Block I: approach to CV Pt.

Question 1

describe the order of blood flow

Answer 1

1. deoxygenated blood from body
2. sup/inf. VC
3. R atrium
4. tri-cupsid valve
5. R ventricle
6. 5. semi-lunar pulmonary valve
7. Pulmonary arteries
8. lung for oxygenation
9. Pulmonary veins
10. L atria
11. bicuspid valve
12. L ventricle
13. aorta
14. systemic circulation
15. becomes doexygenated at capillary beds, returns via venous flow to sup/inf VC and cycle restarts

Question 2

blood is supplied to heart tissue via coronary arteries during what phase of the cardiac cycle?

Answer 2

diastole (resting/filling phase)

Question 3

the [] of the aorta supplies the heart with the L and R coronary arteries

Answer 3

first 2 branches of aorta

Question 4

what major artery branches from the L coronary artery

Answer 4

Left Anterior Descending (LAD)

Question 5

[]% of flow from the atria to the ventricles is passive

Answer 5

70, addtl. 30% from atrial contraction/atrial kick

Question 6

outflowing systemic arteries function on a [] pressure system

Answer 6

high, need to perfuse tissue to oxygenate

Question 7

there is a [] pressure system in systemic venous return

Answer 7

low

Question 8

outflowing pulmonary arteries function on a [] pressure system

Answer 8

high

Question 9

there is a [] pressure system on pulmonary venous return

Answer 9

low

Question 10

as systole begins, ventricular contraction [] pressure in ventricles

Answer 10

raises pressure

Question 11

as [] begins, ventricular contraction increases pressure in ventricles

Answer 11

raises

Question 12

the increase in ventricular pressure during systole causes [] on the valves

Answer 12

forces mitral and tricupsid valves CLOSED to prevent backflow into atria during high pressure

Question 13

what is happening at the moment where the S1 sound is being made

Answer 13

“lub”

Mitral and tricuspid valves are being forced shut during ventricular contraction
-prevents backflow of blood into atria during contraction

Question 14

what does S1/lubb indicate

Answer 14

beginning systole

Question 15

what are the two components of the S1 sound?

Answer 15

1. mitral vavle closing

2. closure of tricuspid valve

Question 16

what happens after ventricular systole?

Answer 16

as blood leaves ventricles, the preassure in ventricles falls BELOW that of pulomary and aortic artery
-allows aortic and pulmonic valves to close , causing the S2 sound

Question 17

what is happening during S2

Answer 17

pressure in ventricles falls below aorta and pulmonic arteries
which forces the two semilunar valves (aortic, pulmonic) shut

Question 18

what are the two components of the S2 sound

Answer 18

1. A2: aortic semu lunar valve closing

2. P2: pulmonic semi lunar valve closing

Question 19

the S2 sound indicates what

Answer 19

end of systole, beginning of diastole

Question 20

what happens as ventricular pressure falls below atrial pressure in diastole

Answer 20

mitral and tricuspid valves open to allow blood blow back intro ventricles (diastole)

Question 21

what is between S1 and S2

Answer 21

systole

Question 22

what is between S2 and S1

Answer 22

diastole

Question 23

filling of ventricles sometimes produces an [] sound

Answer 23

S3

Question 24

[] may be the first clinical sign of congestive heart failure

Answer 24

S3 sound (of ventricular filling)

Question 25

the [] can sometimes be heard as a 4th heart sound

Answer 25

atrial kick

Question 26

what is happening during atrial diastole

Answer 26

all heart relaxed, atrial fill with blood from sup/inf CV and pulmonary arteries

Question 27

what is happening during atrial systole

Answer 27

after 70% passive fillling, atria contract to push remaining 30% into ventricles "atrial kick" [sometimes S4 sound] M1 and T1 valves open

Question 28

what is happening during ventricular systole

Answer 28

1. pressure builds in ventricles 2. M1,T1 closure due to pressure build up (prevents back flow) [S1] 3. ventricles contract 4. semi lunar (aortic, pulmonary) valves open

Question 29

what is happening during ventricular diastole

Answer 29

1. pressure falls in ventricles 2. pulmonic and aortic valves close (S2: A2, P2) 3. M1, T1 valves open for passive filling of ventricles (can prod. S3 if CHF, or S4 if atrial kick)

Question 30

what is another name for EDV

Answer 30

pre-load

Question 31

[] is the fiber length of ventricles prior to the onset of the contraction, i.e. the amount of stretch during diastole

Answer 31

EDV, pre-load *think balloon getting filled with air

Question 32

[] is the resistance of L ventricular ejection and outflow i.e. stress of ventricular wall at the end of systole

Answer 32

after load *think squeezing mouthpiece of balloon while letting air out

Question 33

what is the P wave on an EKG

Answer 33

atrial contraction (kick, sometimes S4 sound)

Question 34

what is the QRS complex on EKG

Answer 34

ventricular contraction

Question 35

what is the T wave on EKG

Answer 35

diastole, recovery

Question 36

where is the apical impulse best felt

Answer 36

lower L chest, can be palpated

Question 37

how is a vigorous apical impulse described

Answer 37

heave, lift

Question 38

what might a sustained/enlarged apical impulse indicate

Answer 38

myocardial hypertrophy/dysfunction

Question 39

if an apical impulse is very prominent and NOT sustained, what might this indicate

Answer 39

volume overload or high output states

Question 40

additional pulsations in apical impulse may reflect []

Answer 40

regional abrnomalities of L ventricular contraction

Question 41

a parasternal lift indicates []

Answer 41

R ventricular hypertrophy, pulmonary HTN, L atrial enlargement

Question 42

what is the PMI, where is it best felt?

Answer 42

Point of Maximum impulse: point at which apical impulse is most readily seen/felt 5th intercostal space in around mid-clavicular line

Question 43

[] is a fine, palpable rushing vibration felt over the precordium

Answer 43

thrill

Question 44

[] is likened to putting your hand on a purring cat

Answer 44

thrill

Question 45

[] has the same significance as murmurs

Answer 45

thrills

Question 46

thrills have the same significance as []

Answer 46

murmurs

Question 47

[] is a result of eddies from blood coursing through abnormal heart or arteries and leads to a vibration transmitted to peripheral structures

Answer 47

thrill/murmur

Question 48

[] is more sensitive to vibrations

Answer 48

ear

Question 49

most murmurs are accompanied by []

Answer 49

thrills

Question 50

valve sounds are best heard in the area [] the direction of blood flow

Answer 50

away

Question 51

specific heart sounds are best heart over areas where [] in relation to the valve

Answer 51

over ares where blood flows after it passes through a valve

Question 52

where is the aortic valvue auscultated

Answer 52

2nd intercostal space, along R sternal border

Question 53

where is the pulmonic valve auscultated

Answer 53

2nd intercostal space, along L sternal border

Question 54

where is the 2nd pulmonic sound auscultated

Answer 54

3rd intercoatal space along L sternal border "erb's point"

Question 55

where is the tricuspid valve best heard

Answer 55

4th L intercostal space, lower L sternal border

Question 56

there is the mitral valve best heard

Answer 56

5th L intercostal space, mid-clavicular line | similar to PMI

Question 57

describe Lub/S1 sound

Answer 57

1. indicates systole | 2. is sound of M1, T1 being forced closed by increasing ventricular pressure as ventricles contract

Question 58

S1 correlates to the [] on EKG

Answer 58

QRS complex

Question 59

where is S1 best heart

Answer 59

apex of heart

Question 60

[] occurs simultaneously with carotid pulse

Answer 60

S1

Question 61

[] is usually louder than S2

Answer 61

S1

Question 62

S2/dubb description

Answer 62

is the sound of pulmonic and aortic valves (A2, P2) closing, marks end of systole and begining diastole can sometimes be split -A2 closes slightly before P2

Question 63

why might an S2 be split

Answer 63

normal, because pressures are higher and depolarization occurs earlier in L heart

Question 64

where is S2 best heard?

Answer 64

erb's point 3rd IC space along LSB

Question 65

when might S2 sounds be accentruated

Answer 65

conditions that cause abnormal delay in pulmonic valve closure 1. increased vol. in R ventricle - ventricular septal defect - atrial septal defect 2. chronic R ventricular outflow obstruction - pulmonic stenosis 3. acute/chronic dilation of R ventricle due to sudden rise in pressure - PE

Question 66

period between S1-S2 is []

Answer 66

systole

Question 67

S2-S1 is []

Answer 67

diastole

Question 68

events occur slightly later in [] side of heart

Answer 68

R | -pressure lower

Question 69

what is an S3 sound

Answer 69

ventricular filling | -quiet difficult to hear

Question 70

when does S3 occur

Answer 70

right after S2

Question 71

in intesnt S3 sound may be described as a []

Answer 71

gallop

Question 72

S3 occurs during what phase of cardiac cycle?

Answer 72

diastole, heart in early diastole after S2

Question 73

[] is caused by deceleration of blood flowing into ventricles when ventricles reaches its final stage of filling

Answer 73

S3 "atrial kick"

Question 74

where is S3 best heard

Answer 74

apex of heart, with patient laying on L side

Question 75

when may an S3 sound be heard in a patient (disease states)

Answer 75

1. pregnancy 2. CHF 3. MI 4. myocardial contusion 5. volume overload of ventricle 6. mitral valve regurgitation

Question 76

what is an S4 sound

Answer 76

1. second phase of ventricular filling | 2. vibration in valves, papillae, and ventricular walls

Question 77

an intense S4 sound may be galled a []

Answer 77

gallop

Question 78

when does S4 occur

Answer 78

before S1, at the end of diastole

Question 79

[] is caused by vibrations of L ventricular muscle of mitral valve & left ventricular flow tracts as a result of forceful atrial contraction into distended ventricle

Answer 79

S4

Question 80

when might an S4 be heard in a patient? (disease states)

Answer 80

1. decreased vascular compliance due to HTN 2. CAD 3. aortic stenosis 4. cardiomyopathy 5. profond anemia 6. pregnancy 7. thyrotoxicosis

Question 81

what is the most common cause of an S4 gallop

Answer 81

decreased ventricular compliance due to HTN

Question 82

cardiac valves generally open []

Answer 82

noiselessly, unless thickened, roughed or altered

Question 83

a snap sound indicates []

Answer 83

MITRAL valvular stenosis

Question 84

a click sound indicates []

Answer 84

SEMILUNAR valve stenosis

Question 85

mid-to-late non-ejection systolic clicks may indicate []

Answer 85

mitral valve prolapse

Question 86

[] is a high frequency sound that occurs shortly after S1 in mid, early, late systole

Answer 86

click

Question 87

what are clicks and when are they best heard?

Answer 87

1. high frequency sound that 2. shortly after S1 - mid-late systole

Question 88

clicks indicate []

Answer 88

mitral valve prolapse

Question 89

[] is a sustained noise that is audible during times of systole, diastole or both

Answer 89

murmur

Question 90

a systole murmur occurs when

Answer 90

between S1 and S2 | -when ventricles are contracting

Question 91

what causes a systolic murmur

Answer 91

forward flow across aortic of pulmonic valve regurgitant flow from mitral/tricuspid valve

Question 92

what is holosystolic?

Answer 92

systolic murmur merges with first sound

Question 93

what is pansytolic?

Answer 93

systolic murmur that occurs throughout entire systolie

Question 94

when does a diastolic murmur occur

Answer 94

between S2-S1 | when ventricles are relaxed and filling during diastole

Question 95

what are some abnormalities that may cause a diastolic murmur

Answer 95

1. aortic reguritation 2. pulmonic regurgitation 3. mitral stenosis 4. tricuspid stenosis

Question 96

diastolic murmus are [] pathologic

Answer 96

ALWAYS

Question 97

why are diastolic murmurs always pathologic

Answer 97

1. include mitral valve stenosis and aortic valve regurgitation

Question 98

murmurs with thrills are [] significant

Answer 98

ALWAYS

Question 99

[] begins after S1 and ends before S2 with a peak in early-mid systole

Answer 99

ejection

Question 100

when does ejection peak?

Answer 100

occurs after S1 and ends before S2, peaks in early-mid systole

Question 101

what causes an ejection

Answer 101

aortic/pulmonic valve stenosis | happens as blood leaving/ejecting from heart

Question 102

what is a grade 1 murmur

Answer 102

very faint

Question 103

what is a grade 2 murmur

Answer 103

quiet

Question 104

what is a grade 3 murmur

Answer 104

moderately loud

Question 105

what is a grade 4 murmur

Answer 105

loud with palpable thrill

Question 106

what is a grade 5 murmur

Answer 106

very loud, easily pablpable

Question 107

what is a grade 6 murmur

Answer 107

very loud, audible with stethescope off chest

Question 108

a very faint murmur is grade []

Answer 108

1

Question 109

a quiet murmur is grade []

Answer 109

2

Question 110

a moderately loud murmur is grade []

Answer 110

3

Question 111

a loud murmur with palpable thrill is grade []

Answer 111

4

Question 112

a very loud murmur that is easily palpable is grade []

Answer 112

5

Question 113

a very loud murmur that is audible with stethescope off chest is a grade [] murmur

Answer 113

6