Cardiac Cycle/Murmurs

Question 1

During which phase (systole or diastole) are the AV valves closed to prevent the backflow of blood?

Answer 1

systole

Question 2

True or False: AV valves open and close passively are are wimpy like Brainy from Hey Arnold.

Answer 2

True.

breathes breathes breathes

Question 3

True or False: the papillary muscles help the AV valves close via the chordae tendinae.

Answer 3

FALSE. The AV valves are passive.

Question 4

So what’s the fxn of the papillary muscles?

Answer 4

They pull the vanes of the valves inwards towards the ventricles to prevent their buldging too far backward into the atria.

Question 5

What % of blood flows into the ventricles PASSIVELY from the atria?

Answer 5

80%

Question 6

What causes the additional 20% of the ejected blood to flow from the atria to the ventricles?

Answer 6

atrial contraction

Question 7

Rapid ventricular filling (passively) occurs how long in the filling phase?

Answer 7

first 1/3

Question 8

What causes the “a” wave on the atrial pressures?

Answer 8

“a”trial contraction

Question 9

What causes the “c” wave on the atrial pressures?

Answer 9

‘c”losure of the AV valves

Question 10

What causes the “v” wave on the atrial pressures?

Answer 10

“v”entricular contraction

Question 11

This is the period where the ventricles are actively contracting but there is no ejection.

Answer 11

Isovolumetric contraction

Question 12

After the ventricles get a pressure higher than the aorta, blood is squirted into the aorta, leading to this phase.

Answer 12

Rapid ejection phase.

Question 13

After the blood is squirted itno the aorta, the pressures are higher than the LV, closing the aortic valve, and leading to this phase of the cardiac cycle.

Answer 13

Isovolumetric relaxation

Question 14

What causes the S1?

Answer 14

Closure of the AV valves

Question 15

What electrical disordere can cause S1 to split?

Answer 15

RBBB

Question 16

Conditions that shorten the PR interval (MS, high CO or tachycardia) can cause which one: accentuated or reduced S1?

Answer 16

Accentuated

Question 17

Which conditions can prolong the PR interval, causing a reduced S1 sound?

Answer 17

1st degree AV block, MR, MS, stiff LV

Question 18

What causes the late pulmonic closure to cause the splitting of S2?

Answer 18

expansion of the chest during inspiration creates a negative pressure in the chest –> increased capacitance of the pulmonary vessels –> delay in diastolic back pressure onto pulomary valve –> P2 delayed

Question 19

What causes the early atrial valve closure to cause the splitting of S2?

Answer 19

increased capacity of intrahtoracic veins from neg pressure –> reduced venous return to LA and LV –> reduced LV filling –> shortened LV filling –> early A2 during inspiration

Question 20

The intensity of S2 depends on what factor of the blood?

Answer 20

velocity

Question 21

RBBB or PS can cause what abnormal splitting of S2?

Answer 21

Widened splitting

Question 22

ASD can cause what abnormal splitting of S2?

Answer 22

Fixed splitting

Question 23

LBBB or AS can cause what abnormal splitting of S2?

Answer 23

Paradoxical splitting

Question 24

Where in the the cardiac cycle is S3 found?

Answer 24

Early diastole

“Ken——tuck–y”

Question 25

Is S3 sharp or dull?

Answer 25

dull

Question 26

What causes S3?

Answer 26

tensing of the chordae tendineae during rapid filling and expansion of the ventricle. like plucking a guitar string... bongggggg

Question 27

True or False: S3 is normal in kids and young adults cuz the ventricle is supple and capable of rapid expansion.

Answer 27

True

Question 28

Contraction of the atria against a stiffened ventricle can cause what heart sound?

Answer 28

S4

Question 29

Where in diastole does S4 occur?

Answer 29

Late diastole

Question 30

What are the characteristics of a 1/6 grade murmur?

Answer 30

barely audible

Question 31

What are the characteristics of a 2/6 grade murmur?

Answer 31

faint but immediately audible

Question 32

What are the characteristics of a 3/6 grade murmur?

Answer 32

easily heard

Question 33

What are the characteristics of a 4/6 grade murmur?

Answer 33

easily heard with palpable thrill

Question 34

What are the characteristics of a 5/6 grade murmur?

Answer 34

very loud with stethoscope light on chest

Question 35

What are the characteristics of a 6/6 grade murmur?

Answer 35

audible without the stethoscope on the chest

Question 36

What are the 3 ways to decrease the preload to the heart?

Answer 36

valsalva, sitting-->stranding, amyl nitrate

Question 37

What are the 5 ways to increase the preload to the heart?

Answer 37

standing-->squatting, passive leg elevation, Muller, isometric hand grip, vasopressors

Question 38

What are the 3 systolic ejection murmurs?

Answer 38

1. aortic/pulmonary stenosis 2. HCM 3. innocent murmurs

Question 39

Where is the radiation in AS?

Answer 39

carotids

Question 40

Does HCM murmurs get louder or quieter if you decrease preload?

Answer 40

Louder

Question 41

Why are innocent murmurs "innocent?"

Answer 41

theyre just high-flow states like youth, pregnancy, fever, anemia, hyperthyroidism, etc.

Question 42

What are the 3 pansystolic murmurs?

Answer 42

1. MR 2. TR 3. VSD

Question 43

Any murmur on the R side of the heart gets louder or softer during inspiration?

Answer 43

Louder

Question 44

Do pansystolic murmurs change the intensity throughout S1-S2 or remain the same?

Answer 44

remain the same

Question 45

Does MR get louder when u increase or decrease preload?

Answer 45

Increase

Question 46

What is the sign called of TR where it gets louder during inspiration?

Answer 46

Carvallos sign

Question 47

What is the triad for severe TR?

Answer 47

carvallos sign, pulsatile JVD, and pulsatile liver

Question 48

Where is VSD best heard?

Answer 48

4-6th L intercostals

Question 49

Does VSD increase with inspiration?

Answer 49

No

Question 50

What is the 1 mid-to-late systolic murmur?

Answer 50

MVP

Question 51

What causes MVP?

Answer 51

Bowing of abnormally redundant and elongated valve leaflets into the left atrium.

Question 52

What happens mid-systolic which is indicative of MVP?

Answer 52

click

Question 53

What are the 2 EARLY diastolic murmurs?

Answer 53

AR and PR

Question 54

What is the shape of AR?

Answer 54

Decrescendo after A2

Question 55

This is an assocation with AR that may happed due to high flow across the aortic valve.

Answer 55

Systolic ejection murmur

Question 56

This is an assocaition with AR that is a diastolic rumble from a functional MS.

Answer 56

Austin Flint murmurs most likely a test question lol. there were like 5 slides just on this 1 thing.

Question 57

This is a sign of AR where theres a systolic murmur over femoral artery when steth is compressed proximally and a diastolic murmur when compressed distally.

Answer 57

Duroziez sign

Question 58

What is the main cause of PR?

Answer 58

pulmonary arterial HTN

Question 59

This is a type of murmur in PR from pulmonary HTN and has a loud component of S2.

Answer 59

Graham steel murmur

Question 60

This is the cause of PR when u hear an afterpulmonic component of S2 with a crescendo-decrescendo pattern.

Answer 60

Deformity in the pulmonic valve.

Question 61

What are the 2 mid-to-late diastolic murmurs?

Answer 61

1. AV valve stenosis | 2. increased flow across the AV valves

Question 62

What happens after S2 in MS? give me the shape of the murmur

Answer 62

opening snap --> fade down --> re-appears when atria contract before S1

Question 63

What is MS almost always a sequela of?

Answer 63

rheumatic fever