Lecture 11: Cardiac Cycle and Heart Sounds

Question 1

Does a murmur always indicate that there is a problem or an underlying dz?

Answer 1

No, not always.

Question 2

If a patient is diagnosed with a heart murmur, what should you do next?

Answer 2

Conduct an electrocardiogram

Question 3

Systole corresponds with:

Contraction/relaxation

Depolarization/ repolarization

Answer 3

Contraction

Depolarization

Question 4

Diastole corresponds with:

Contraction/relaxation

Depolarization/ repolarization

Answer 4

Relaxation

Repolarization

Question 5

What is the difference between systolic BP and diastolic BP?

Answer 5

Systolic BP–> the pressure exerted on the artery when the heart contracts

Diastolic BP–> the pressure on the artery when the heart is at rest

Question 6

In the cardiac cycle, do the electrical and mechanical activity occur at the same time?

Answer 6

Yes

Question 7

Atrial systole occurs during?

Answer 7

P wave

Question 8

Atrial diastole occurs during?

Answer 8

PR interval

—-slow conduction through the AV node—

Question 9

Ventricular Systole occurs during?

Answer 9

QRS complex

(which is also atrial diastole and repolarization)

Question 10

Late ventricular systole occurs during?

Answer 10

ST segment

Question 11

Ventricular diastole (repolarization) occurs during?

Answer 11

T wave

Question 12

The lub sound or S1 comes from?

Answer 12

AV valves closing

Question 13

The dub sound or S2 comes from?

Answer 13

Semilunar valves closing

Question 14

S3 sounds, which can sounds like Ken-tuckee occurs from?

Answer 14

blood filling the relaxed and empty ventricle (ventricular filling)

Question 15

S4 sounds, which present as Tenness-ee occur from?

Answer 15

atrial filling from high pressure in SVC (occurs before S1)

Question 16

Which side of the heart is a low pressure system; L or R?

Answer 16

Right.

Left side of the heart is a high pressure ssystem

Question 17

What is the order of heart sounds?

Answer 17

S4–> S1–> S2–> S3–> S4–> S1

Question 18

What are the 2 abnormal valve heart sounds?

Answer 18

1. Regurgitation–> turbulent flow sound when blood is moving in the opposite direction than what it should be

2. Stenosis–> Noise when blood moves through a stiff, damaged valve.

Question 19

How do we idenfy abnormal heart sounds?

Answer 19

We identify them by when they occur in the cardiac cycle:

• sytolic murmur will occur in ventricular systole
• diastolic murmur will occur in ventricular diastole

Question 20

All People Enjoy Time Magazine Stands

for what and what intercostal spaces ?

Answer 20

*Aortic : Right 2nd ICS along sternum

*Pulmonic: Left 2nd ICS along sternum

Erbs Point: (S1S2) Left 3rd ICS

*Tricuspid: Lower left sternal border/4th ICS

*Mitral: Left 5th ICS, medial to mid clavicular line

Question 21

How are heart murmurs graded?

Answer 21

On a scale of 1-6

1. Soft murmur in quiet room

2. Soft murmur in loud room

3. Prominent heard murmur

4. Loud murmur with a thrill

5. Loud heard with edge of steth tilted against chest

6. Loud murmur heard from 5-10mm from chest + thrill

Question 22

What is considered a pathologic murmur?

Answer 22

Any murmur that is great or equal to 3/6

Question 23

What valves are open and closed during ventricular systole?

Answer 23

Ventricular systole (ventricular contraction)

• Semilunar valves= open
• AV valves= closed

Question 24

What is aortic stenosis?

What is pulmonic stenosis?

Answer 24

Aortic stenosis–> restricted flow through the aortic valve

Pulmonic stenosis–> restricted through through the pulmonic valve.

Question 25

What valves are open and closed during atrial systole?

Answer 25

Semilunar valves are closed AV valves are open.

Question 26

What are the general rules for what makes murmurs loud or soft?

Answer 26

**RINSPIRATION**- Inspiration makes RIGHT murmurs in the tricuspid and pulmonic valve louder **LEXPIRATION**- expiration makes LEFT murmurs in the **mitral** and aortic valves louderder

Question 27

**Preload is the volume of blood sent to the heart.** What happens to the murmur when preload is increased or decreased?

Answer 27

**Preload is increased-**-\> louder **When preload is decreased-**-\> softer

Question 28

Why is **HOCM** (hypertrophic obstructive cardiomyopathy) one of the two exceptions for the **rules of preload**?

Answer 28

An **increase in preload improves an aortic mur**mur by pushing the septum away from the aortic outflow tract, letting blood eject moreesily. A **decrease in preload worsens the aortic murmur** because less blood is pushing the outflow track open, thus, fucking up blood flow.

Question 29

Why is **MVP (mitral valve prolapse)** the second exception for the rules of preload?

Answer 29

IN MVP: mitral valve cusps prolapse into left atria under normal pressure and blood flow. Increase in preload improves murmur by returning the prolaspsed leaflets to their normal position.

Question 30

**Afterload** is the pressure the ventricles have to generate to move blood forward into the arterial system (PVR). What happens to the **murmur when afterload is increased or decreased?**

Answer 30

Increased afterload--\> makes the murmur louder Decreased afterload--\> makes the murmur softer **Except with HOCM and MVP, where the opposite occurs.**

Question 31

**Aortic stenosis**

Answer 31

Aortic stenosis --\> increasing, then decreasing murmur between S1 and S2 ## Footnote **1. Old- SAD: Syncopy, Angina, Dyspnea** **2. Calcified aortic valve** **3. Radiates UP to carotids (cresendo-descendo presentation)**

Question 32

**Mitral regurgitation**

Answer 32

A constant, steady murmur heard between S1 and S1 Best heard at apex of heart and radiates to the axilla.

Question 33

**Tricuspid regurgitation**

Answer 33

**Want to TRI some drugs?** ## Footnote **-Usually due to IV drug abuse** **-Constant murmur between S1 and S2.**

Question 34

**Aortic regurgitation**

Answer 34

Seen in: 1. CT disorder 2. Marfan's syndrome 3. Femoral bruits 4. Head bobbing 5. Water hammer pulse **AR, there she BLOWS** -early blowing diastolic murmur that occurs during S2 and S1

Question 35

**Mitral stenosis**

Answer 35

D/t Rheumatic fever The **O**perating **S**ystem is **M**icro**S**oft **Heard between S2 and S1, when the mitral valve opens, it causes an OS (opening snap**

Question 36

**HOCM** ## Footnote is associated with sudden cardiac death at a young age. What is different during preload and after load as discussed earlier?

Answer 36

**Decreased pre/afterload= louder murmur** **Increased pre/afterload = softer murmur**

Question 37

**Mitral valve prolapse** Characterized by?

Answer 37

- Click in the middle of systole - IF YOU SEE **MYCOMATOUS VALVULAR DZ**--\> THINK OF MITRAL VALVE PROLAPSE