S1 heart sound
mitral and tricuspid valves close
S2 heart sound
aortic and pulmonary valves close
S3 heart sound causes?
early diastolic, occurs with increased filling pressures
cause: CHF, MR, pregnancy, children, dilated cardiomyopathy
S4 heart sound causes?
late diastolic, occurs with elevated atrial pressures
cause: ventricular hypertrophy
physiologic splitting of heart sounds
occurs during inspiration
when does fixed splitting of heart sounds occur?
paradoxical splitting of heart sounds causes?
wide splitting of heart sounds
RBBB, pulmonic stenosis
sound of patent ductus arteriosus? causes?
continuous machine-like murmur
congenital heart disease, congenital rubella
sound of ventricular septal defect?
holosystolic, harsh murmur at left sternal border
sound of mitral stenosis? causes?
sound: opening click w/ delayed diastolic rumbling (interval btwn S2 and click is inversely correlated w/ severity)
cause: rheumatic fever
sound of mitral valve prolapse? causes?
sound: mid systolic click followed by systolic crescendo murmur
cause: myxomatous dgeneration, rheumatic fever (almost always), or chordae rupture
sound of mitral regurgitation? causes?
sound: holosystolic at apex with radiation to axilla (best heard in L decubitus position)
cause: MVP, LV dilation, ischemic heart disease, or rupture of chordae tendinae
sound of tricuspid regurgitation? causes?
holosytolic, radiates to R sternal border
cause: rheumatic fever, infective endocarditis, or things that cause RV dilation
sound of aortic stenosis? physical findings? causes?
sound: crescendo-descendo systolic ejection murmur (ejection click may be heard); loudest at 2nd right intercostal space (base) with radiation to carotids
parvus et tardus - pulses are weak w/ a delayed peak
cause: aortic sclerosis (age-related), bicuspid aortic valve
sound of aortic regurgitation? physical findings? causes?
sound: diastolic decrescendo murmur
PE: bounding pulses and head bobbing
causes: bicuspid aortic valve, aortic root dilation, endocarditis, rheumatic fever, SLE, syphilis
purpose of hand grip?
increase TPR (more remains in LV)
purpose of valsalva and standing?
decrease VR (less blood in heart's circuit)
purpose of inspiration vs expiration?
Inspiration - increase VR (more enters RA/RV)
Expiration - increase flow to LA from pulmonary circuit
purpose of rapid squatting vs prolonged squatting?
rapid: increase VR, increase preload
prolonged: increase afterload
what increases intensity of AS? decreases?
increase: rapid squatting
decrease: hand grip, valsalva
what increases intensity of MR? decreases?
increases: anything that increases TPR: hand grip, squatting
what increases intensity of MS? decreases?
increase: expiration (increase LA return from pulmonic circulation)
what increases intensity of VSD
increase: hand grip (to increase afterload)
what increases intensity of AR? decreases?
increase: hand grip
decrease: vasodilators, valsalva
what increases intensity of MVP? decrease?
increase: handgrip, squatting (increase TPR; later onset of click/murmur)
decrease: valsalva, standing (decrease VR; earlier onset of click/murmur)
what increases the intensity of R heart sounds?
what increases intensity of tricuspid regurgitation? decreases?
increase: inspiration (maneuvers that increase RA return)
type of arrhythmia?
at risk for?
- Irregularly irregular
- Ø P waves in between irregularly spaced QRS complexes
At risk of: Atrial stasis, thromboembolic stroke
- Rate control
- Pharmacological or electrical cardioversion
type of arrhythmia?
Rapid succession of identical back-to-back atrial depolarization waves
- Class IA, IC, or III (slows down atrial contraction so that the waves can collide and cancel out, and the SA node can take over)
- ß blockers or Ca channel blockres
- catheter ablation