Cardiac Cycle & Heart Sounds

Question 1

S1 (lub)

Answer 1

Closure of the bicuspid/mitral and tricuspid valves

Question 2

S2 (dub)

Answer 2

Closure of the Aortic Valve or Pulmonary valves

Question 3

S3 (kentucky)

Answer 3

Atrial Depolarization and the resulting flow of blood into the ventricle upon ventricular diastole

Question 4

S4 (tenessee)

Answer 4

The last bit of blood being pushed in the ventricles of the heart by the chordae tendonae of the atria

Question 5

Regurgitation

Answer 5

when blood flows backwards from the point that it should be flowing properly through the valve

Question 6

Stenosis

Answer 6

when blood flows harder than it should because of a hardening of the aortic valve or the pulmonary valves

Question 7

Aortic Valve (where to listen)

Answer 7

Right side of the 2nd intercostal space

Question 8

Pulmonary Valve (where to listen)

Answer 8

Left side of the 2nd intercostal space

Question 9

Tricuspid Valve (where to listen)

Answer 9

Left 4th intercostal space

Question 10

Mitral valve (where to listen)

Answer 10

Listen at the Left 5th intercostal space on the mid axillary line

Question 11

Murmur 1 Grading

Answer 11

You can hear it with a stethoscope in quiet place

Question 12

Murmur 2 Grading

Answer 12

You can hear it with a stethoscope in loud places

Question 13

Murmur 3 Grading

Answer 13

Prominently heard murmur

Question 14

Murmur 4 Grading (dangerous)

Answer 14

You can hear it with thrills and you can hear it as you go axillary

Question 15

Murmur 5 Grading (dangerous)

Answer 15

Loud murmur with thrills and you can hear it with the stethoscope tilted

Question 16

Murmur 6 Grading (dangerous)

Answer 16

Loud murmur with thrills and you can hear from far away without the stethoscope

Question 17

RINSPIRATION (just draw the diagram out)

Answer 17

On the right side of the chest you can hear the pulmonary and tricuspid valves are louder

Question 18

LEXPIRATION (just draw the diagram out)

Answer 18

On the left side of the chest you can here aortic and mitral valves faster

Question 19

What is the effect of the preload on the heart?

Answer 19

During a larger volume of preload, you can here the heart louder usually.

During less preload (less volume in the ventricles), it is harder to here the murmurs of the heart.

Question 20

Hypertrophic Cardiomyopathy (HOCM)

Answer 20

Exceptional:
You can actually here the hypertrophic cardiomyopathy better under less preload because the ventricles will try to contract harder to push the blood out of the ventricles.

*** an increase in the preload will cause the cardiomyopathy to be hidden.

Question 21

Mitral Valve Prolapse (MVP)

Answer 21

HIGH LEVELS of ventricular volume (preload) can help the prolapsed mitral valve fold back into place!

that is why it is better to here a mitral valve prolapse during a lower amount of preload levels

Question 22

The Effect of Afterload on the Murmurs

Answer 22

Increased levels of Afterload Pressure usually will INCREASE THE NOISE MADE BY THE MURMUR, LOWER AFTERLOAD WILL DECREASE THE NOISE MADE BY THE MURMUR

***Exceptions:
Increased afterload= softer murmurs
Decreased afterloads= louder murmurs

Question 23

Aortic Stenosis (Systolic Murmur)

Answer 23

Loudest--> Increased Preload, Increased Afterload
between s1+ s2
ca2+ deposits in the aortic valve
OLD- SAD (synchopy, angina, dyspnea)
radiate into the carotid arteries

Question 24

Mitral Regurgitation (holosystolic murmur)

Answer 24

caused by rheumatic heart disease
radiates to the axilla (giving the “thrill”)
best heard at apex of the heart

Question 25

Tricuspid Regurgitation (holosystolic murmur)

Answer 25

“Want to TRI drugs?”

Patient gets tricuspid regurgitation from IV Drug Abuse

Between S1 + S2

Question 26

Aortic Regurgitation (diastolic murmur)

“AR she BLOWS”

Answer 26

the blowing diastolic murmur

Pt has Marfan’s Syndrome, Head Bobbing

Question 27

Mitral Stenosis (diastolic murmur)

“The OS is MS”

Answer 27

Opening snap is Mitral Stenosis

History of Rheumatic Fever

Question 28

Mitral Valve Prolapse

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

Answer 28

Mitral Valve Prolapse (Mid Systolic Click)