PCM Lecture: Cardiac Cycle & Sounds

Question 1

What cardiac issues are pts with Marfan’s syndrome prone to?

Answer 1

Aortic aneurisyms and leaking -> they have a weak aorta

Question 2

What does having your pt lean forward when listening to the heart help with?

Answer 2

Increases heart sounds and helps hear pericarditis

Question 3

Why would you want to have a pt stand up when listening for murmurs?

Answer 3

To hear if the murmurs are louder or quieter

Question 4

What are the symptoms of acromegaly?

Answer 4

Big jaws, prominent masculine features, big nose, lots of hair, etc -> predisposition for coronary heart disease and hypertension

Question 5

What are the symptoms of hyperthyroidism

Answer 5

Bulging eyes, tremors, tachycardias, sweaty, anxious -> extra stress on the heart

Question 6

What are symptoms of myxedema?

Answer 6

Very hypothyroid -> have slow HR, hyperlipidemia, hypertension, dry skin, patchy hair loss, trouble hearing

Question 7

How does body temperature affect HR?

Answer 7

For every 1 degree above 100.4 degrees will increase heart rate by 10 bpm

Question 8

What is shamrock’s angle?

Answer 8

The little light that comes through when you put your nails together -> lost in clubbed fingers

Question 9

What are palpable thrills?

Answer 9

Turbulent blood flow causing murmurs thats felt on the outside of the body

Question 10

As you percuss during PE of the heart, where should you start and end?

Answer 10

Start at. Lateral border of the chest and move more medial

Question 11

Where is the listening post for the aortic valve?

Answer 11

2nd intercostal space to the R of the sternum

Question 12

Where is the listening post for the pulmonary vlave?

Answer 12

2nd intercostal space left of the sternum

Question 13

Where is the listening post for the tricuspid valve?

Answer 13

4th intercostal space at lateral sternal border

Question 14

Where is the listening post for the mitral valve?

Answer 14

Apex of heart -> 5th left intercostal at midclavicular line

Question 15

Which murmur grades are palpable and which are not?

Answer 15

Grades 1-3 have NO palpabile thrill and sounds 4-6 DO have a palpable thrill

Question 16

A _____________ murmur begins after S1 and stops before S2; brief gaps are audible between the murmur and the heart sounds

Answer 16

Midsystolic murmur

• Listen carefully for the gap just before S2

Question 17

A _____________ murmur starts with S1 and stops at S2, without a gap between murmur and heart sounds

Answer 17

parasystolic (holosystolic)

Question 18

A _______________ murmur usually starts in mid- or late systole and persists up to S2

Answer 18

A late systolic murmur

Question 19

A ______________ murmur starts immediately after S2 without a discernible gap and then usually fades into silence befor the next S1

Answer 19

Early diastolic murmur

Question 20

A _____________ murmur starts a short time after S2. It may fade away, as illustrated or merge into a late diastolic murmur

Answer 20

Middiastolic murmur

Question 21

What is the range of a moderately reduced EF?

Answer 21

30-39

Question 22

What is the range of a mildly reduced EF?

Answer 22

40-49

Question 23

What is a kussmauls sign?

Answer 23

When the jugular veins increase during inspiration -> this is seen in pts with R heart failure, constrictive pericarditis or RV infarction

• Venous Column (JVP) should fall during inspiration, not rise

**This is seen in R heart failure, constrictive pericarditis or RV infarction