Harvey

Question 1

what generates heart sounds?

Answer 1

blood velocity changes / valve closure

Question 2

what are the good and bad causes of a split heart sound?

Answer 2

good - larger volume

bad - slower contraction speed

Question 3

S3 - when, sound, why

Answer 3

when - early-mid diastolic
sound - groaning
why - ventricular wall noise from resistance to filling

Question 4

S4 - when, why

Answer 4

when - late diastolic, end of ventricular filling

why - ventricular wall resistance to atrial kick

Question 5

what are the best ways to hear S3 and S4?

Answer 5

apex with the bell in left lateral recumbent position

Question 6

RA pressure

Answer 6

0 - 5 mm Hg

Question 7

RV pressure

Answer 7

30 / 5

Question 8

pulmonary mean pressure

Answer 8

20

Question 9

the pulmonary wedge pressure is equal to the pressure in what chamber? what is the pcwp?

Answer 9

LA

15

Question 10

LV pressure

Answer 10

120/10

Question 11

what is the order of naming convention for heart murmurs?

Answer 11

grade - cycle - intensity - radiation

Question 12

what are the left sided systolic murmurs?

Answer 12

aortic stenosis
mitral regurgitation
hypertrophic cardiomyopathy

Question 13

what are the right sided systolic murmurs?

Answer 13

pulmonic stenosis

tricuspid regurgitation

Question 14

what are the causes of aortic stenosis?

Answer 14

age, calcification 
congenital disease (bicuspid valve) 
infective endocarditis

Question 15

is aortic stenosis a left-sided or right-sided murmur? is it systolic or diastolic?

Answer 15

left sided

systolic

Question 16

what is the cause of hypertrophic cardiomyopathy?

Answer 16

left ventricular outflow tract obstruction

Question 17

is aortic regurg a left-sided or right-sided murmur? is it systolic or diastolic?

Answer 17

left sided

diastolic

Question 18

what are the causes of aortic regurg?

Answer 18

endocarditis
root dilation
congenital (bicuspid valve)
CT disorder

Question 19

is mitral stenosis a left-sided or right-sided murmur? is it systolic or diastolic?

Answer 19

left sided

diastolic

Question 20

where does mitral stenosis radiate?

Answer 20

precordial area

Question 21

what are the causes of mitral stenosis?

Answer 21

infectious endocarditis

calcific changes

Question 22

does mitral regurg permit backward flow during systole or diastole?

Answer 22

systole

Question 23

what are the causes of mitral regurg?

Answer 23

MVP from myxomatous degeneration 
endocarditis, rheumatic fever 
CT disease 
MI with papillary rupture 
pulmonary HTN

Question 24

when is MV prolapse heard?

Answer 24

late systole

Question 25

what is an austin flint murmur?

Answer 25

severe aortic regurgitation

Question 26

is an austin flint murmur systolic or diastolic? where is it best heard?

Answer 26

mid-diastolic or pre-systolic apex

Question 27

what does an austin flint murmur sound like?

Answer 27

low pitched rumbling

Question 28

what is the direction of flow in an austin flint murmur?

Answer 28

mixing of antegrade mitral valve blood and regurgitant blood from the aorta

Question 29

what does a pericardial friction rub sound like? how is it heard best?

Answer 29

cabasa leaning forward and exhaling

Question 30

which condition is heard better upon doing a valsalva maneuver?

Answer 30

HCM

Question 31

what does the hand squeeze do? which murmurs increase when doing a hand squeeze?

Answer 31

increases systolic gradient and intraventricular pressures AR, MR, TR, VSD

Question 32

what is the effect of hand squeezing on aortic stenosis?

Answer 32

decrease in intensity

Question 33

what is the effect of hand squeezing on HCM?

Answer 33

decrease in intensity

Question 34

the hand grip maneuver will decrease murmur intensity in what conditions?

Answer 34

aortic stenosis HCM mitral valve prolapse

Question 35

the hand grip maneuver will increase murmur intensity in what conditions?

Answer 35

aortic regurg mitral regurg VSD

Question 36

what is the effect of valsalva on blood return?

Answer 36

reduces return and LV volume

Question 37

what is the effect of valsalva on stenoses?

Answer 37

increase

Question 38

where / how is MR augmentation heard best?

Answer 38

left lateral recumbent

Question 39

where / how is AS augmentation heard best?

Answer 39

reverse semi-fowler's in exhalation (lean forward and exhale)