PCM

Question 1

Order of heart sounds

Answer 1

S4, S1, S2, S3

Question 2

What is SBP?

Answer 2

pressure exerted upon the artery during heart contraction

Question 3

What is DBP?

Answer 3

pressure exerted upon the artery wall during heart rest

Question 4

When does atrial repolarization occur?

Answer 4

it’s hidden in the QRS complex

Question 5

What side of the heart is the high pressure system?

Answer 5

left side (right side is low pressure)

Question 6

What causes a murmur?

Answer 6

valve in non-compliant, incompetent, stiff, or damaged

Question 7

How do we evaluate a murmur?

Answer 7

echocardiogram

Question 8

When should you be concerned with a murmur?

Answer 8

when associated with symptoms (sweating, dizziness, high BP, losing consciousness…)

*pathological: LOUD heart sounds

Question 9

Regurgitation

Answer 9

turbulent flow sound when blood is moving in an opposite direction than it should

Question 10

Stenosis

Answer 10

turbulent flow when blood is moving through a stiff, damaged valve

Question 11

Where do I listen to the heart?

Answer 11

Aortic (R 2nd ICS), Pulmonic (L 2nd ICS), Tricuspid (L 4th/5th ICS), and Mitral (R 4th ICS)

*All Physicians Take Money

Question 12

Grade 1

Answer 12

soft murmur heard in a quiet place

Question 13

Grade 2

Answer 13

soft murmur heard in noisy place

Question 14

Grade 3

Answer 14

prominent heart murmur

Question 15

Grade 4

Answer 15

loud murmur with a thrill

Question 16

Grade 5

Answer 16

Loud murmur heard with edge of the stethoscope tilted against the chest and a thrill

Question 17

Grade 6

Answer 17

Loud murmur heard 5-10mm from the chest and a thrill

*you walk into the room and hear this…super loud

Question 18

RINspiration vs. LEXspiration

Answer 18

1. inspiration, right side of heart gets louder (tricuspid and pulmonic)
2. expiration, left side of heart gets louder (mitral and aortic)

Question 19

Preload

Answer 19

volume of blood sent the heart

• increasing–> LOUDER murmur
• decreasing–>SOFTER murmur

Question 20

HOCM

Answer 20

• increase in preload improves aortic murmur by pushing the septum away from the aortic outflow track allowing blood to be ejected more easily
• decreased preload worsens the murmur
• FH os sudden cardiac death (20-30s)

*afterload: increased (softer), decreased (louder)

Question 21

Mitral Valve Prolapse

Answer 21

• leaflets of mitral valve prolapse into the left atria under normal pressure and blood flow
• increase in preload improves the clock heard with MVP by allowing the prolapsed leaflets to return to normal orientation
• Midsystolic “click”
• clinical presentation of a young woman with a psychiatric history
• Myxomatous valvular disease in the stem question

“See the MVP to be the MVP, and everything will click”

*afterload: increased (softer), decreased (louder)

Question 22

Afterload

Answer 22

-pressure the ventricles have to generate to move blood forward into the arterial system
increased=louder
decreased=softer

*exceptions: MVP, HOCM (opposite)

Question 23

Aortic Stensosis

Answer 23

• Crescendo-Decrescendo murmur

- Case presentation: Old (SAD), calcified aortic valve, radiates UP to the carotid arteries

Question 24

Mitral Regurgitation

Answer 24

• Rheu-mitral (RHD can cause this from RF from strep)
• best heard at apex
• radiates to axilla
• holosytolic murmur (chhhh. chhh. steady kind of murmur)

Question 25

Tricuspid Regurgitation

Answer 25

• history of IV Drug abuse because bacteria enter the valve first (creates vegetations, and destroy the valve)
• holosystolic murmur

“Want to TRI some drugs?”

Question 26

Aortic Regurgitation

Answer 26

• early blowing diastolic murmur
• presentations: CT disorders, Marfan’s syndrome, “head bobbing”, water hammer pulse, femoral bruits…

“AR, thar she BLOWS”

Question 27

Mitral Stenosis

Answer 27

• opening “Snap”
• RHEUmitral (history of RF)
• The Operating System is Microsoft (opening snap due to mitral stenosis)

Question 28

Keys to HOCM diagnosis

Answer 28

• louder with decreased preload and afterload

- softer with increased preload and afterload