of RV emptying
   pulmonic stenosis
2. fixed-splitting: produces a great delay in the pulmonic valve
   arterial septal defect
3. paradoxical splitting: delay aortic valve closure
   aortic stenosis

Question 21

systolic murmurs

Answer 21

1. aortic stenosis
   crescendo and decrescendo
   usually due to age-related calcification
2. Mitral regurgitation
   high-pitch “blowing murmur” (loudest in apex)
   due to rheumatic fever and/or ischemic heart disease
3. mitral valve prolapse (most frequent)
   late systolic crescendo (loudest just before S2 at apex)
   due to rheumatic fever and/or Marfan syndrome and/or ehlers-danlos syndrome
4. Tricuspid regurgitation
   high-pitched “blowing murmur” in tricuspid area
   due to right ventricle dilation and rheumatic fever
5. ventricular septal defect
   harsh sound, loudest in tricuspid area

Question 22

Diastolic murmur

Answer 22

1. Aortic regurgitation
   high-pitched blowing early diastolic
   causes: aortic root dilation, bicuspid aortic valve, endocarditis, rheumatic fever
2. mitral stenosis
   delayed rumbling
   caused by sequela of rheumatic fever

Question 23

continuous mumur

Answer 23

patent ductus arteriosus:

machine-like murmur
best heard in the left infraclavicular area (loudest at S2)

causes: congenital rubella / prematurity