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Flashcards in cardio page 276 - 280 Deck (44):
1

what the 2 cases that S3 is normal?

1. in children
2. pregnant women

2

what wave is due to RV contraction (closed tricuspid valve bulging into atrium)?

c wave

3

when is S4 best heard?

at apex with pt in Lt. lateral decubitus position

4

what 2 paths are associated with S4?

1. ventricular hypertrophy
2. hypertrophic cardiomyopathy

5

what is the mech of S4 heart sound?

Lt. atrium pushing against still LV wall also known as atrial kick (takes place in late diastole)

6

what heart murmur is associated with syncope, angina, dyspnea on exertion?

aortic stenosis

7

name all the holosystolic murmur

mitral/tricuspid regurge, VSD

8

which murmurs are loudest at tricuspid area?

VSD, tricuspid regurge

9

where is the tricuspid area?

5th intercostal and Lt. lower sternal border

10

what is pulsus parvus et tardus? what path is associated with it?

pulses are weak with a delayed peak, aortic stenosis

11

name 2 paths associated with aortic stenosis?

1. age related calcification
2. early onset calcification of bicuspid aortic valve

12

what murmur is described as "high pitched blowing early diastolic decrescendo murmur?"

aortic regurgitation

13

name 5 paths associated with aortic regurgitation

1. aortic root dilation
2. bicuspid aortic valve
3. endocarditis
4. rheumatic fever
5. Lt. HF

14

PDA is a continuous machine like murmur loudest at

S2

15

where is PDA murmur best heard?

Lt. infraclavicular area

16

describe murmur sound for mitral valve prolapse

late systolic crescendo murmur with midsystolic click

17

why do you get mid systolic click in MVP?

due to sudden tensing of chordae tendineae

18

what is the most frequent valvular lesion?

MVP

19

will dec preload lead to dec or inc MVP murmur?

inc, early onset of click/murmur

20

which 2 beside maneuvers will dec preload?

1. valsalva (phase 2)
2. standing up

21

what are the 2 murmurs that become louder with dec preload?

1. MVP
2. hypertrophic cardiomyopathy murmur

22

what bedside maneuver inc afterload?

hand grip

23

what bedside maneuver inc preload?

rapid squatting and leg raising

24

during inspiration, describe the preload (venous return) change in Rt. and Lt. side of heart

1. inc preload in Rt. side
2. dec preload in Lt. side

25

name all the systolic heart murmur? (6 of them)

1. aortic/pulmonic stenosis
2. mitral/tricuspid regurge
3. VSD
4. MVP

26

name all the diastolic heart murmur (4 of them)

1. aortic/pulmonic regurge
2. mitral/tricuspid stenosis

27

what are the 3 bedside maneuvers that increases venous return (preload)?

1. inspiration
2. rapid squatting
3. leg raising

28

name 2 paths associated with paradoxical splitting

1. aortic stenosis
2. Lt. bundle branch block

29

describe normal spltting

it's a splitting of S2. since the pressure is less in the lung than in the system, aortic valve is closed faster than the pulmonic valve

30

is the splitting btw A2 and P2 wider or narrower in expiration?

narrower

31

what 2 paths are associated with wide splitting of S2?

1. pulmonic stenosis
2. Rt. bundle branch block

32

name 2 paths associated with S4 heart sound?

1. ventricular hypertrophy
2. hypertrophic cardiomyopathy

33

cardiac myocytes are electrically coupled to each other by

gap junction

34

the plateau of the cardiac muscle action potential is maintained by what 2 currents?

1. Ca2+ influx
2. K+ efflux

35

myocardial action potential is made of how many phases?

phase 0 - 4

36

explain briefly what takes place during each phase of the myocardial action potential (from phase 0 to 4)

1. phase 0: opening of the voltage gated Na+ channel
2. phase 1: inactivation of voltage gated Na+ channel, voltage gated K+ channels begin to open
3. phase 2: plateau (Ca2+ influx, K+ efflux)
4. phase 3: repolarization by K+ efflux
5. phase 4: resting potential by high K+ permeability

37

during the plateau of phase 2, Ca2+ influx triggers what?

Ca2+ release from sarcoplasmic reticulum and myocyte contraction

38

during inspiration, explain the changes of preload of Lt and Rt side of the heart and changes of the effect on mitral/tricuspid murmur

during inspiration
1. dec preload on Lt. side --> dec mitral murmur
2. inc preload on Rt. side --> inc tricuspid murmur

39

name 3 bedside maneuvers that inc preload/venous return to the Rt. atrium

1. inspiration
2. rapid squatting
3. leg raising

40

how does squatting affect the TPR (total peripheral resistance)?

inc TPR

41

how does the intensity of AS murmur change with squatting?

inc (b/c TPR inc)

42

in what path does squatting improve cyanosis by dec Rt. to Lt. shunt?

tetrology of fallot

43

valsalva phase 2 and standing up dec preload thus dec most heart murmur except for 2 murmurs. what are they?

1. hypertrophic cardiomyopathy murmur
2. MVP (leads to earlier onset of click/murmur)

44

name all the jugular venous pulse

a, c, v waves
x, y descents