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Flashcards in Exam Review Deck (78):
1

Which valve lesions increase with hand grip?

mitral regurgitation
aortic regurgitation

2

Which valve lesions decrease with hand grip?

aortic stenosis
hypertrophic cardiomyopathy murmur

3

What kind of murmur mitral regurgitation?

holo-systolic blowing murmur
soft S1

in acute = can be shorter

increases with expiration, hand grip

4

What kind of murmur tricuspid regurgitation?

holo-systolic blowing murmur

increases with inspiration

5

What kind of murmur aortic stenosis?

ejection sound
systolic crescendo-decrescendo murmur

no splitting S2 or paradoxical split [more split on expiration] = more severe
later peaking murmur = more severe

6

What kind of murmur mitral valve prolapse?

mid-systolic click then last systolic crescendo murmur

7

What kind of murmur aortic regurgitation?

early diastolic blowing murmur decrescendo
can also have mid systolic ejection murmur

in acute = can be shorter


increase with hand grip and expiration

8

What kind of murmur mitral stenosis?

loud S1
loud P2
opening snap then mid diastolic murmur with pre-systolic accentuation

shorter interval between S2 and OS

9

What kind of murmur hypertrophic obstructive cardiomyopathy?

ejection systolic murmur at left border
may have mitral regurgitation as well

10

What kind of murmurs increase with valsalva/standing?

hypertrophic obstructive cardiomyopathy

11

What kind of murmurs decrease with valsalva/standing?

almost all include AS [except hypertrophic cardiomyopathy]

12

What kind of murmurs increase with squatting?

AS and MVP

13

What kind of murmurs decrease with squatting?

hypertrophic obstructive cardiomyopathy

14

What is difference pressure R and L sides?

R pressure = 1/4 of L pressures

15

When are lungs [PCWP], pulmonary veins, LA and LV same pressure?

in diastole

16

What is pressure difference LV and aorta?

aorta>LV diastole
same in systole

17

When are central venous pressure, RA and RVEDP same?

in diastole

18

What is pressure difference RV and pulmonary artery?

pulmonary artery > RV diastole
same in systole

19

What differentiates systole from diastole [electric + valve]?

systole = starts at WRS and ends at aortic valve closure
diastole = from aortic closure to R

20

What is S1 sound?

mitral valve closure

21

What is S2 sound?

aortic and pulmonary valves close [A2 then P2]

22

What is S3 sound?

rapid early diastolic flow into ventricle

associated with mitral regurg, CHF, dilated ventricles

23

What is S4 sound?

atrial contraction = atrial kick in late diastole

sign of high atrial pressure
associated with ventricular hypertrophy

24

What does a wave in JVP represent?

atrial contraction

25

What does c wave in JVP represent?

mitral/tricuspid close causes small pressure rise --> mitral/tricuspid valve bulging into atrium

26

What does x descent in JVP represent?

atrial relaxation and downward displacement of tricuspid/mitral during ventricular contraction

27

What does v wave in JVP represent?

increase right atrial pressure/filling against closed tricuspid/mitral

28

What does y descent in JVP represent?

blood flow from RA to RV

29

What does JVP represent?

right atrial pressure

30

What does high JVP mean?

high right atrial pressure = right sided heart failure

31

What is difference LA and RA wave forms?

same wave form LA just slightly higher pressure

32

What does pulmonary capillary wedge pressure represent?

left atrial pressure = left ventricle diastolic pressure

33

What is pressure difference pulm artery, RV, RA?

all have similar diastolic pressure but
RA < RV < pulmonary artery

34

If you see right atrium pressure bigger than RV in diastole what should you think?

tricuspid stenosis

35

If you see tall v wave in RA and looks closer to RV pressure what should you think?

tricuspid regurgitation

36

If pressure LA ~20 and pressure LV = 120/10 what should you think?

mitral stenosis

the diastolic pressure should be the same

37

If LV systolic pressure = 140 and aorta = 140/40 what should you think?

aortic regurgitation

very low diastolic pressure in aorta b/c blood pumped back into LV

38

What should you think if wide pulse pressure but normal systolic BP?

aortic regurgitation

39

What should you think if there is a systolic gradient between LV and aorta?

aortic stenosis

40

Compare LA vs LV or RA vs RV in systole or diastole?

compare in diastole = when the mitral/tricuspid are open so atria and ventricles should have same pressure

41

If LA v wave elevated and looks like LV what should you think?

mitral regurgitation

42

If LV = 200 in systole and aorta = 120 what should you think?

aortic stenosis

43

How do you compare just AR to AS + AR?

AR = have diastolic murmur and can also have systolic ejection murmur

AS + AR = have diastolic murmur from AR and delayed peaking crescendo-decrescendo from AS + paradoxical splitting of S2 [more split in expiration] from AS

44

What is difference aortic stenosis vs mitral regurgitation?

AS = have initial gap then ejection sound and crescendo-decrescendo systolic murmur

MR = have holosystolic murmur

45

If you have a diastolic pressure gradient what does it mean?

stenosis of some valve!

46

If you have a systolic gradient LV and aorta what does it mean?

aortic stenosis

47

If you have loss of LV/aorta gradient in diastole what does it mean?

aortic regurgitation

48

If you have 140/40 BP and early diastolic murmur what should you think?

aortic regurgitation

49

What heart sounds in mitral stenosis?

loud S1 = rapid closure of mitral
loud P2 = pt has pulmonary HTN
diastolic opening snap [OS] then mid-diastolic murmur with pre-systolic accentuation

50

What does it mean if there is no loud S1 and you have mitral stenosis?

valve degenerated/calcified/immobile

51

What causes exaggerated mitral stenosis?

- in exercise
- in expiration
- left lateral position
- if shorter diastolic filling time
- if squat

52

Why does mitral stenosis murmur increase with short filling interval?

less time for LA pressure to reduce, increase pressure gradient

53

Why use beta blocker in mitral stenosis?

to decrease HR, increase diastolic time, decrease pulmonary symptoms

54

What are signs of more severe mitral stenosis?

decreased interval S2 and O2

55

What position do you put someone in to increase sound of mitral stenosis?

put them in left lateral position

56

Where do you hear mitral stenosis murmur?

left 5th inter

57

Left 5th intercostal space at midclavicular line is which valve?

mitral

58

Lower left sternal border is which valve?

tricuspid

59

Upper left sternal border is which valve?

pulmonic

60

Upper right sternal border is which valve?

aortic

61

Which valve issues systolic murmurs?

MRS = mitral regurgitation systolic
ASS = aortic stenosis systole

62

Which valve issues diastolic murmurs?

MSD = mitral stenosis diastolic
hARD =

63

What is mnemonic valve diseases and whether they are heard systole or diastole?

MRS = mitral regurgitation systole
MSD = mitral stenosis diastole
hARD = aortic regurgitation diastole
ASS = aortic stenosis systole

64

Which murmurs increase with inspiration vs expiration?

RiLe = right inspiration, left expiration

65

Why do right sided heart sounds increase on inspiration?

during inspiration blood increased to heart [less intrathoracic P], more blood flow through right heart --> louder sounds

66

Why do left sided heart sounds increase on expiration?

during expiration --> push blood into systemic circulation [more intrathoracic P], more blood flow through left heart --> louder heart sounds

67

Whats common cause of mitral prolapse?

marfans, adult polycystic kidney disease

68

If tricuspid murmur what should you think?

IV drug user

69

If mitral murmur what should you think?

rheumatic fever

70

What part of atrial wave on pressure figure is S4?

S4 = peak of a wave = atrial contraction

71

What is measure of LV preload?

left ventricular end-diastolic pressure

72

What does high LVEDP mean? low LVEDP?

high LVEDP --> heart failure
low LVEDUP --> dehydration or hemorrhage

73

What is another pressure equivalent to LVEDP?

mean left atrial pressure

74

What is equation for CO?

CO = HR * SV

75

What is equation for SV?

SV = EDV - ESV = width of PV loop

76

What are the determinants of SV?

- preload
- contractility
- afterload

77

What is preload?

degree ventricle is distended before systole
bigger preload [aka bigger EDV] --> bigger SV

78

What kind of heart failure if ejection fraction < 50% normal?

systolic HF

diastolic HF = normal ejection fraction