Heart sounds, EKGs, murmurs Flashcards
(160 cards)
1
Q
Missed beat not preceeded by prolonged PR intervals
A
2nd degree heart block, Mobitz type II
2
Q
y descent
A
Blood flow from RA to RV
2
Q
EKG of 2nd degree heart block, Mobitz type II
A
No change in PR interval with dropped beats, usually in a 2:1 P:QRS ratio
3
Q
Effect of expiration
A
Increase LA return = increase mitral stenosis
3
Q
Continuous machine-like murmur
A
PDA
4
Q
Flow murmur with diastolic rumble
A
ASD
(rumble = increased flow across tricuspid valve)
4
Q
Blowing holosystolic murmur loudest at left sternal border
A
TR
5
Q
Which maneuvers increase the intensity of MR?
A
Squatting, hand grip
(anything that increases TPR)
5
Q
U wave
A
Hypokalemia, bradycardia
6
Q
What effect does hand grip have?
A
Increased systemic vascular resistance
7
Q
a wave
A
RA contraction
8
Q
No identifiable waves
A
V fib
9
Q
Radiates to right sternal border
A
TR
10
Q
What would you hear in a patient with pulmonic stenosis?
A
Wide splitting of S2
(increases on inspiration)
11
Q
What correlates with severity of MS?
A
Increased severity = decreased duration between S2 and OS
11
Q
Irregularly spaced QRS complexes
A
A fib
11
Q
Leads V1-V2
A
Anterior septum (LAD)
12
Q
Anterolateral (LAD or LCX) leads
A
V4-V6
13
Q
Hand grip decreases the intensity of which murmurs?
A
Hypertrophic cardiomyopathy
AS
14
Q
What would you hear in a patient with left bundle branch block (LAD occlusion)?
A
Paradoxical splitting
14
Q
Wide pulse pressure
A
Chronic AR
14
Q
EKG of 2nd degree heart block, Mobitz type 1
A
Progressive lengthening of PR interval followed by a missed beat (no QRS)
15
Q
Leads V4-V6
A
Anterolateral (LAD, LCX)
16
Q
What would you hear in a patient with aortic stenosis?
A
Crescendo-decrescendo murmur with paradoxical splitting
17
List 3 causes of MVP
Rheumatic fever, myxomatous degeneration (too much dermatan sulfate), chordae rupture
18
Leads V1-V4
Anterior wall (LAD)
20
What causes paradoxical splitting?
Delayed empyting of the LV
Aortic stenosis, left bundle branch block
21
c wave
Tricuspid valve bulging into RA during RV contraction
21
Wide splitting vs fixed splitting
Wide = increases even more on inspiration
Fixed = widended with no change with breathing
21
What causes WPW?
Increased conduction through accessory pathway from atria to ventricles (Bundle of Kent) so ventricles begin to depolarize earlier
22
MVP predisposes to:
IE
23
Describe Jervell and Lange-Nielson syndrome
Long QT + sensorineural deafness
23
Leads II, III, aVF
Inferior wall (RCA)
24
JV wave that's absent in TR
X descent
25
Describe paradoxical splitting
A2 occurs after P2 and on inspiration P2 moves closer to A2, paradoxically eliminating the split
26
Atria and ventricles beat independently of each other
3rd degree heart block
27
When and where is a VSD best heard?
Left sternal border, 5th interspace
Pansystolic
28
Speed of pacemakers
SA \> AV \> Purkinje/bundles/ventricles
29
What cause pulsus parvus et tardus?
AS
30
Characteristic finding in WPW
Delta wave, shortened PR interval
31
Radiates to carotids
AS
31
A fib
(No P waves - irregularly spaced QRS's)
31
Progressive increase in PR interval followed by dropped beat (QRS)
2nd degree heart block, Mobitz type I
33
x descent
Tricupsid valve going down into RV during atrial relaxation
Absent in TR
35
Which diastolic murmurs are heard best at left sternal border?
Aortic and pulmonic regurg
35
OS
MS
35
Delay through AV node
P interval
37
Decreases the intensity of AS and hypertrophic cardiomyopathy
Hand gripping
38
Long QT + deaf
Jervell and Lange-Nielson syndrome (AR)
39
Loudest at left infraclavicular area
PDA
40
Late systolic crescendo murmur
MVP
41
EKG of atrial flutter
Sawtooth appearance = identical back-to-back atrial depolarization waves
42
Sawtooth EKG
A flutter
43
Prognosis of 1st degree heart block
Benign and asymptomatic
44
Which maneuver accentuates VSD?
Hand grip
(increase TPR = increase LV pressure = increase left-to-right shunt)
45
Two causes of PDA
Prematurity
Congenital rubella
46
Which occurs first: pulmonic or aortic valve closure?
Aortic (A before P)
46
EKG of A fib
Absent P wave, irregularly spaced QRS complexes
47
What would decrease the intensity of AR?
Vasodilators (hydralazine)
48
What causes wide fixed splitting?
ASD
(increases volume in RA and RV = delayed closure of pulmonic valve regardless of breathing)
48
Absent P wave
A fib
49
Which systolic murmurs are heard best at the left sternal border?
Hypertrophic cardiomyopathy
50
What "splits" on inspiration? Why?
S2 heart sound (A2 and P2)
Decreased intrathoracic pressure = increased RV volume = delayed closure of pulmonic valve
Also, pulmonary compliance increases during inspiration, contributing to the prolonged S2
51
Effect of standing
Decrease venous return
52
When is MVP loudest?
Just before S2
53
What would you expect to hear in a patient with MR?
Blowing holosystolic murmur loudest at apex and radiating to axilla
54
Delayed rumbling late diastolic murmur
MS
55
Completely erratic rhythm
V fib
55
Leads I, aVL
Lateral wall (LCX)
57
Decreases intensity of most murmurs
Valsalva, standing
58
What is pulsus parvus et tardus?
Delayed, weak pulses due to AS
58
Bounding pulses
AR
58
What causes the opening snap?
Abrupt halt of mitral valve leaflets
59
P waves and QRS complexes bear no relation
3rd degree heart block
60
ST depression
Subendothelial infarct
62
What would you expect to hear in a patient with MVP?
Late systolic crescendo murmur with mid-systolic click heard best at apex
64
Which murmurs are loudest at right sternal border?
Aortic stenosis
Flow murmur
Aortic valve sclerosis
66
When and where is an ASD best heard?
Left sternal border, 5th interspace
Diastole
67
Describe Romano-Ward syndrome
Long QT only (AD)
69
Effect of Valsalva
Decrease venous return
69
Only murmur intensified by Valsalva/standing
Hypertrophic cardiomyopathy
70
Holosystolic murmurs
MR, TR, VSD
71
Effects of rapid squatting
Increased preload/venous return, increased afterload
71
What would you expect to hear in a patient with TR?
Blowing holosystolic murmur loudest at left sternal border that radiates to right sternal border
72
Syncope, dyspnea, and angina on exertion
AS
74
Head bobbing
AR
75
What would you hear in a patient with right bundle branch block (LAD occlusion)?
Wide splitting
76
Shortened PR interval
WPW
78
Radiates toward axilla
MR
79
Drugs that prolong QT interval
Sotalol
Risperidone
Macrolides
Cholorquine
Protease inhibitors
Quinidine
81
Increases sytemic vascular resistance
Hand grip
81
What are the two congenital long QT syndromes?
Romano-Ward syndrome
Jervell and Lange-Nielsen syndrome
82
What would you expect to hear in a patient with VSD?
Harsh holosystolic murmur loudest at tricuspid area
83
Treatment of torsades
Magnesium
84
Normal in children but pathologic in adults
S3
86
What would you expect to hear in a patient with MS?
S2 followed by OS and late diastolic rumbling murmur
87
Which maneuver would increase AR?
Hand grip (increased TPR)
88
Atrial flutter (sawtooth)
89
List 3 causes of MR
Ischemic heart disease, LV dilation, MVP
90
Symptoms of 2nd degree heart block, Mobitz type I
Asymptomatic
91
Mechanical contraction of ventricles
QT interval
92
Where is murmur of aortic stenosis heard best?
Right sternal border
93
2nd degree heart block, Mobitz type 1
(progessively long PR intervals with a missed beat)
94
Patients with congenital long QT syndrome are at increased risk for:
Torsades/sudden cardiac death
96
Which maneuver would enhance MS?
Expiration
(increases LA return)
97
Back-to-back atrial depolarization
Atrial flutter
98
Identical back-to-back waves
Atrial flutter
(creates the sawtooth appearance)
100
Stiff left ventricle
S4
101
Irregularly spaced QRS complexes + no P waves
A fib
103
What murmur is common in Turner's patients?
Crescendo-decrescendo radiating to carotids (AS)
Due to bicuspid aortic valve
104
Increases intensity of MR, AR, VSD, MVP
Hand gripping (increase TPR)
105
Leads for inferior wall (RCA)
II, III, aVF
106
WPW
107
S4
Stiff left ventricle ("atrial kick")
107
Which maneuver would increase TR?
Inspiration
108
Speed of conduction
Purkinje \> atria \> ventricles \> AV node
110
What maneuvers can be done to manipulate MVP?
Standing/Valsalva (decrease preload) --\> earlier murmur
111
2nd degree heart block, Mobitz type II
(Normal PR intervals, dropped beat)
112
Delta wave
WPW
113
Which maneuver increases MS?
Expiration
114
Leads of anterior septum (LAD)
V1-V2
115
Requires immediate CPR/defibrillation
V fib
116
ST elevation
Transmural infarct
118
Which murmur increases with squatting?
AS
120
Enhanced by expiration
MS
121
2:1 P:QRS
2nd degree heart block, Mobitz type II
122
EKG of V fib
Completely erratic rhythm, no identifiable waves
123
ST segment
Isoelectric, ventricles depolarized
124
Prolonged PR interval with no dropped beat
First degree AV block
126
When is PDA murmur loudest?
Before S2
127
Which murmurs are heard best at the left sternal border, 5th intercostal space?
Tricupsid regurg (pansystolic)
VSD (pansystolic)
Tricuspid stenosis (diastolic)
ASD (diastolic)
129
What would you expect to hear in a patient with AR?
Blowing early diastolic decrescendo murmur
131
Increased filling pressure
S3
132
WPW patients are at increased risk for:
Re-entry/SVT
133
Which is the only maneuver that decreases the intensity of hypertrophic cardiomyopathy?
Squatting
134
Blowing holosystolic murmur loudest at apex
MR
135
Leads for anterior wall (LAD)
V1-V4
136
Harsh holosystolic murmur loudest at tricuspid area
VSD
137
Lateral wall (LCX) leads
I, aVL
138
Symptoms suggesting AS
Syncope, dyspnea, angina on exertion
139
Split S2 - physiologic
Inspiration
141
What are two causes of AS?
Age-related calcification, Turner's/bicupsid aortic valve
142
Predisposes to torsades
Long QT interval
143
Classic cause of 3rd degree heart block?
Lyme disease
144
PR interval
Delay through AV node
145
What can cause MR or TR?
Endocarditis or rheumatic heart disease
146
QT interval
Mechanical contraction of ventricles
148
What causes congenital long QT syndromes?
Channelopathies resulting in disordered myocardial repolarization
149
Increase intensity of right heart sounds
Inspiration
150
Fhx sudden cardiac death + long QT + normal hearing
Romano-Ward syndrome
151
Which murmurs are accentuated by hand gripping?
MR, AR, VSD, MVP (later onset of click)
152
EKG of first degree heart block
Prolonged PR interval with no dropped beats
153
Blowing early diastolic decrescendo murmur
AR
154
Long QT interval predisposes to:
Torsades
155
Q wave
Old/evolving transmural infarct present
156
What would you hear in a patient with an ASD?
Wide fixed splitting
157
v wave
Increased RA pressure during filling
158
What causes wide splitting?
Delayed RV emptying
(pulmonic stenosis, right bundle branch block)
159
Atrial flutter (sawtooth)
160
S3
Increased filling pressure (MR, CHF)
Normal in pregnancy and childhood
