cardio page 276 - 280

Question 1

what the 2 cases that S3 is normal?

Answer 1

1. in children

2. pregnant women

Question 2

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

Answer 2

c wave

Question 3

when is S4 best heard?

Answer 3

at apex with pt in Lt. lateral decubitus position

Question 4

what 2 paths are associated with S4?

Answer 4

1. ventricular hypertrophy

2. hypertrophic cardiomyopathy

Question 5

what is the mech of S4 heart sound?

Answer 5

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

Question 6

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

Answer 6

aortic stenosis

Question 7

name all the holosystolic murmur

Answer 7

mitral/tricuspid regurge, VSD

Question 8

which murmurs are loudest at tricuspid area?

Answer 8

VSD, tricuspid regurge

Question 9

where is the tricuspid area?

Answer 9

5th intercostal and Lt. lower sternal border

Question 10

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

Answer 10

pulses are weak with a delayed peak, aortic stenosis

Question 11

name 2 paths associated with aortic stenosis?

Answer 11

1. age related calcification

2. early onset calcification of bicuspid aortic valve

Question 12

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

Answer 12

aortic regurgitation

Question 13

name 5 paths associated with aortic regurgitation

Answer 13

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

Question 14

PDA is a continuous machine like murmur loudest at

Answer 14

S2

Question 15

where is PDA murmur best heard?

Answer 15

Lt. infraclavicular area

Question 16

describe murmur sound for mitral valve prolapse

Answer 16

late systolic crescendo murmur with midsystolic click

Question 17

why do you get mid systolic click in MVP?

Answer 17

due to sudden tensing of chordae tendineae

Question 18

what is the most frequent valvular lesion?

Answer 18

MVP

Question 19

will dec preload lead to dec or inc MVP murmur?

Answer 19

inc, early onset of click/murmur

Question 20

which 2 beside maneuvers will dec preload?

Answer 20

1. valsalva (phase 2)

2. standing up

Question 21

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

Answer 21

1. MVP

2. hypertrophic cardiomyopathy murmur

Question 22

what bedside maneuver inc afterload?

Answer 22

hand grip

Question 23

what bedside maneuver inc preload?

Answer 23

rapid squatting and leg raising

Question 24

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

Answer 24

1. inc preload in Rt. side

2. dec preload in Lt. side

Question 25

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

Answer 25

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

Question 26

name all the diastolic heart murmur (4 of them)

Answer 26

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

Question 27

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

Answer 27

1. inspiration 2. rapid squatting 3. leg raising

Question 28

name 2 paths associated with paradoxical splitting

Answer 28

1. aortic stenosis | 2. Lt. bundle branch block

Question 29

describe normal spltting

Answer 29

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

Question 30

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

Answer 30

narrower

Question 31

what 2 paths are associated with wide splitting of S2?

Answer 31

1. pulmonic stenosis | 2. Rt. bundle branch block

Question 32

name 2 paths associated with S4 heart sound?

Answer 32

1. ventricular hypertrophy | 2. hypertrophic cardiomyopathy

Question 33

cardiac myocytes are electrically coupled to each other by

Answer 33

gap junction

Question 34

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

Answer 34

1. Ca2+ influx | 2. K+ efflux

Question 35

myocardial action potential is made of how many phases?

Answer 35

phase 0 - 4

Question 36

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

Answer 36

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

Question 37

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

Answer 37

Ca2+ release from sarcoplasmic reticulum and myocyte contraction

Question 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

Answer 38

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

Question 39

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

Answer 39

1. inspiration 2. rapid squatting 3. leg raising

Question 40

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

Answer 40

inc TPR

Question 41

how does the intensity of AS murmur change with squatting?

Answer 41

inc (b/c TPR inc)

Question 42

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

Answer 42

tetrology of fallot

Question 43

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

Answer 43

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

Question 44

name all the jugular venous pulse

Answer 44

a, c, v waves | x, y descents