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12 Cards in this Set
- Front
- Back
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Contrast low frequency extra sounds to high frequency heart sounds and name two of each
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diaphragm (picks up high freq sounds - S1, S2)
bell (picks up extra sounds - S3 and S4) |
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explain the mechanism behind S3.
explain the mechanism behind S4. |
S3 follows S2 & results from resistance to EARLY LV FILLING (by a stiff non-compliant LV-- signaling CHF) whereas S4 precedes S1 & results from LATE FILLING (“atrial kick” squeezing blood into stiff LV)
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S3 is sign of decompensated heart failure with VOLUME/PRESSURE overload, whereas S4 is a sign of VOLUME/PRESSURE overload.
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S3- volume overload (S3 is sign of decompensated HF or regurgitant valve)
S4 - pressure overload often dected in LVH or aortic stenosis |
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What causes A2-P2 “physiologic splitting” during inspiration?
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Delay in P2 mostly due to longer RV emptying
Result of inspiratory delay in pulmonic valve when a pt is breathing in; right atrial and ventricular filling becomes more; so pulmonic closure sound will expectedly be delayed when you breathe in. |
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Identify and describe the pathophysiologic mechanisms of wide & fixed splitting of S2.
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this is hallmark of atrial septal defect (ASD)
When you have ASD, you have shunting at atrial level. And since you have higher pressure in left atrium, blood flows from left to right atrium. Subsequently, right atrium/ventricle will get more blood and have more filling – the emptying takes longer pulmonic valve will take a longer time to shut (even if pt doesn’t breathe in). If you ask pt to breathe in, the sound is still there. The inspiration does not delay further the pulmonic valve bc it’s already delayed to the max. |
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the dynamic auscultatory findings in MVP (response to standing/squatting) are similar to what other heart dz with a systolic murmur?
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HCM
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which of the following best differentiate acute pericarditis from acute myocardial infarction?
a. ST elevations occur in acute MI but not in acute pericarditis b. ST elevations occur in both but are diffuse in acute pericarditis c. PR segment depression occurs in acute pericarditis only d. both a and c e. both b and c |
E.
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which of the following tx's for AMI may be harmful in acute pericarditis?
a. aspirin b. Beta blocker c. ACE inhibitor d. thrombolytic e. nitroglycerin |
D. bc can lead to pericardial bleeding (and even tamponade)
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when you see delta wave on EKG, it's indicative of the following?
a. Accessory pathway b. Antegrade (from A to V) conduction down accessory pathway c. Retrograde condution (from V to A) up the accessory pathway d. A and B e. A and C |
D.
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Which of the following may predispose WPW patients to potentially life threatiening arrhythmias?
A. antegrade conduction down an accessory pathway at a very high rate (>250 beats/min) B. Antegrade conduction down the AV node at rates up to 190-200 beats/min C. Accessory pathway with a SHORT effective refractory period D. Accessory pathway with a LONG effective refractory period E. A and/or C |
E.
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would you treat a pt with supposed WPW, but delta wave disappears once placed on a treadmill, with AV blocker?
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never treat with AV blocker
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what if pt has short PR, but no delta wave, how would you treat?
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since the pt probably has some AV node conduction issues, it's best to give pt beta blocker or CCB to slow down AV node conduction
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