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cardiology > Cardiac Auscultation and Cardiac Heart Sounds > Flashcards

Cardiac Auscultation and Cardiac Heart Sounds Flashcards

1
Q

_______is the small rise in right atrial pressure due to right atrial contraction

A

a wave

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2
Q

__________is the small rise in right atrial pressure as the tricuspid valve closes and bridges toward the right atrium

A

c wave

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3
Q

__________is the rise in right atrial pressure during ventricular systole when the tricuspid valve is closed (supposedly)

A

v wave

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4
Q

what is normal S2 splitting defined as

A

normal physiologic splitting of S2 means that 2 distinct components of S2 can be heard during inspiration but not during expiration

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5
Q

where is normal S2 splitting best heard at

A

3LSB

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6
Q

what population is S3 heart sounds normal in

A

children and young adults

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7
Q

what are some of the most common causes of paradoxical splitting of the 2nd heart sound

A 
left bundle branch block
left ventricular outflow obstruction
right ventricular pacemaker
right ventricular ectopic beats
systemic hypertension (rarely)
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8
Q

fixed splitting of the second heart sound is the ausculatory hallmakr of

A

atrial septal defect (ASD)

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9
Q

a fixed splitting of S2 and a mid systolic murmur is extremely indicative of

A

atrial septal defects

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10
Q

S3 heart sounds are normal in

A

children and young adutls

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11
Q

what is the cause of S3 heart sounds

A

tensing of the chordae tendinae and or sudden limitation of longitudinal ventricular expansion during early rapid ventricular filling

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12
Q

when is the third heart sound heard

A

early to mid diastole

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13
Q

what is the frequency of the third heart sound

A

low (a dull thud)

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14
Q

where is the third heart sound heard best

A

apex (left) lower Left Sternal border

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15
Q

which heart sound if found is rarely normal

A

S4

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16
Q

what is S4 heart sound caused by

A

atrium vigorously contracting against a stiffened ventricle (results from reduced ventricular compliance)

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17
Q

when is the S4 heared

A

late diastole (presystole)

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18
Q

what is the frequency of S4

A

low

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19
Q

where is the S4 heart sound best heard

A

apex (L), lower LSB/Xiphoid right

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20
Q

all ______increase in intensity (loudness) during inspiration except the pulmonic ejection click

A

right sided

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21
Q

squatting to standing does what to venous return

A

decreases venous return

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22
Q

squatting to standing does what to ventricular preload

A

decreases

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23
Q

squatting to standing does what to systemic vascular resistance

A

decreases

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24
Q

standing to squatting does what to venous return, preload and systemic vascular resistance

A

increases!

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25
Q

passive elevation of the legs does what to venous return

A

increases venous return

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26
Q

what does the valsalva maneuver do to venous return

A

decreases (also decreases ventricular preload)

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27
Q

what does the muller maneuver do to venous return and threfore preload

A

increases venous return and preload

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28
Q

what does PVC’s do to preload

A

increases preload (post ectopic beat)

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29
Q

what does isometric exercise do to CO, heart rate, etc

A 
increases systemic resistance
increases pressure
increases heart rate
increases CO
increases left ventricular filling pressure
increases left ventricular olume
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30
Q

what does amyl nitraite do

A

potent vasodilator and within first 30 seconds decreases systemic arteiral resisant and after 30-60 seconds it increases heart rate and CO

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31
Q

when should vasopressors be avoided

A

in CHF or HTN pts

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32
Q

action of methoxamine and phenylephrine

A

decrease hrrt rate and cardiac output

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33
Q

no palpable thirll

A

grades 1-3

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34
Q

palpable thrill

A

grades 4-6

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35
Q

what murmur begins with or after S1 and ends before S2

A

systolic murmur

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36
Q

what murmur begins with or after S2 and ends before the next S1

A

diastolic

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37
Q

what murmur begins in systole and continues without interruption through S2 into all or part of diastole

A

continuous

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38
Q

a valve that does not open properly will cause a murmur of

A

stenosis

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39
Q

a valve that does not close properly will cause a murmur of

A

regurgitation or insufficiency

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40
Q

the aortic and pulmonic valve is __during systole and ______-during diastole

A

open during systole and closed during diastole

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41
Q

the mitral and tricuspid valves are _______-during systole and ______-during diastole

A

closed, open

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42
Q

aortic/pulmonic systolic murmur is

A

stenosis

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43
Q

aortic/pulmonic diastolic murmur is

A

regurgitation

44
Q

mitral or triscupid diastolic murmur is murmur of

A

stenosis

45
Q

mitral or tricuspid systolid murmur is a murmur of

A

regurgitation

46
Q

what are some potential causes of systolic murmurs

A

outflow obstruction of either ventricle, insufficiency of either at AV valve, VSD, aortic sclerosis, ventricular ejection in high flow states

47
Q

mitral valve prolapse causes

A

mid systolic click, late systolic murmur

48
Q

acute mitral regurgitation mummur

A

early systolic decrescendo murmur

49
Q

chronic mitral regurgitatiom murmur

A

classic holosystolic murmur

50
Q

characteristics of chronic mitral regirgitation

A

doesn’t get louder during inspiration
best heard at the cardiac apex, and sometimes radiating to the left axilla and gets louder during isometric handgrip, sudden squatting or vasppressor administration

51
Q

where is a chronic mitral regirgitation heard best

A

cardiac apex sometimes radiating to the left axilla

52
Q

does chronic mitral regurgiattion get louder during inspirtaion

A

no

53
Q

what can you do to make a chronic mitral regirgitation murmur get louder

A

isometric handgrip
sudden squatting
vasopressor administration

54
Q

acute mitral regirgitation is a

A

early systolic descrecendo murmur

55
Q

mitral valve prolapse is a

A

mid systolic click late systolic murmur

56
Q

squatting makes mitral valve prolapse click _______and murmur _____

A

later, shorter and often softer

57
Q

standing or valsalva maneuver makes mitral valve prolaspe click __________ and murmur ____-

A

click earlier and murmur longer and often louder

58
Q

carvallos sign

A

murmur gets louder during inspiration

59
Q

what is the classic triad for severe tricuspid regurgitation

A

carvallos sign
pulsatile JVD
pulsatile liver

60
Q

tricupid regurgitation characteristics

A

holosystolic murmur

louder during inspiration

61
Q

where is VSD best heard

A

lower left sternal border (LSD)

62
Q

does a VSD get louder during inspiration

A

NO

63
Q

systolic ejection murmurs

A

crescendo-decrecendo murmur

64
Q

what is the ausculatory hallmark for bicupid aortic valve (aortic stenosis murmur)

A

aortic ejection click

65
Q

what are the two acquired ways to aortic stenosis

A

crescendo-descrendo murmur

66
Q

where is aortic stenosis murmur heard best

A

2rSB radiating to the carotids

67
Q

how do you determine if a aortic stenosis murmur is severe

A

if it peaks early in systole it is NOT severe

68
Q

pulsus parvus et tardus is

A

diminished or delayed carotid upstroke

69
Q

aortic stenosis may have

A

paradoxical splitting of the 2nd heart sound

diminished or absent A2 and aortic ejection sound (most common in congenital AS)

70
Q

characteristics of hypertrophic cardiomyopathy murmur

A

gets louder during valsalva maneuver, standing or amylnitrate and gets softer with isometric handgrip and squatting

71
Q

characteristics of aortic stenosis murmur

A

gets louder during sqatting and amylnitrate inhlation

gets softer with tanding, valsalva and isometric hand grip

72
Q

pulmonic stenosis murmur

A

crescendo-decrescendo murmur that increases during insiration

73
Q

where is a pulmonic stenosis murmur best heared

A

2 LSB

74
Q

does the pulmonic stenosis murmur radiate to the carotids

A

NOT

75
Q

if ejection click is present in pulmonic stenosis it gets _____–during inspiration

A

softer

76
Q

potential causes of diastolic murmurs

A

insufficiency of either ventricular outflow valve (AR) and (PR) or stenosis of MS or TS valves

77
Q

primary murmur of aortic insufficeincy

A

early diastolic
decrescendo
high pitched
blowing

78
Q

when is a primary murmur of aortic insufficiency heard

A

best with diaphragm of stethoscope at 3L or RSB with patient leaning forward during help deep, end exhalation

79
Q

patients with aortic insufficiency may also have

A

systolic ejection murmur and austin filint murmur

80
Q

what is an austin flint murmur

A

diastolic rumble best heard with the bell of stethoscope at the apex

81
Q

what is duroziez sign

A

systolic murmur over femoral artery when stethoscope is compressed proximally, and a diastolic murmur over femoral artery when stethoscope is compressed distally

82
Q

what is the most predictive sign of severe aortic insufficienc

A

duroziez sing

83
Q

signs associated with high stroke volume

A 
wide pulse pressure
quinke's pulse (
hill sign 
corrigan pulse
traube sign
mueller sign
84
Q

what is hill sign

A

popliteal systolic blood pressure exceeds brachail systolic blood pressure by greater than 60 mmHg

85
Q

what is quincke’s pulse

A

phasic blanching of the nail bed

86
Q

what is mueller sign

A

pulsating uvula

87
Q

what is traube sign

A

pistol shot sound over femoral artery

88
Q

what is corrigan (water-hammer) pulse

A

palpable abrubt upstroke and rapid fall in arterial pulsation

89
Q

what is the murmur called that is due to pulmonary hypertensiion

A

graham steel murmur

90
Q

characteristics of graham steell murmur

A 
early diastolic
begins with a loud pulmonic component of S2
decresendo
high pitched
blowing
gets louder during inspirtion
91
Q

where is the graham steel murmur heard best

A

diaphragm of stehoscope

2nd-4th ICS, LSB

92
Q

what does the murmur that is caused by pulmonic insufficiency due to defomity of the pulmonic valve sound like

A 
mid diastolic
begins after pulmonic component of S2
crescendo-decrescendo
low pitch
louder during insiration
93
Q

where are diastolic murmurs best heard

A

bell of stethoscope at 3rd to 4th ICS, LSB

94
Q

mitral stenosis is almost always a sequela of

A

rheumatic fever

95
Q

mitral stenosis murmur

A

mid diastolic murmur, low pitched rumble

96
Q

where is the mitral stenosis murmur best head

A

when patient is in the left lateral recumbent position with the bell of the stethoscope at the cardiac apex

97
Q

what are some of the associated findings of mitral stenosis

A

opening snap (high pitched sound that occurs after s2 early in diastole), loud s1

98
Q

the ___murmur sounds just like mitral stenosis except

A

tricuspid

gets louder during inspiration and best heard at lower sternal border

99
Q

what are potential causes of continuous murmurs

A 
PDA
cervical venous hum
hepatic venous hum
arteriovenous connections
ruptured aneurysm of sinus valsalva
100
Q

what is becks triad

A

hypotension
jugular venous distension
muffled or distant heart sounds

101
Q

becks triad is indicative of

A

pericardial tamponade

102
Q

what is exaggerated pulsus paradoxus

A

exaggeration of the normal decline in systolic arterial pressure during inspiration

103
Q

what is kussmaul sign

A

increase in jugular venous pressure (distention) during inspiration (normally, JVP decreases during inspiration

104
Q

a pericardial friction rub is an ausculatory hallmark of

A

acute pericarditis

105
Q

scratch sound at lower left sternal border

A

pericardial friction rub

106
Q

pericardial friction rub is best heard

A

lower left SB, when patient is at full exhalation

cardiology (11 decks)

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