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Flashcards in Cardiac Cycle And Sounds Deck (17)
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1

When would S4 be heard in relation to the other heart sounds?

Just before S1

2

When would an S3 be heard in relation to the other heart sounds?

Just after S2

3

What might cause an abnormally loud S1?

Vigorous ventricular contraction

Delayed closure of mitral valve (mitral valve prolapse, mitral stenosis, left atrial myxoma)

4

What might cause an abnormally soft S1?

Weak ventricular contraction

Early closure of MV (long PR interval, acute endocarditis)

5

What might cause S1 splitting?

Delay in closure of TV - d/t right BBB, LV ectopic beats or paced beats

6

There may be physiologic splitting of S2. This would be heard over ____ or _____ ICS at left sternum.

If heard any lower, it could indicate _______.

If heard any higher, it could indicate _______.

2; 3rd

COPD

Obesity

7

Wide physiologic split of S2

RBBB

8

Wide fixed split of S2

Atrial septal defect with regular rhythm

9

Paradoxic splitting (reversed splitting) of S2

A2 and P2 meld during inspriation, often in elderly with aortic flow murmurs

10

Conditions commonly associated with S3

CHF, regurg, L-R shunts

[in CHF S3 suggests decreased EF]

11

Conditions commonly associated with S4

HTN
Ischemic cardiomyopathy
Hypertrophic cardiomyopathy
Aortic stenosis

12

Small, non-tender erythematous or hemorrhagic lesion on palms or soles of feet indicative of endocarditis

Janeway lesions

13

Tender, raised, red lesions on hands or feet potentially indicative of endocarditis

Osler's nodes

14

What part of the physical exam is the most accurate estimate of RA pressure, volume status, and cardiac function?

Jugular venous pressure

15

Normal JVP

3-4 cm above the angle

16

Abdominojugular test

Patient placed in 45-90 degrees

Observe neck veins while applying pressure to abdomen

Normal CVP will remain unchanged after a beat or two. Positive test with rise of >4cm and remains elevated for 10s or more, or when falls more than 4 cm when pressure released

17

Kussmaul's sign

Paradoxic elevation of CVP during inspiration

Normally JVP will fall bc of decreasing right pressure as intrathoracic pressures fall

Classically associated with constrictive pericarditis; commonly attributed to severe heart failure, PE, and RV infarct