Heart sounds, EKGs, murmurs Flashcards Preview

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Flashcards in Heart sounds, EKGs, murmurs Deck (160):
1

Missed beat not preceeded by prolonged PR intervals

2nd degree heart block, Mobitz type II

2

y descent

Blood flow from RA to RV

2

EKG of 2nd degree heart block, Mobitz type II

No change in PR interval with dropped beats, usually in a 2:1 P:QRS ratio

3

Effect of expiration

Increase LA return = increase mitral stenosis

3

Continuous machine-like murmur

PDA

4

Flow murmur with diastolic rumble

ASD

 

(rumble = increased flow across tricuspid valve)

4

Blowing holosystolic murmur loudest at left sternal border

TR

5

Which maneuvers increase the intensity of MR?

Squatting, hand grip

 

(anything that increases TPR)

5

U wave

Hypokalemia, bradycardia

6

What effect does hand grip have?

Increased systemic vascular resistance

7

a wave

RA contraction

8

No identifiable waves

V fib

9

Radiates to right sternal border

TR

10

What would you hear in a patient with pulmonic stenosis?

Wide splitting of S2

(increases on inspiration)

11

What correlates with severity of MS?

Increased severity = decreased duration between S2 and OS

11

Irregularly spaced QRS complexes

A fib

11

Leads V1-V2

Anterior septum (LAD)

12

Anterolateral (LAD or LCX) leads

V4-V6

13

Hand grip decreases the intensity of which murmurs?

Hypertrophic cardiomyopathy

AS

14

What would you hear in a patient with left bundle branch block (LAD occlusion)?

Paradoxical splitting

14

Wide pulse pressure

Chronic AR

14

EKG of 2nd degree heart block, Mobitz type 1

Progressive lengthening of PR interval followed by a missed beat (no QRS)

15

Leads V4-V6

Anterolateral (LAD, LCX)

16

What would you hear in a patient with aortic stenosis?

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