Cardiac Cycle and Valvular Heart Disease

Question 1

In young healthy individuals is atrial contraction a significant source of ventricular filling?

Answer 1

no

Question 2

When is atrial contraction a significant source of ventricular filling?

Answer 2

when ventricular filling is reduced because of reduced compliance

Question 3

What is the S1 sound produced by? (sound associated with it)

Answer 3

the “lub” sound

closure of mitral and tricuspid valves

Question 4

What is the S2 sound produced by? (also sound associated with it)

Answer 4

the “dub” sound
closure of the aortic(A2) and pulmonic sounds (P2 component)

Question 5

What is physiological splitting of S2?

Answer 5

during inspiration due to increased output of rt heart physiological splitting in which the pulmonic valve closes later than the aortic valve occurs

Question 6

What is a widened split?

Answer 6

Upon inspiration, the natural physiological split, or delay in pulmonic valve closure is even more delayed

Question 7

Meaning of a widened split?

Answer 7

pulmonic stenosis

right bundle branch block

Question 8

What is a fixed split?

Answer 8

When you hear S2 split both upon inspiration and expiration

Question 9

Meaning of a fixed split?

Answer 9

ASD; L-R shunt

Question 10

What is paradoxical splitting?

Answer 10

When the pulmonary valve closes before the aortic valve; you are technically hearing P2 close first even though it has a natural delay so P2 upon inspiration gets closer to timing for aortic valve to close and now you hear 1 sound

You are hearing the aortic valve close later instead of sooner

Question 11

What is the meaning of paradoxical splitting?

Answer 11

left bundle branch block

advanced aortic stenosis

Question 12

What is the S3 sound?

Answer 12

It occurs just after the opening of the AV valves during rapid filling of the ventricle

Usually produced by expansion compliant ventricle

normal in children

in older adults signifies volume overload

Question 13

What is S4 sound?

Answer 13

coincides with atrial contraction; is produced when atrium contracts against a stiff ventricle

Question 14

What are examples of when you hear an S4 sound?

Answer 14

concentric hypertrophy, aortic stenosis, and myocardial infarction

Question 15

Where is the aortic auscultation point?

Answer 15

second intercostal space on rt side, and mid-clavicular line

Question 16

What is the pulmonic ausculatation point?

Answer 16

second intercostal space on the left side, about mid-clavicular line

Question 17

What is the tricuspid auscultation point?

Answer 17

fifth ICS just at left sternal border

Question 18

Where is the mitral ausculation point?

Answer 18

sixth ICS on the left side, about mid-clavicular line

Question 19

Which venous wave has the highest deflection of the venous pulse and is produced by contraction of the right atrium?

Answer 19

a wave

Question 20

What is the c wave of the venous pulse curve caused by mainly? What event does it begin at?

Answer 20

due to bulging of the tricuspid valve into the atrium (rise in atrial pressure)

occurs near beginning of ventricular contraction

Question 21

What is x descent produced by on venous pulse curve?

Answer 21

produced by a decreasing atrial pressure during atrial relaxation

Question 22

What is the v wave?

Answer 22

produced by filling of the atrium during ventricular systole when the tricuspid valve is closed

Question 23

What is y descent?

Answer 23

produced by the rapid emptying of the right atrium immediate after the opening of tricuspid valve

Question 24

Describe what each venous pressure curve represents and why?

Answer 24

From top to bottom:

A Normal
B A fib
C tricuspid regurgitation
D tricuspid stenosis

Question 25

Formula for stroke volume

Answer 25

Stroke volume = end-diastolic volume – end-systolic volume

Question 26

If increased contractility is the only variable that changes in a pressure volume loop; where will the loop shift?

Answer 26

to the left

Question 27

What falls during excercise? preload, ESV, peak systolic pressure, or SV?

Answer 27

ESV

Question 28

A stenotic valve is a resistor and therefore when can you hear the mumur?

Answer 28

when valve is open

Question 29

A regurgitant valve allows back-flow of blood. When can you hear this type of murmur?

Answer 29

when the valve is normally closed

Question 30

What type of murmur would you hear for aortic stenosis?

Answer 30

crescendo decrescendo

Question 31

What valvular conditions is being seen here?

Answer 31

aortic stenosis

Question 32

What valvular condition is being seen here?

Answer 32

aortic stenosis

Question 33

What valvular condition is being seen here?

Answer 33

aortic regurgitation retrograde flow from aorta to left ventricle produces a low aortic diastolic pressure large aortic PP

Question 34

What is being seen here?

Answer 34

Aortic regurgitation (insufficiency) all volumes are increased (SV, ESV, EDV) though end diastolic pressure pretty much the same (eccentric hypertrophy) No true isovolumetric relaxation

Question 35

A short S2: OS (opening snap) interval is a reliable indicator of what valvular condition?

Answer 35

severe mitral stenosis

Question 36

If you hear a click instead of an opening snap? What valvular condition may this indicate?

Answer 36

MVP

Question 37

What condition can be seen here?

Answer 37

mitral stenosis elevated atrial pressure and volume

Question 38

What condition can be seen here?

Answer 38

mitral stenosis

Question 39

What condition is being seen here? What type of murmur would you hear?

Answer 39

mitral insufficiency regurgitation atrial volumes and pressures are increased ventricular volumes and pressure are increased during diastole pansystolic or holosystolic murmer

Question 40

What condition is being seen here?

Answer 40

mitral insufficiency regurgitation no true isovolumetric contraction ventricular volumes are pressures are increased during diastole

Question 41

What condition is being seen here?

Answer 41

mitral insufficiency regurgitation no true isovolumetric contraction ventricular volumes are pressures are increased during diastole