Cv - Physiology Of Cardiac Auscultation

Front 1

physiological split of S2 is caused by

Back 1

inspiration causes increased negative pressure in the thoracic cavity

this causes 2 things:
1. increased venous return and thus increased output to lungs meaning the pulmonary valve stays open longer

2. decreased output of blood to the left side of the heart from the lungs meaning the aortic valve closes earlier

Front 2

aortic regurgitation

Back 2

backflow into the left ventricle due to improper closure of aortic valve

decreased diastolic pressure

decrescendo early diastolic murmur

increased systolic volume due to regurgitation might cause mid-systolic murmur

might hear austin-flint murmur - mid diastolic to presystolic murmur due to force of regurgitation on the mitral valve disrupting inflow from left atrium

Front 3

T/F stenosis is problem closing valve

Back 3

false; problem opening valve

Front 4

T/F valvular regurgitation/insufficiency is problem opening valve

Back 4

false; problem closing valve

Front 5

AV, PV stenosis causes systolic/diastolic murmur

Back 5

systolic murmur - AV and PV should be open during systole, but can't because of stenosis

Front 6

AV, PV regurg causes a systolic or diastolic murmur?

Back 6

diastolic - AV and PV should be closed during diastole, but can't properly close in regurg

Front 7

MV, TV stenosis causes a systolic or diastolic mumur?

Back 7

diastole - MV and TV should be open during diastole, but can't in stenosis

Front 8

MV, TV regurg causes a systolic or diastolic mumur?

Back 8

systole - MV and TV should be closed during systole, but can't close in regurg

Front 9

acute vs chronic aortic regurgitation murmurs

Back 9

acute regurgitation - the left ventricles less able to tolerate the increased stroke volume

-> increased diastolic pressure will pre-close the mitral valve

-> pressure in LV will equilibrate with arterial diastolic pressure to prevent arterial diastolic collapse

-> less early diastolic murmur

-> dont hear presystolic part of the austin flint murmur or the 1st heart sound due to pre-closure of mitral valve

Front 10

aortic regurgitation causes

Back 10

AV root dilation - most common

infective endocarditis - most common infectious cause

essential hypertension

chronic rheumatic fever

Front 11

signs of aortic regurgitation

Back 11

quincke sign - pulsatile nail bed

de musset sign - head bobbing

trabue sign - pistol shot souds over brachial or femoral

durozier sign - to and fro bruits in femoral artery

corrigan pulse - visible bounding, collapsing pulses in neck and arms while sitting

bisferiens pulse - two pronged palpable pulse in carotid

waterhammer pulse - shock wave from pulse with arm extended upward

Front 12

aortic stenosis causes

Back 12

calcific stenosis - most common cause in old people

congenital bicuspid valve easier to calcify - most common in people < 30

rheumatic heart disease

Front 13

aortic stenosis pathophysiology

Back 13

hear diamond shaped mid systolic - no holosystolic

causes slow rising aortic pressure (parvus et tardus)

prolonged systolic ejection

premature ventricular contraction

postextrasystolic potentiation (PESP) - see a weak premature ventricular contraction followed by a very strong postextrasystolic contraction - due to inotropic state

hear S4

Front 14

T/F aortic stenosis murmur is made worse by increasing preload

Back 14

True

Front 15

severity of aortic stenosis is determined by

Back 15

length of harsh outflow murmur

fourth heart soud

gallavardin murmur heard from the apex

Front 16

triad of symptoms in aortic stenosis

Back 16

angina, dyspnea, syncope

Front 17

Mitral regurgitation causes

Back 17

most common cause: mitral prolapse

rheumatic fever

endocarditis - dental procedures

rupture of the papillary muscle - ischemic disease

Front 18

mitral regurgitation pathophysiology

Back 18

retrograde flow of blood into the LA due to dysfunctional MV - can't close

LA becomes dialated

volume overload -> left side heart failure

Front 19

mitral prolapse

Back 19

floppy valve and elongation of leaflets inflate during ventrcal systole and herniate into the LA

there is a redundancy of valve tissue

Front 20

mitral prolapse murmur

Back 20

valve is competent until late systole

in LATE systole, the valve prolapses -> click sound followed by a murmur

difference from hypertrophic cardiomyoptathy - presence of click and handgrip maneuver increases mitral proplapse murmur while decreases murmur in HTC

click sound due to sudden straining of chordae

late systolic murmur

decreasing venous return (standing, valsalva) -> click occurs earlier and murmur lasts longer and lounger (less volume means less distance to prolapse so it occurs earlier)

increasing venous return (squatting) -> later click and shorter murmur (similar pattern to hypertrophic cardiomyopathy)

difference from hypertrophic cardiomyopathy - mitral prolapse has a click, mitral prolapse murmur INCREASES with handgrip maneuver

Front 21

non prolapse mitral regurg murmur

Back 21

valve leaflet tissue is deficient unlike in prolapse where tissue is redundant

increase ventricle volume will worsen mitral regurg (opposite happens with mitral prolapse)

treatment is to decrease preload/afterload

the is no click associated with nonprolapse MR

Front 22

chronic MR vs Acute MR

Back 22

chronic MR - increased compliance allows less pressure impact - holosystolic murmur

acute MR - truncated mumrur


note that mitral prolapse is associated with a click, mitral regurgitation does not

Front 23

mitral stenosis cause

Back 23

almost always from rheumatic fever - group A Strep

see in pregnant woman with dyspnea

Front 24

what kind of drugs to avoid with mitral stenosis

Back 24

arterial dilation or inotropic drugs

Front 25

effects of exercise on mitral stenosis

Back 25

tachycardia decreases time for diastolic inflow and increased CO has less time to through the valve

hear an earlier opening snap and louder mumur

elevated LA pressures -> pulmonary edema

pregnancy and fever have similar effect

Front 26

mitral stenosis where to hear, what kind of murmur

Back 26

hear over the LA

mid diastolic murmur follows opening snap

increases in HR or CO will increase murmur

Front 27

valsalva maneuver effect on the preload

Back 27

decreases preload by increasing pressure in the thoracic cavity

Front 28

standing vs squatting effect on preload

Back 28

standing - lower venous return/preload

squatting - increased venous return/preload

Front 29

handgrip maneuver effect

Back 29

increases afterload/systemic peripheral resistance

Front 30

early diastolic murmurs

Back 30

result from semilunar valve backflow

aortic, pulmonic valve regurg

shorter murmur is worse

Front 31

mid diastolic mumurs

Back 31

result from infow problems through a stenotic valve or high volume through non-stenotic valve

mitral regurgitation (high LA pressures flow to LV)

mitral stenosis
austin flint murmur
tricuspid stenosis

Front 32

early systolic mumurs

Back 32

begin with 1st heart sound, ends before the 2nd

mitral regurg
pulmonic stenosis

Front 33

mid systolic murmurs

Back 33

spereate from the 1st and 2nd heart sounds

usually associated with ejection through an outflow tract

outflow stenosis: aortic/pulmonic

high volume outflow - anemia, pregnancy, ASD, aortic regurg

high outflow velocity - hypertrophic CM

innocent murmur

dilated aorta/pulm artery

Front 34

late systolic murmurs

Back 34

beging after 1st sound, extend to 2nd

mitral prolapse

hypertrophic CM

coarctation of aorta

patent ductus arteriosus

Front 35

holosystolic murmurs

Back 35

start with 1st heart sound and extend to 2nd

mitral regurg
tricuspid regurg

VSD

hypertrophic cardiomyopathy

pulmonic stenosis severe (remember that during inspiration pulmonary valve is open longer - thus can extend length)

Front 36

T/F hypertrophic cardiomyoapthy is associated with almost all types of murmurs

Back 36

true

Front 37

hypertrophic cardiomyopathy and mitral prolapse murmur changes with standing, squatting, valsalva strain

Back 37

squatting: quieter and shorter
valsalva: louder and longer
standing: louder and longer

Front 38

continuous mumur

Back 38

extends from systole to diastole (past the 2nd sound)

due to high pressure flow source to a lower pressure

patent ductus arteriosus