Physical Diagnosis Flashcards
Causes of mid systolic heart murmurs
AS, HOCM, PS, increased pulm flow from asd
What causes Split S2 with MR?
Due to early closure of the aortic valve
When is an S4 heard?
Occurs with atrial contribution to late ventricular diastolic filling when LV compliance is reduced and diastolic pressure is increased. (Braunwald, PE chpt, pg 135)
Triple cadence beat
a. Occurs with HOCM with a palpable S4 and the two components of the systolic pulse. (Braunwald, PE chpt, pg 135)
What causes a split S1?
RBBB (Braunwald, PE chpt, pg 135)
Loud S1,soft S2
a. Short PR intervals (<160 ms)]
b. Early mitral stenosis when valves are pliable (Braunwald, PE chpt, pg 135)
6. What causes a softer S2?
a. Late stages of mitral stenosis when valves are calcified and rigid
b. Contractile dysfunction
c. Long P-R intervals, use of beta blockers (Braunwald, PE chpt, pg 135)
S2 splits
a. The interval btw aortic and pulmonic valve closure increases during inspiration and decreases during expiration. (Braunwald, PE chpt, pg 135)
8. What causes the S2 interval btw aortic and pulmonic valve closure to increase?
a. Complete RBBB b/c of delayed pulmonic valve closure
b. Severe MR b/c of premature aortic valve closure (Braunwald, PE chpt, pg 135)
9. What causes fixed splitting of S2?
a. Ostium secundum ASD (Braunwald, PE chpt, pg 135).
10. What causes narrow but physiologic splitting of S2?
a. Pulmonary hypertension (Braunwald, PE chpt, pg 135).
Cause of reversed or split S2
a. Pathological aortic valve closure
b. Complete LBBB
c. RV apical pacing
d. Severe aortic stenosis
e. HOCM
f. Myocardial ischemia (Braunwald, PE chpt, pg 135)
- What is the only right-sided cardiac disease that decreases in intensity with inspiration?
Ejection with PS
What are systolic clicks and how does load affect their timing?
a. Happens with mitral or tricuspid valve prolapsed
b. When there is decreased preload, the click will happen closer to S1 heart sound
c. When there is increased preload, the click will happen closer to S2 heart sound. (Braunwald, PE chpt, pg 135).
What are the Kotteroff sounds?
a. a. The first Korotkoff sound is the snapping sound first heard at the systolic pressure. A clear tapping sound; onset of the sound for two consecutive beats is considered systolic.
b. The second sounds are the murmurs heard for most of the area between the systolic and diastolic pressures.
c. The third = A loud, crisp tapping sound.
d. The fourth sound, at pressures within 10 mmHg above the diastolic blood pressure, were described as “thumping” and “muting”.
e. The fifth Korotkoff sound is silence as the cuff pressure drops below the diastolic blood pressure. The disappearance of sound is considered diastolic blood pressure- two points below the last sound heard.
f. The second and third Korotkoff sounds haven’t had clinical significance.
What is the A2 to OS interval
a. During diastole, the high-pitched opening snap (OS) of the mitral stenosis occurs a short distance after S2. The A2-OS interval is inversely proportional to the height of the left atrium-LV diastolic pressure gradient
b. The intensity of both S1 and OS decrease with progressive calcification and rigidity of the anterior mitral valve leaflet. (Braunwald, PE chpt, pg 136).
c. Severe mitral stenosis is suggested by a long or holodiastolic murmur indicating persistent LA-LV gradient, a short A2-OS interval consistent with greater degrees of LA pressure elevation, a loud P2 or single S2 and/or right ventricle lift suggestive of PHT, and elevated jugular venous pressure with “cv” waves, hepatomegaly, and all signs of right heart failure (Braunwald, PE chpt, pg 144).
Pericardial knock
a. High pitched early diastolic sound corresponding to an abrupt cessation of ventricular expansion after AV valve opening and with the prominent “y” descent seen in the jugular venous waveform in patients with constrictive pericarditis (Braunwald, PE chpt, pg 136).
Auscultation characteristics of acute MR and TR
a. A decrescendo, early systolic murmur from the progressive attenuation of the left ventricle-LA pressure gradient during systole because of the steep and rapid rise in pressure within the noncompliant LA. (Braunwald, PE chpt, pg 136).
21. Describe the murmur heard with acute TR?
a. In patients with normal PA pressures, an early systolic murmur which increases in intensity with inspiration. Can see regurgitant “cv” waves on the jugular venous pulse recording. (Braunwald, PE chpt, pg 136).
carvallo sign
The intensity of the holosystolic heart murmur of TR increases with inspiration (Braunwald, PE chpt, pg 146)
