CPS case 4

Question 1

presystolic murmur

Answer 1

mitral or tricuspid stenosis

Question 2

holosystolic murmur (pansystolic)

Answer 2

mitral or tricuspid regurgitation or of ventricle septal defect

Question 3

aortic ejection murmur

Answer 3

ejection click, and fading before the second heart sound heard

Question 4

systolic murmur in pulmonic stenosis

Answer 4

spilling through aortic second sound, pulmonic valve closure being delayed

Question 5

S1

Answer 5

mitral and tricuspid valve closure

Question 6

S2

Answer 6

aortic/pulmonic valve closure

Question 7

S3

Answer 7

early ventricular filling

Question 8

S4

Answer 8

late ventricle filling (atrial contribution)

Question 9

S3 can be heard

Answer 9

best at apex

• after S2 during rapid ventricular filling
• normal in children and young adults

Question 10

pathological causes of S3 heart sound

Answer 10

• excessive rapid filling with normal compliance
• high output states
• mitral regurgitation
• normal filling rate with decreased compliance or increased ESV
• hypertrophic cardiomyopathy
• left-ventricular dysfunction

Question 11

when can continuous murmur be heard?

Answer 11

patent ductus arteriosus

Question 12

unstable angina

Answer 12

non occlusive
non specific on ECG
normal cardiac enzymes

Question 13

NSTEMI

Answer 13

occluded thrombus sufficient to cause tissue damage and mild myocardial necrosis

• ST depression +/- T wave inversion on ECG
• elevated cardiac enzymes

Question 14

STEMI

Answer 14

complete thrombus occlusion

• ST elevations on ECG or new LBBB
• elevated cardiac enzymes
• more severe symptoms

Question 15

some causes for left axis deviation

Answer 15

LV hypertrophy
LBBB
inferior wall MI
hyperkalemia

Question 16

some causes of right axis deviation

Answer 16

RV hypertrophy
RBBB
lateral wall MI

Question 17

MI location: anterior

Answer 17

ECG leads: V1-V4

Artery involved: Mid LAD

Question 18

MI location: septal

Answer 18

ECG leads: V1-V2

artery involved: septal branch

Question 19

MI location: extensive anterior

Answer 19

ECG leads: V1-V6

artery: proximal LAD

Question 20

MI location: lateral

Answer 20

ECG leads: V5, V6, I, aVL

artery: circumflex

Question 21

MI location: high lateral

Answer 21

ECG leads: I, aVL

artery: diagonal

Question 22

MI location: inferior

Answer 22

ECG leads: II, III, aVF

artery: posterior descending

Question 23

MI location: inferoposterior

Answer 23

ECG leads: II, III, aVF, V1-V2

artery: RCA

Question 24

MI location: inferopostlateral

Answer 24

ECG leads: II, III, aVF, V1,2,5,6

artery: RCA/dominant

Question 25

acute infarct of posterior wall (RCX)

Answer 25

appear opposite of an anterior infarct - large positive R waves - ST segment depressions in V1-V2 (maybe V3) leads

Question 26

left main coronary artery occlusion

Answer 26

ST elevations in aVR