Cardiovascular

Question 1

Where is the point of maximal impulse (PMI) located?

Answer 1

Left border of the heart, 5th intercostal space, at or just medial to the left midclavicular line.
- In dextrocardia the PMI is located on the right side of the chest
- PMI >2.5 cm is evidence of LVH
- Displacement of the the PMI lateral to the midclavicular line occurs in LVH and ventricular dilatation from MI or heart failure

Question 2

What are the diastolic sounds of S3 and S4 correlated with?

Answer 2

They are pathologic sounds correlated with systolic and diastolic heart failure, respectively.

Question 3

S3

Answer 3

Corresponds to an abrupt deceleration of inflow across the mitral valve.

Question 4

S4

Answer 4

An increased left ventricular and diastolic stiffness which decreases compliance.

Question 5

Which valves are open in diastole?

Answer 5

Mitral and tricuspid are open. Aortic and pulmonic are closed.

Question 6

Define systole.

Answer 6

Ventricular contraction & ejection.
- aortic valve open, mitral valve closed
- when the left ventricle ejects blood into the aorta. After the ventricle ejects much of its blood into the aorta, the pressure levels off and starts to fall.

Question 7

Define diastole.

Answer 7

Ventricular relaxation & filling.
- aortic valve closed, mitral valve open
- once ventricular pressure levels off, Ventricular pressure falls further and blood flows from atrium to ventricle.

Question 9

Which valves are open during systole?

Answer 9

Aortic & pulmonic

Question 10

What is S1?

Answer 10

Closure of tricuspid and mitral valves.

Question 11

What is S2?

Answer 11

Closure of pulmonic and aortic valves?

Question 12

What does maximal left ventricular pressure correspond to?

Answer 12

Systolic blood pressure

Question 13

A third heart sound is created by

Answer 13

Diastolic filling

Question 14

A fourth heart sound is created by

Answer 14

Atrial contraction.
Reflects ventricular stiffness, as seen in hypertension or acute MI.

Question 15

Describe splitting of S2

Answer 15

During inspiration, right heart filling time is increased, which increases right ventricular stroke volume and the duration of right ventricular ejection compared with the LV. This delays closure of the pulmonic valve, splitting S2.
- can be heard at the second and third intercostal spaces close to the sternum.

Question 17

Where is S1 best heard?

Answer 17

Cardiac apex.
-mitral component throughout precordium and loudest at apex
- tricuspid component loudest at lower left sternal border

Question 18

Define heart murmurs.

Answer 18

Heart sounds distinguished by their pitch and longer duration. Attributed to turbulent blood flow and usually indicate valvular disease.

Question 19

Stenotic valve

Answer 19

A valve with an abnormally narrowed orifice that obstructs blood flow and causes a murmur.

Question 20

Regurgitating murmur

Answer 20

Valves that close abnormally such that blood is allowed to leak backward in a retrograde direction and produces a murmur.

Question 21

Where on the chest wall can the aortic valve be best heard?

Answer 21

Right second intercostal spaces close or cardiac apex

Question 22

Where on the chest wall can the pulmonic valve best be heard?

Answer 22

Left second and third intercostal spaces close to the sternum.

Question 24

Where on the chest wall can the tricuspid valve best be heard?

Answer 24

At or near the lower left sternal border.

Question 25

Where on the chest wall can the mitral valve best be heard?

Answer 25

Cardiac apex

Question 26

Cardiac output

Answer 26

Heart rate x Stroke volume

Question 27

Stroke volume

Answer 27

Preload, myocardial contractility, & afterload

Question 28

Causes of decreased right ventricular preload

Answer 28

Exhalation, dehydration, & pooling of blood in the capillary bed or the venous system.

Question 29

Causes of increased right ventricular preload

Answer 29

Inspiration, increased volume of blood flow from exercising muscles, increased blood volume of a dilated RV in heart failure.

Question 30

Myocardial contractility

Answer 30

- Increases when stimulated by the sympathetic nervous system. - Decreases when blood flow or oxygen delivery to the myocardium is impaired, as in MI.

Question 31

Where does blood pressure in the arterial system peak and trough?

Answer 31

Peak- systole Trough- diastole

Question 32

Factors affecting blood pressure

Answer 32

- Left ventricular stroke volume - Distensibility of the aorta and the large arteries - Peripheral vascular resistance, particularly at the arteriolar level - Volume of blood in the arteriolar system

Question 33

What is JVP?

Answer 33

Right atrial pressure, which, in turn, equals central venous pressure and right ventricular end diastolic pressure. Best estimated from the right internal jugular vein.

Question 34

A wave of jugular venous pulsation

Answer 34

Atrial contraction, tricuspid valve open

Question 35

“V” wave of jugular venous pulsation

Answer 35

Venous filling, atrium tense, tricuspid closed

Question 36

“X” wave of jugular venous pulsation

Answer 36

Atrial relaxation then filling, tricuspid closed

Question 37

“Y” descent wave of jugular venous pulsation

Answer 37

Atrial emptying, tricuspid open

Question 38

“C” wave of jugular pulsations

Answer 38

Coincides with S1 and systole

Question 39

Cannon “a” waves of jugular pulsation

Answer 39

Occur in increased resistance to right atrial contraction - tricuspid stenosis - severe 1st, 2nd, & 3rd degree AV block - supraventricular tachycardia - junctional tachycardia - pulmonary HTN - pulmonic stenosis

Question 40

Absent “a” waves of jugular pulsation

Answer 40

Atrial fibrillation

Question 41

Increased “v” wave of jugular pulsations

Answer 41

Tricuspid regurgitation, atrial septal defects, constrictive pericarditis

Question 42

What donpalpitations usually mean?

Answer 42

Disease of the conduction system of the heart

Question 43

What signs are present if the LV is not pumping adequately?

Answer 43

Pulmonary edema, SOB with/without exertion, orthopnea, lightheadedness or loss of consciousness if blood supply to the brain is inadequate

Question 44

What signs point to RV pump dysfunction?

Answer 44

Peripheral edema

Question 45

What condition presents with anterior chest pain, often tearing or ripping and radiating into the back or neck?

Answer 45

Acute aortic dissection

Question 46

Causes of chest pain in the absence of obstructive coronary artery disease include

Answer 46

Micro vascular coronary dysfunction Abnormal cardiac noicioception More common in women

Question 47

Which non-cardiac conditions may produce palpitations?

Answer 47

Anxiety Hyperthyroid