pulses & waves Flashcards
What does the a-wave in JVP represent?
Atrial contraction (before carotid pulse)
Prominent in TS, PS, pulmonary HTN, RVH; absent in atrial fibrillation; canon a-wave in complete heart block, ventricular tachycardia.
What conditions are associated with a prominent a-wave?
- TS
- PS
- Pulmonary HTN
- RVH
These conditions lead to increased atrial pressure during contraction.
What does the v-wave in JVP represent?
Atrial filling (with carotid pulse)
Prominent in tricuspid regurgitation (TR).
What is pulsus alternans?
Alternating strong & weak beats
Associated with heart failure and indicates poor prognosis.
What does pulsus bisferiens indicate?
Aortic waveform with 2 peaks
Seen in hypertrophic cardiomyopathy and mixed aortic regurgitation + aortic stenosis.
Define pulsus paradoxus.
Weak pulse in inspiration & strong pulse in expiration
Typically observed in cardiac tamponade.
What is pulsus bigeminus?
Groups of 2 beats separated by a longer interval
Associated with premature ventricular or ectopic heart beats.
Describe pulsus parvus et tardus.
Slow rise, late peak, low amplitude, anacrotic notch
Commonly seen in aortic stenosis (AS).
Where is the apex beat normally palpable?
At the tip of fingers at 5th ICS MCL
In the majority of cases, it is not palpable.
What does a tapping apex beat indicate?
Very rare, felt in pure isolated mitral stenosis
Represents palpable S1.
What causes a heaving apex beat?
Hypertrophic pressure overload
Conditions include aortic stenosis, hypertrophic obstructive cardiomyopathy, systemic hypertension, and coarctation of the aorta.
What characterizes a hyperdynamic apex beat?
Dilated and hypertrophic (volume overload)
Felt in aortic regurgitation, mitral regurgitation, patent ductus arteriosus, and ventricular septal defect.
How is a hyperdynamic apex beat felt?
As multiple intercostal spaces (big area)
High amplitude and goes down fast.
What does a large heart indicate when feeling the apex beat?
Felt down and out (dilated = displaced)
Usually indicative of volume overload conditions.
What is S3 in cardiac sounds?
Ventricular gallop
S3 represents rapid ventricular filling in early diastole and indicates an overly compliant left ventricle.
When can S3 be considered normal?
In children, pregnant women, and athletes
It may also indicate pathology in cases such as HF-REF, acute pulmonary edema, aortic regurgitation (AR), mitral regurgitation (MR), and dilated cardiomyopathy.
What does S4 represent?
Atrial gallop
S4 occurs just before S1 and indicates atrial contraction against a stiff non-compliant ventricle.
When is S4 always pathological?
In conditions like HF-PEF, aortic stenosis (AS), hypertrophic obstructive cardiomyopathy (HOCM), systemic hypertension, and coarctation of the aorta
S4 occurs after the passive filling phase when the atria contract to force blood into the ventricles.
What happens to murmurs during expiration?
They become louder
This is relevant for murmurs associated with mitral stenosis (MS), mitral regurgitation (MR), aortic stenosis (AS), aortic regurgitation (AR), and HOCM.
What maneuvers increase the intensity of murmurs?
Squatting and leg raise
These maneuvers increase venous return and can enhance murmur sounds.
What maneuvers decrease the intensity of murmurs?
Standing and Valsalva
These maneuvers decrease venous return and can reduce murmur sounds.
What is the effect of squatting on mitral valve prolapse (MVP) murmur?
Decreases murmur intensity and increases click intensity
In MVP, the click occurs due to the sudden tensing of the mitral valve apparatus.
What is the effect of standing on MVP murmur?
Increases murmur intensity and decreases click intensity
This is due to decreased preload in MVP.
