Cardiac cycle

Question 1

what is the first event in the cardiac cycle?

Answer 1

atrial contraction

Question 2

is there isovolumic contraction during AV valve opening?

Answer 2

no

Question 3

will there be isovolumic contraction with aortic regurgitation?

Answer 3

no

Question 4

how is central venous pressure assessed?

Answer 4

right atrial pressure

Question 5

what are three common causes of increased CVP?

Answer 5

heart failure
tricuspid valve disorders
pulmonary arterial HTN

Question 6

what two waves are most prominent on a jugular venous wave form? what do they correspond to?

Answer 6

X - fall in RA pressure after a wave peak

X’ - descent of cardiac base, atrial relaxation

Question 7

what is the dominant motion of the normal JVP?

Answer 7

X - X’ descent

Question 8

what do normal jugular venous pulsations provide information about?

Answer 8

right heart pressure
congestion
abnormal RA pressure
hydration status

Question 9

what is the cause of a very high A wave in jugular venous pulsations?

Answer 9

RA contracting against a closed RV

complete heart block 
TV disorders (stenosis)

Question 10

what is the cause of a CV wave in jugular venous pulsations?

Answer 10

ventricularization of RA pressure

TV regurgitation (CHV)

Question 11

S1 corresponds to what?

Answer 11

closure of mitral and tricuspid valves

Question 12

S2 corresponds to what?

Answer 12

aortic (A2) and pulmonic (P2) closure

varies with respiratory cycle

Question 13

what is the cause of physiological splitting of S2?

Answer 13

inspiration 
increased venous return to RV 
increased RVEDV 
increased time to expel blood from RV 
pulmonic valve stays open longer

Question 14

when is widened splitting of S2 heard? why?

Answer 14

expiration

1. RBBB - delay in RV contraction - delay in pulmonic closure
2. pulmonic stenosis - more time to open - delay in closure

Question 15

when does fixed splitting of S2 occur? why?

Answer 15

atrial septal defect

high capacitance, low resistance of pulmonary vasculature
delayed back pressure responsible for pulmonic valve closure
P2 is delayed

Question 16

what are the causes of paradoxical splitting of S2? when does it occur, and why?

Answer 16

LBBB
advanced aortic stenosis

expiration - abnormal delay in closure of aortic valve (A2 follows P2)

Question 17

does timing of opening snap in mitral stenosis change with respiration?

Answer 17

no

Question 18

what is the third heart sound S3?

Answer 18

1. early diastole following opening of AV valves during rapid ventricular filling
2. produced by tension of chordae tendinae during rapid filling

Question 19

what is the fourth heart sound S4? when in the cardiac cycle is it heard?

Answer 19

produced when trying to fill a stiff ventricle - coincides with atrial contraction

presystolic (late diastole)

Question 20

in which situations is S4 heard?

Answer 20

low compliance / hypertrophy / acute MI

Question 21

where is an early diastolic murmur heard?

Answer 21

left sternal border

Question 22

what type of murmur is heard at the left sternal border?

Answer 22

early diastolic murmur

Question 23

where is a pansystolic murmur heard?

Answer 23

tricuspid area

mitral area

Question 24

what types of murmurs are heard at the tricuspid area?

Answer 24

pansystolic

mid to late diastolic

Question 25

what type of murmur is heard at the mitral area?

Answer 25

pansystolic

Question 26

ejection type murmurs are due to what causes?

Answer 26

aortic stenosis | pulmonic stenosis

Question 27

pansystolic type murmurs are due to what causes?

Answer 27

mitral regurg tricsupid regurg VSD

Question 28

late systolic type murmurs are due to what cause?

Answer 28

mitral valve prolapse

Question 29

aortic and pulmonic stenoses cause what type of murmur?

Answer 29

ejection type

Question 30

mitral and tricuspid regurg, and VSD cause what type of murmur?

Answer 30

pansystolic

Question 31

mitral valve prolapse cause what type of murmur?

Answer 31

late systolic

Question 32

aortic stenosis is heard best at what area? what does it sound like?

Answer 32

2nd ICS pt leaning forward harsh quality between S1 and S2

Question 33

mitral regurg is common in patients with what condition?

Answer 33

heart failure

Question 34

mitral regurg is heard best at what area? what does it sound like?

Answer 34

apex, radiates to axilla holo-systolic of constant intensity, plateau shaped extending from S1 to S2

Question 35

aortic regurg is heard best at what area? what does it sound like?

Answer 35

3rd or 4th ICS high pitched and blowing in quality

Question 36

what can increase aortic regurg heart sounds?

Answer 36

tightening of fists