Cardiology-Basics

Question 1

Base and apex of the heart

Answer 1

Question 2

aortic and pulmonary areas to the ___ and ____ of the sternum

Answer 2

aortic and pulmonary areas to the right and left of the sternum

Question 3

Differences between S1, S2

Answer 3

1. Carotid pulse: S1 just precedes, S2: Follows
2. Louder at: apex: S1 , base: S2
3. Lower pitch and longer: S1, Higher pitch and shorter: S2

http://depts.washington.edu/physdx/heart/tech.html

Question 4

Categories of heart sounds

Answer 4

1. 1st & 2nd Heart Sounds
2. 3rd & 4th Heart Sounds
3. Clicks & Snaps
4. Murmurs
5. Rubs
6. Maneuvers

Question 5

Aortic stenosis

Answer 5

1. Harsh late-peaking crescendo-decrescendo systolic murmur
2. Heard best- right 2nd ICS
3. Radiation to the carotids.

Question 6

A murmur is characterized by:

Answer 6

1. Intensity
2. Timing
3. Configuration
4. Frequency
5. Location.

Question 7

Semilunar valves

Answer 7

The aortic and pulmonary valves

Question 8

A mid-systolic murmur associated with a single S2 suggests:

Answer 8

Severe aortic stenosis

Question 9

The most common causes of a mid-systolic murmur are

Answer 9

Benign (innocent) flow murmurs,

Question 10

Types of murmurs

Answer 10

Systolic

Diastolic

Continous

Question 11

Early systolic murmurs

Answer 11

• Mitral regurgitation
• Tricuspid regurgitation
• Ventricular septal defect

Question 12

Midsystolic ejection murmurs

Answer 12

1. Innocent midsystolic murmurs
2. Increased semilunar blood flow
3. Aortic valve sclerosis
4. Aortic outflow obstruction (AS etc)

Question 13

Holosystolic murmurs

Answer 13

• Mitral regurgitation
• Tricuspid regurgitation
• Ventricular septal defect

Question 14

Late systolic murmur

Answer 14

• Mitral valve prolapse
• Tricuspid valve prolapse
• Ischemic mitral regurgitation

Question 15

Early diastolic murmur

Answer 15

• Aortic regurgitation
• Pulmonic regurgitation
• Left anterior descending artery stenosis

Question 16

Mid-diastolic murmurs

Answer 16

• Mitral stenosis
• Prosthetic mitral valve
• Tricuspid stenosis
• Atrial myxoma
• Carey-Coombs murmur
• Austin Flint murmur
• Left-to-right shunts

Question 17

Late diastolic murmurs

Answer 17

• Mitral stenosis
• Tricuspid stenosis
• Myxoma
• Complete heart block

Question 18

CONTINUOUS MURMURS

Answer 18

Patent ductus arteriosus

Aortopulmonary window

Shunts

Arteriovenous fistulas

Coarctation of the aorta

Question 19

Blowing holosystolic murmur

Heard best at the apex

Radiation to the axilla and inferior edge of left scapula.

Possible associated findings:

S2: wide physiologic splitting

S3

Answer 19

MR

Question 20

An apical diastolic rumbling murmur in pure aortic regurgitation

Answer 20

Austin Flint

Question 21

Soft holosystolic murmur

Heard best at the LLSB without radiation

Intensity increases with inspiration or pressure over liver

Answer 21

TR

Question 22

Early diastolic

• high-pitched and “blowing.”
• decrescendo configuration like that of aortic regurgitation;
• differentiation is difficult if not impossible by auscultation alone.
• may increase in intensity during inspiration and can be more localized
• best heard over the left second and third interspaces.

Answer 22

Pulmonic insufficiency

Explanation: Pathologic pulmonic regurgitation is most frequently a result of pulmonic hypertension (Graham-Steell murmur) or residual after Tetralogy of Fallot repair in adults

Question 23

Low frequency rumbling mid-diastolic murmur, with presystolic component possible

Heard best at apex

Accentuated in left lateral decubitus position

Answer 23

MS

Question 24

Fixed aortic valve obstruction is distinguished from dynamic subaortic outflow tract obstruction by changes in the murmur with

Answer 24

Valsalva: AS goes down, HOCM goes up

Amyl Nitrite: Both go up

Handgrip: AS goes down, HOCM goes down

Squatting: AS goes up, HOCM goes down

Question 25

Differentiate between MR and AS murmur in heart failure

Answer 25

MR murmur is pansystolic with radiation to axilla

Question 26

Differentiate: PS and AS

Answer 26

1. Pulmonary stenosis is usually congenital 2. In adults, associated with carcinoid. 3. PS murmur is best heard in upper LSB 4. PS will cause RHF

Question 27

Severe R from AS

Answer 27

1. Severe TR: holosystolic murmur 2. Best heard: lower sternal borders 3. TR: V wave

Question 28

Differntiate: AS from aortic sclerosis

Answer 28

1. No symptoms 2. Brief, not loud

Question 29

Aortic stenosis murmur conducted to the apex with a musical quality

Answer 29

Gallavardin murmur

Question 30

Harsh quality midsystolic murmur Heard best LSB Increases with decreased venous return Possible associated findings: 1. Sustained apical beat to palpation 2. S4 (50% of the time)

Answer 30

HOCM

Question 31

Differentiating SEM from a regurgitant murmur

Answer 31

Hand grip: decreases the intensity of the ejection murmur Amyl nitrite: increases the intensity of the ejection murmur

Question 32

Late systolic murmurs are most commonly caused by

Answer 32

MVP

Question 33

Early diastolic murmur is usually due to

Answer 33

Aortic or pulmonic regurgitation

Question 34

Timing of the Mitral stenosis murmur

Answer 34

mid-diastolic, late diastolic murmur, or both.

Question 35

Causes of a continuous murmur include

Answer 35

1. PDA 2. Aortopulmonary window (rare, confusingly also refers to radiologic term) 3. Some shunts 4. AV fistulas 5. Coarctation

Question 36

Low-frequency diastolic sounds that appear to originate in the ventricles

Answer 36

S3, S4

Question 37

S3, S4 are best heard with:

Answer 37

bell

Question 38

Aortic, Pulmonary, Tricuspid and Mitral areas

Answer 38

1. Aortic: 2 RICS 2. Pulmonary: 2 LICS 3. Tricuspid: 4 LICS 4. Mitral: Apex

Question 39

Beginning of the middle third of diastole, approximately 0.12 to 0.18 seconds after S2. "Kentucky" with the final syllable ("-CKY") representing

Answer 39

S3

Question 40

Significance of S3

Answer 40

1. Normal under 40 years 2. Normal in some trained athletes 3. Should disappear before middle age. 4. Re-emergence later: heart failure.

Question 41

Significance of S4

Answer 41

Decreased left ventricular distensibility. Thus, S4 is common in hypertensive heart disease, AS, and HOCM

Question 43

Rx: blood pressure lowering in hypertensive emegency with CHF

Answer 43

IV nitroglycerine

Question 45

Antihypertensives in pregnancy

Answer 45

1. Methyldopa 2. Labetalol

Question 46

CAD.LipidMx Patient with CAD+myalgias, mildly elevated CK

Answer 46

1. Switch statin OR 2. lower dose

Question 47

CHB+Cardiomyopathy+clean coronary+ventricular tachycardias Most likely Dx

Answer 47

Sarcoidosis

Question 48

Ascending aorta aneurysm: size requiring surgery

Answer 48

5.5 cm

Question 49

A 26-year-old woman with a history of hypertension characterized as difficult-to-control and depression is admitted to the hospital to mental health services for treatment of suicidal ideation. Before hospital admission, she was taking amlodipine, 10 mg daily; chlorthalidone, 25 mg daily; methyldopa, 500 mg twice daily; and sertraline, 100 mg daily. All of these medications have been continued during her hospitalization. She has now been hospitalized for 2 weeks, her mental health has stabilized, and she is ready for discharge. However, her systolic blood pressure has been approximately 150 to 170 mm Hg during most of her stay in the inpatient psychiatric unit. She has no physical complaints. Her available outpatient records reveal similar blood pressure readings over the previous year. Other than the elevated blood pressure, her physical examination findings are normal. Her pulse rate is 70 beats/min, respiratory rate is 12 breaths/min, and BMI is 23.5 kg/m2. Laboratory data, including serum sodium, potassium, creatinine, and TSH measurements, are normal. In addition to arranging for an outpatient follow-up appointment in 4 weeks, which of the following is the best course of action for this patient who is being discharged from the hospital? A. Discontinue sertraline and begin citalopram, 20 mg daily B. Begin lisinopril, 10 mg daily, and measure serum renin and aldosterone levels C. Begin losartan, 25 mg daily, and perform duplex Doppler ultrasonography of the renal arteries D. Begin fosinopril, 10 mg daily, and order an outpatient polysomnography test E. Begin metoprolol succinate, 25 mg daily, and measure plasma metanephrine levels

Answer 49

Begin losartan, 25 mg daily, and perform duplex Doppler ultrasonography of the renal arteries ## Footnote Rationale: FMD is a "common" cause of secondary hypertension in young women. There is no hypokalemia to suggest hyperaldosteronism (choice C).

Question 50

this class of drugs should be considered for patients whose blood pressure remains elevated after treatment with a 3-drug regimen to maximal or near maximal doses. Resistant hypertension may be associated with secondary causes of hypertension includin

Answer 50

spironolactone ## Footnote An increasing body of evidence has suggested benefits of mineralocorticoid receptor antagonists, such as eplerenone and spironolactone, in improving blood pressure control in patients with resistant hypertension, regardless of circulating aldosterone levels.