EXAM #1: CARDIAC CYCLE

Question 1

What is the first event in the cardiac cycle?

Answer 1

Atrial contraction

Question 2

When does the second phase of the cardiac cycle start?

Answer 2

AV valves close

Question 3

What is the second phase of the cardiac cycle?

Answer 3

Isovolumetric contraction

Question 4

What is the third phase of the cardiac cycle?

Answer 4

Ventricular ejection

Question 5

What marks the beginning of ventricular ejection?

Answer 5

Semilunar valve opening

Question 6

What is the 4th phase of the cardiac cycle?

Answer 6

Isovolumetric relaxation

Question 7

What marks the beginning of isovolumetric relaxation?

Answer 7

Aortic valve closes

Question 8

What is the fifth phase of the cardiac cycle?

Answer 8

Rapid ventricular filling

Question 9

What marks the beginning of rapid ventricular filling?

Answer 9

AV valve opening

Question 10

What is the sixth phase of the cardiac cycle?

Answer 10

Diastasis

Question 11

What does CVP stand for?

Answer 11

Central Venous Pressure

Question 12

What are three common causes of increased CVP?

Answer 12

1) Heart Failure
2) Tricuspid valve disorder
3) Pulmonary arterial HTN

Question 13

What is a common cause if tricuspid valve disorders?

Answer 13

CHF–dilation of the RV

Question 14

What causes pulmonary arterial HTN?

Answer 14

1) Pulmonary vein HTN

2) Abnormalities in the pulmonary tree

Question 15

Draw the normal jugular venous pressure waveform and label the distinct parts of the wave.

Answer 15

N/A

Question 16

What does the “a” wave of the jugular venous pressure waveform represent?

Answer 16

Atrial systole

Question 17

What does the “c” wave of the jugular venous pressure waveform represent?

Answer 17

Ventricular contraction and ballooning of the tricuspid valve into the RA

Question 18

What does the “x” wave of the jugular venous pressure waveform represent?

Answer 18

Atrial relaXation and a fall in RA pressure

Question 19

What does the “v” wave of the jugular venous pressure waveform represent?

Answer 19

Venous filling of the RA

Question 20

What does the “y” wave of the jugular venous pressure waveform represent?

Answer 20

RA emptYing i.e. rapid ventricular filling

Question 21

What is the “h” wave of the jugular venous pressure waveform represent?

Answer 21

Continued filling of the RA during diastole

Question 22

What vessel should be cannulated for measurement of the jugular venous pressure/ CVP?

Answer 22

Right Internal Jugular

Question 23

What does a large “a” wave on the jugular venous pressure waveform represent?

Answer 23

Reduced RV compliance or elevated RV EDV i.e.

1) Tricuspid stenosis
2) Complete heart block

Question 24

What will cause the absence of the normal “x” wave on CVP monitoring?

Answer 24

Tricuspid regurgitation i.e. blood flowing back into the RA during ventricular systole

This can be caused by severe CHF

Question 25

What causes S1?

Answer 25

Closure of the AV valves (Lub)

Question 26

What causes S2?

Answer 26

Closure of the semilunar valves (Dub)

Question 27

What causes physiologic splitting of S2?

Answer 27

Respiration *Inspiration causes pulmonary valve to say open longer b/c bigger EDV from decreases intrathoracic pressure

Question 28

How do you identify a widened splitting of S2?

Answer 28

Splitting is audible during expiration and widens during inspriation

Question 29

What causes a widened splitting of S2?

Answer 29

1) RBBB - Delay in RV contraction - Delay in pulmonic closure 2) COPD leading to straining of the RV 3) Pulmonic stenosis

Question 30

What is Fixed Splitting of S2?

Answer 30

Widened split of S2 that is CONSTANT with respiration

Question 31

What causes fixed fixed splitting of S2?

Answer 31

Atrial Septal Defect *More blood is brought in but it is shunted to the LA via the septal defect

Question 32

What is Paradoxical Splitting of S2?

Answer 32

1) P2 component occurs before A2 | 2) Gets BETTER in inspiration

Question 33

What causes Paradoxical Splitting of S2?

Answer 33

1) LBBB | 2) Aortic stenosis

Question 34

What is an "opening snap" associated with?

Answer 34

Mitral Valve Stenosis - Opening should be silent - Calcified/ stiffened-->a sharp-high pitched sound occurs

Question 35

When does the opening snap of mitral valve stenosis occur?

Answer 35

After the end of S2

Question 36

What is an S3?

Answer 36

- Heart sound heard during rapid ventricular filling | - Caused by rapid flow of blood from the atria into the ventricles

Question 37

What causes an S3?

Answer 37

- Normal in kids | - Adults= volume overload e.g. CHF

Question 38

What is S4?

Answer 38

Late diastolic sound, corresponds with atrial contraction ***Occurs prior to S1*****

Question 39

What causes S4?

Answer 39

Atrial contraction against a stiff (poorly compliant) LV e.g. 1) LVH 2) MI

Question 40

What is the mnemonic to remember the locations of the cardiac valves on auscultation of the chest?

Answer 40

"All Physicians Take Money" ``` A= Aortic P= Pulmonary T= Tricuspid M= Mitral ```

Question 41

What are the three types of systolic murmurs?

Answer 41

1) Ejection 2) Pansystolic 3) Late systolic

Question 42

What are the ejection type mumurs?

Answer 42

1) Aortic stenosis | 2) Pulmonic stenosis

Question 43

What are the pansystolic murmurs?

Answer 43

1) Mitral regurgitation 2) Tricuspid regurgitation 3) Ventricular Septal Defect

Question 44

What is the late systolic murmur?

Answer 44

Mitral valve prolapse

Question 45

What feature of aortic stenosis signifies severity?

Answer 45

Location of the peak - Early= mild - Late= severe

Question 46

What commonly causes mitral regurgitation?

Answer 46

Heart Failure

Question 47

Describe the intensity of mitral regurgitation.

Answer 47

Constant

Question 48

How is the murmur associated with aortic reguritation described?

Answer 48

Early decrescendo

Question 49

Where is aortic regurgitation best heard?

Answer 49

3rd or 4th left ICS *Think that the blood is going from the aorta back into the LV*