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320 Cards in this Set
- Front
- Back
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the area of the anterior chest overlying the heart and great vessels
|
precordium
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the area of the chest that holds the greater vessels and the heart
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mediastinum
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the apex of the heart is what side of the heart?
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bottom
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the top of the heart is what side of the heart?
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base
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where is the heart located?
|
2nd intercostal
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what is the name of the pulse created by the apex?
|
apical impulse
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where is the apical impulse located?
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5th intercostal space, 7-9 cm from midsternal line
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what great vessels return UNOXYGENATED venous blood to the RIGHT side of the hear?
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superior & inferior vena cava
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what great vessel leaves the RIGHT ventricle, bifurcates, and carries the venous blood to the LUNGS?
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pulmonary artery
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what great vessel returns freshly oxygenated blood to the left side of the heart?
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pulmonary vein
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what layer of the heart is a tough, fibrous, double-walled sac that contain serous fluid?
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pericardium
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what layer of the heart is muscular and does the actual pumping?
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myocardium
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what layer of the heart is the thin layer of endothelial tissue that lines the inner surface of the heart chambers and valves?
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endocardium
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the right side of the heart pumps blood where?
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lungs
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the left side of the heart pumps blood where?
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body
|
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where is the base of the heart located?
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2nd intercostal space
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where is the apex of the heart located?
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5th intercostal space
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purpose of valves
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prevent backflow of blood
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what is the name of the valves that separate the atria and the ventricles?
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atrioventricular valves
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what is the name of the right atrioventricular valve?
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tricuspid
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what is the name of the left atrioventricular valve?
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mitral
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the pumping phase of the heart is called what?
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systole
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when do the atrioventricular valves close?
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systole
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what valves separate the ventricles and the arteries?
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semilunar valves
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what is the name of the left semilunar valve?
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aortic valve
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what is the name of the right semilunar valve?
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pulmonic valve
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when do the semilunar valves open?
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systole
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what is the only artery in the body that carries unoxygenated blood?
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pulmonic artery
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what takes up 2/3 of the cardiac cycle?
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diastole
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what takes up 1/3 of the cardiac cycle?
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systole
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what part of the cycle is when the ventricles relax and fill with blood?
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diastole
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what part of the cycle is when the heart contracts and the pulmonary and systemic arteries are filled?
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systole
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when are the atrioventricular valves open?
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diastole
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when are the ventricles relaxed?
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diastole
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what is the passive phase of blood filling called?
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early/protodiastolic
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what is the active phase of blood filling called?
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presystole/atrial systole
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when does atrial systole occur?
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during ventricular diastole
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describe pressure during systole
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ventricular pressure is higher than atria pressure
mitral and tricuspid valves swing shut |
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what sound is caused by the closing of the atrioventricular valves?
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S1
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the closing of the mitral and tricuspid valves signals the beginning of what phase of the cardiac cycle?
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systole
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what sound is caused by the closing of the aortic and pulmonic valves?
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S2
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the closing of the aortic and pulmonic valves signals the end of what phase of the cardiac cycle?
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systole
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cardiac cycle events occur slightly later in what side of the heart?
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right side
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where do you hear S1?
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at the apex
carotid artery pulse |
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the "lub" is what heart sound?
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S1
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does the mitral valve or the tricuspid valve close first?
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mitral
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does the aortic valve or the pulmonic valve close first?
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aortic valve
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the "dub" is what heart sound?
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S2
|
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where is S2 best heard?
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at the base of the heart
|
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how does inspiration effect systole?
|
more venous return to the right
less return to the left |
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when the aortic valve closes significantly earlier than the pulmonic valve, what is the name of the sound heard?
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split S
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ventricular gallop is what heart sound?
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S3
|
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vibrations caused by ventricular filling cause what sound?
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S3
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what sound occurs when the ventricles are resistant to filling during the EARLY rapid filling phase?
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S3
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atrial gallop is what heart sound?
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S4
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when the valve is stiff and does not close correctly, it is called what?
|
stenosis
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when does S4 occur?
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end of diastole/presystole
|
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what causes atrial gallop?
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ventricle resistant to filling
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a gentle, blowing, swooshing sound heard on the chest wall is what?
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a murmur
|
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what causes a heart murmur (4)
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increased velocity
decreased velocity valve defects decreased viscosity |
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all heart sounds are high/low frequency?
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low
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what are the characteristics of heart sounds? (4)
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frequency/pitch
intensity/loudness duration timing |
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what is the name of the heart's ability to contract by itself?
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conduction
|
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what initiates an electrical impulse in the heart?
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the sinoatrial node
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what is the "pacemaker" of the heart?
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sinoatrial node
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ECG waves are labeled what?
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PQRST
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depolarization of the atria
is what part of the ECG wave? |
P
|
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the time for atrial depolarization and time for the impulse to travel through the AV node to the ventricles
is what part of the ECG wave? |
PR interval
|
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depolarization of the ventricles
is what part of the ECG wave? |
QRS
|
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repolarizationof the ventricles
is what part of the ECG wave? |
T wave
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the resting adult pumps how many liters of blood per minute?
|
4 - 6
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cardiac output formula
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CO = systolic volume X beats per minute
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venous return that builds during diastole is known as what?
|
preload
|
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the greater the stretch, the stronger the heart's contraction
is what law? |
Frank-Starling
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Frank-Starling Law is associated with what?
|
preload
|
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the opposing pressure the ventricle must generate to open the aortic valve against the higher aortic pressure
is known as what? |
afterload
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the artery located between the trachea and the sternomastoid muscle is what?
|
carotid artery
|
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characteristics of carotid artery pulse
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smooth rapid upstroke
rounded, smooth summit gradual downstroke with dicrotic notch |
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what veins empty unoxyenated blood directly to the superior vena cava?
|
jugular veins
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jugular veins give information about activity on what side of the heart?
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right
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volume and pressure increases when what side of the heart fails to pump efficiently?
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right side
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what are the two jugular veins called?
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larger internal jugular
external jugular |
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what causes diffuse pulsations in the sterna notch when the person is supine?
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larger internal jugular vein
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where is the larger internal jugular vein located?
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deep and medial to the sternomastoid muscle
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where is the external jugular vein located?
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lateral to the sternomastoid muscle, above the clavicle
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what is the most common extra sound during systole?
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midsytolic click
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aortic valve
is best heard on what side? |
right
|
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pulmonic valve
is best heard on what side? |
left
|
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the fetal heart begins to beat when?
|
at 3 weeks gestation
|
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oxygenation in the fetus takes place where?
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at the placenta
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does blood in the fetus go to the lungs?
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no
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where does the fetal heart reroute blood that should go to the lungs?
|
foramen ovale
ductus arteriosus |
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when does the foramen ovale close?
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within the first hour of life
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when does the ductus arteriosus close?
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within 10 to 15 hours of birth
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the baby's left ventricle mass reach the adult ratio of 2:1?
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1 year
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what is the adult ratio of left ventricle to right ventricle?
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2:1
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where is the apex of the infant's heat?
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4th interspace
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where is the apex of the child's heart?
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5th interspace
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child's heart position in comparison to adult position
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more horizontal
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when does the child's heart reach adult position?
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7 years
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blood volume in pregnancy increases by what percent?
|
30-40%
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when does the most rapid blood volume expansion occur during pregnancy?
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2nd trimester
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what increases during pregnancy?
|
blood volume
stroke volume cardiac output pulse |
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how many beats per minute increase is there during pregnancy?
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10-15
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how does pregnancy effect blood pressure?
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decreases it
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why does blood pressure decrease during pregnancy?
|
peripheral vasodilation
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when does blood pressure drop to its lowest point during pregnancy?
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2nd
|
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how is systolic blood pressure effected between 20 and 60 years of age?
|
systolic bp increases by 20 mmHg
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how is systolic blood pressure effected between 60 and 80 years of age?
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increases by 20 mmHg
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how does aging affect the size of the heart?
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does not
BUT left ventricular wall thickness increases |
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what is the purpose of the left ventricular wall thickness increasing during aging?
|
an adaptive mechanism
creates an increased workload on the heart |
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how does aging effect diastolic pressure?
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it does not
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how does aging effect resting heart rate?
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it does not
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how does aging effect cardiac output at rest?
|
it does not
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how does aging effect cardiac output with exercise?
|
decreases the ability
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how is decreased cardiac output with exercise shown??
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decreased maximum heart rate with exercise
diminished sympathetic response |
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what noncardiac factors cause a decrease in maximum work performance with aging?
|
decrease in skeletal muscle performance
increase in muscle fatigue increased sense of dsypnea |
|
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what kind of arrhythmias increase with age?
|
supraventricular
ventricular |
|
|
ectopic beats in aging people
|
may compromise cardiac output and blood pressure when disease is present
|
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why are tachyarrhythmias less tolerated in aging adults?
|
myocardium is thicker and less compliant
further compromises a vital organ whose function has already been affected by aging or disease |
|
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tachycardia produces a what % decrease in cerebral blood flow?
|
40-70%
|
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an older person with cerebrovascular disease might be affected how by tachycardia?
|
syncope
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how is the P-R interval effected in aging adults?
|
prolonged
1st degree AV block |
|
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how is the QT interval effected in aging adults?
|
prolonged
|
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how is the QRS interval effected in aging adults?
|
it is not
|
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how does aging effect bundle branch block?
|
increases incidence
|
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coronary artery disease accounts for how many deaths of older people?
|
half
|
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|
what is considered hypertension?
|
>140 mm Hg
>90 mm Hg |
|
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how does aging effect hypertension?
|
increases it
|
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|
heart disease is highest in what race?
|
blacks
|
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what groups of women have higher cardiovascular risk factors?
|
black and Mexican-American
|
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|
race and smoking among women
what group of women smoke the most? |
white
|
|
|
serum cholesterol levels in blacks
|
higher during childhood
lower during adulthood |
|
|
overweight
BMI |
25+
|
|
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obesity
BMI |
30+
|
|
|
percent increase in diabetes between 1994 and 2002
|
54%
|
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|
American Indians and diabetes
|
more than twice the rate of Us adults overall
|
|
|
diabetes complications
|
kidney disease
blindness amputation |
|
|
chest pain that occurs when the heart's vascular supply cannot keep up with metabolic demand
|
angina
|
|
|
chest pain
alternative origins |
pulmonary
musculoskeletal gastrointestinal |
|
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excessive sweating is known as what?
|
diaphoresis
|
|
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paroxysmal nocturnal dyspnea occurs with what?
|
heart failure
|
|
|
how does paroxysal nocturnal dyspnea work?
|
lying down increases volume of intrathoracic blood
weakened heart cannot accommodate the increased load |
|
|
classical signs of paroxysmal nocturnal dyspnea?
|
awaken after 2 hours of sleep with the perception of needing fresh air
|
|
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the need to assume a more upright position
is known as what? |
orthopnea
|
|
|
hemoptysis
is often what kind of disorder? |
pulmonary disorder
|
|
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what does hemoptysis also occur with?
|
mitral stenosis
|
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fatigue in the evening is indicative of what?
|
decreased cardiac output
|
|
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fatigue all day or in the morning is indicative of what?
|
anxiety or depression
|
|
|
cyanosis or pallor
is indicative of what? |
myocardial infarction
low cardiac output states as a result of decreased tissue perfusion |
|
|
nocturia
occurs with what? |
heart failure (in the person who is ambulatory during the day)
|
|
|
diabetes mellitus
is a risk factor for what? |
coronary artery disease
|
|
|
blood sugar levels above 130 mg/dL
is a risk factor for what? |
coronary artery disease
|
|
|
hormonal replacement therapy for postmenopausal women
is a risk factor for what? |
coronary artery disease?
|
|
|
an infant who fatigues during nursing
is indicative of what? |
heart failure
|
|
|
what is the normal strength of the carotid artery pulse?
|
2+
|
|
|
the condition in which pressure over the carotid sinus leads to a decreased heart rate, decreased BP, and cerebral ischemia with syncope
is what? |
carotid sinus hypersensitivty
|
|
|
carotid sinus hypersensitivity
occurs with what? |
older adults with hypertension
occlusion of the carotid artery |
|
|
increased carotid pulse occurs with what kind of states?
|
hyperkinetic
|
|
|
a blowing, swishing sound that indicates blood flow turbulence
is called what? |
a bruit
|
|
|
a bruit indicates what?
|
turbulence due to a local vascular cause
|
|
|
bruits occur with what?
|
atherosclerotic narrowing
|
|
|
a carotid bruit is audible when?
|
when the lumen is occluded by 1/2 to 2/3
|
|
|
bruit loudness decreases after the lumen is occluded by how much?
|
2/3
|
|
|
how does the bruit sound when the lumen is completely occluded?
|
it disappears
|
|
|
a murmur is caused by what?
|
a cardiac disorder
|
|
|
you can judge the heart's efficiency as a pump by assessing what?
|
the central venous pressure in the external jugular vein
|
|
|
unilateral distention of external jugular veins is due to what?
|
a local cause such as kinking or aneurysm
|
|
|
full distended external jugular veins above 45 degrees signify what?
|
increased central venous pressure as with heart failure
|
|
|
location of internal jugular pulse
|
lower, more lateral, under or behind the sternomastoid muscle
|
|
|
location of the carotid pulse
|
higher and medial to the muscle
|
|
|
quality of the internal jugular pulse
|
undulant and diffuse
two visible waves per cycle |
|
|
quality of the carotid pulse
|
brisk and localized
one wave per cycle |
|
|
respiration and the internal jugular pulse
|
varies with respiration
level descends during inspiration when intrathoracic pressure is decreased |
|
|
respiration and the carotid pulse
|
does not vary
|
|
|
is the internal jugular pulse palpable?
|
no
|
|
|
is the carotid pulse palpable?
|
yes
|
|
|
pressure and the internal jugular pulse
|
light pressure at the bae of the neck easily obliterates
|
|
|
pressure and carotid pulse
|
no change
|
|
|
position of the person and internal jugular pulse
|
level of pulse drops and disappears as the person is broguht to a sitting position
|
|
|
position of person and carotid pulse
|
unaffected
|
|
|
when are all 4 valves closed?
|
during isometric relaxation of the ventricles
|
|
|
what is the reference point for jugular venous pressure?
|
angle of Louis
|
|
|
squeezing "clenched fist" sign is characteristic of what?
|
angina
|
|
|
jugular veins will elevate and stay elevated as long as you push
with what? |
heart failure
|
|
|
can you see the apical impulse?
|
sometimes
|
|
|
a sustained forceful thrusting of the ventricle during systole
is known as what? |
heave/lift
|
|
|
what does a heave or lift occur with?
|
ventricle hypertrophy as a result of increased workload
|
|
|
a right ventricle heave is seen where?
|
sternal border
|
|
|
a left ventricular heave is seen where?
|
at the apex
|
|
|
increased apical impulse force and duration but no change in location occurs with what?
|
left ventricular hypertrophy
|
|
|
apical impulse displaced down and to the left occurs with what?
|
left ventricular dilation
|
|
|
what condition is the apical impulse not palpable with?
|
pulmonary emphysema
|
|
|
what is cardiac enlargement due to?
|
increased ventricular volume
wall thickness |
|
|
what does cardiac enlargement occur with?
|
hypertension
CAD heart failure cardiomyopathy |
|
|
what is heard best in the 2nd right interspace?
|
aortic valve
|
|
|
what is heard best in the 2nd left interspace?
|
pulmonic valve
|
|
|
what is heard best in the left lower sternal border?
|
tricuspid valve
|
|
|
what is heard best in the 5th interspace at around left midclavicular line?
|
mitral valve
|
|
|
an isolated beat that is early, or a pattern that occurs in which every 3rd or 4th beat sounds early
is what? |
premature beat
|
|
|
a pulse deficit signals what?
|
a weak contraction of the ventricles
|
|
|
what does a pulse deficit occur with?
|
atrial fibrillation
premature beats heart failure |
|
|
a fixed split is affected/unaffected by respiration?
|
unaffected
|
|
|
a split where the sounds fuse on inspiration and split on expiration
is called what? |
a paradoxical split
|
|
|
midsystolic click is associated with what?
|
mitral valve prolapse
|
|
|
murmurs may be due to what?
|
congenital defects
acquired valvular defects |
|
|
a systolic murmur may occur with what?
|
normal heart
heart disease |
|
|
a diastolic murmur occurs with what?
|
ALWAYS indicates heart disease
|
|
|
what is the murmur of mitral stenosis described as?
|
rumbling
|
|
|
what is the murmur of aortic stenosis described as?
|
harsh
|
|
|
murmur of aortic regurgitation sometimes may be heard only when the patient is in what position?
|
learning forward in sitting position
|
|
|
failure of shunts to close in infant
is called what? |
patent ductus arteriosus
atrial septal defect |
|
|
cyanosis at or just after birth signals what?
|
oxygen desaturation of congenital heard disease
|
|
|
most important signs of heart failure in an infant
|
persistent tachycardia
tachypnea liver enlargement |
|
|
what are other signs of heart failure in an infant?
|
engorged veins
gallop rhythm pulsus alternans |
|
|
respiratory crackles are an important sign in who?
|
adults
NOT children |
|
|
cardiac enlargement in the infant causes the apex to shift in what direction?
|
to the left
|
|
|
pneumothorax in the infant causes the apex to shift in what direction?
|
away from the affected side
|
|
|
diaphragmatic hernia in the infant causes the apex to shift in what direction?
|
to the right
|
|
|
what is dextrocardia?
|
a rare anomaly in which the heart is located on the right side of the chest
|
|
|
what is persistent tachycardia in a newborn?
|
>200
|
|
|
what is persistent tachycardia in an infant?
|
>150
|
|
|
what is the normal heart range immediately after birth?
|
100 to 180
|
|
|
what is the normal heart range of an infant?
|
120 to 140
|
|
|
is sinus arrhythmia normal or abnormal in an infant?
|
normal
|
|
|
splitting of S2 in a newborn is common when?
|
a few hours AFTER birth
|
|
|
a fixed split S2 in a newborn indicates what?
|
atrial septal defect
|
|
|
a persistent murmur after how many days of life warrant further evaluation?
|
2-3 days
|
|
|
a precordial bulge to the left of the sternum with a hyperdynamic precordium signals what?
|
cardiac enlargement
|
|
|
when does clubbing of the fingers and toes appear in infants?
|
1st year
|
|
|
a substernal heave in the child occurs with what?
|
right ventricular enlargement
|
|
|
an apical heave in the child occurs with what?
|
left ventricular hypertrophy
|
|
|
an apical impulse moves laterally with what?
|
cardiac enlargement
|
|
|
a venous hum is normal/abnormal in children?
|
normal
|
|
|
suspect pregnancy-induced hypertension with a rise of what systolic and what diastolic?
|
30 mm Hg systolic
15 mm Hg diastolic |
|
|
a continuous murmur from breast vasculature is called what?
|
mammary souffle
|
|
|
is a split S normal/abnormal in pregnancy?
|
normal
|
|
|
are systolic murmurs normal or abnormal in pregnancy?
|
normal
|
|
|
murmurs of what kind of disease cannot be obliterated?
|
aortic valve disease
|
|
|
a sudden drop in blood pressure when rising to sit or stand is called what?
|
orthostatic hypotension
|
|
|
S3 is associated with what?
|
heart failure
|
|
|
S3 over what age is always abnormal?
|
35
|
|
|
systolic murmurs occur in what percent of aging people?
|
50%
|
|
|
fluid in the peritoneal cavity
are known as what? |
ascites
|
|
|
acute heart failure follows what?
|
myocardial infarction
|
|
|
chronic heart failure follows what?
|
hypertension
|
|
|
loud S1 occurs with what?
|
hyperkinetic states
mitral stenosis with leaflets still mobile |
|
|
faint S1 occurs with what?
|
first degree heart block
mitral insufficiency severe hypertension-systemic or pulmonary |
|
|
varying intensity of S1 occurs with what?
|
atrial fibrillation-irregularly-irregular rhythm
complete heart block with changing PR interval |
|
|
split S1
factor |
mitral and tricuspid components are heard separately
|
|
|
accentuated S2 occurs with what?
|
systemic hypertension
mitral stenosis, heart failure arotic or pulmonic stenosis |
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diminished S2 occurs with what?
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shock
aortic or pulmonic stenosis |
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fixed split
example |
atrial septal defect
right ventricular failure |
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paradoxical split
example |
aortic stenosis
left bundle branch block patent ductus ateriosus |
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wide split
example |
right bundle branch block
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ejection click is head when?
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early in systole at the start of ejection
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what does ejection click result from?
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opening of the semilunar valves
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where is the aortic ejection click heard?
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2nd right interspace and apex
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where is the pulmonic ejection click hheard?
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2nd left interspace
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aortic ball-in-cage prosthesis
example |
Starr-Edwards
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tilting disk prosthesis
example |
Bjork-shiley
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midsystolic click is associated with what?
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mitral valve prolapse
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when does midsystolic click occur?
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mid to late systole
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midsystolic click
sounds? |
short, high pitched
click quality |
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where is a midsystolic click best heard?
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at the apex
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opening snap
is heard when? |
after S2
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where is an opening snap best heard?
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with diaphragm
at 3rd or 4th left interspace |
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mitral prosthetic valve sound is heard where?
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over the whole precordium
loudest at apex and left lower sternal border |
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when is the S3 sound heard?
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early diastole
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where is the S3 heard?
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apex or left lower sternal border
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Where is the S2 heard best?
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base
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does S3 vary with respiration?
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no
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does S2 vary with respiration?
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yes
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S3 pitch?
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lower pitched
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S2 pitch?
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stays teh same
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in adults, S3 is usually normal/abnormal?
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abnormal
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a sound that is described as dull, soft, low pitched, like "distant thunder" is what?
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S3
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S3 occurs with what?
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volume overlaod
valve regurgitation |
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when does S4 occur?
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when the atria contract late in diastole
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when is S4 heard?
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immediately before S1
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S4 is heard with the bell or the diaphragm?
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bell
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physiologic S4 occurs with who?
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adults over 40 or 50 with no evidence of cardiovascular disease
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pathologic S4 is also called what?
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atrial gallop
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what does pathologic S4 occur with?
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decreased compliance of the ventricle
systolic overload |
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is a right sided or left sided s4 more common?
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left sided
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when both the pathologic S3 and S4 are present, what is it called?
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summation sound
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a sound that is high pitched and scratchy is called what?
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pericardial friction rub
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friction rub is best heard where?
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at the apex
left lower sternal border |
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friction rub is common when?
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1st week after a myocardial infarction
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a thrill in the 2nd and 3rd right interspaces occurs with what?
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severe aortic stenosis
systemic hypertension |
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a thrill in the 2nd and 3rd left interspaces occurs with what?
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pulmonic stenosis
pulmonic hypertension |
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a lift occurs with what?
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right ventricular hypertrophy
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examples of right ventricular hypertrophy
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pulmonic valve disease
pulmonic hypertension chronic lung disease |
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when cardiac enlargement displaces the apical impulse laterally and over a wider area when left venticular hypertrophy and dilation are present
it is called what? |
volume overload
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volume overload occurs with what?
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mitral regurgitation
aortic regurgitation left to right shunts |
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when the apical impulse is increased in force and duration but is not necessarily displaced to the left
this is what? |
pressure overload
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persistence of the channel joining left pulmonary artery to aorta
is what? |
patent ductus arteriosus
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patent ductus arteriosus is normal/abnormal in the fetus?
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normal
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abnormal opening in the atrial septum, resulting usually in left-to-right shunt and causing large increase in pulmonary blood flow
is what? |
atrial septal defect
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abnormal opening in septum between the ventricles, usually subaortic area
is what? |
ventricular septal defect
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wide pulse blood pressure
bounding peripheral pulses from rapid runoff of blood thrift palpable at left upper sternal border continuous murmur/machinery murmur is indicative of what? |
patent ductus arteriosus
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sternal lift
fixed S2 split murmur is systolic, ejection, medium pitch best heard at 2nd left interspace is indicative of what? |
atrial septal defect
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loud, harsh holosytolic murmur
best heard at left lower sternal border accompanied by a thrill is indicative of what? |
ventricular septal defect
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thrill palpable at lower left sternal border
normal S1; loud A2 in S2 diminished P2 murmur is systolic, loud, crescendo-decrescendo is indicative of what? |
tetralogy of fallot
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upper extremity hypertension over 20 mm Hg
absent femoral pulses systolic murmur best heard at the left sternal border is indicative of what |
coarctation of the aorta
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pallor
slow diminished radial pulse thrill in systole over 2nd and 3rd right interspaces and right side of neck S1 normal, ejection click, paradoxical split S4, S4 present is indicative of what |
aortic stenosis
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loud, harsh, midsystolic, crescendo-decrescendo, loudest at 2nd right interspace, radiates widely to side of neck, down left sternal border or apex
is indicative of what? |
aortic stenosis
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thrill in systole at 2nd or 3rd left interspace, ejection, click often present after S1, diminished S2, S4
is indicative of what? |
pulmonic stenosis
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systolic, medium pitch, coarse, crescendo-decrescendo, best heard at 2nd left interspace, radiates to left and neck
is indicative of what? |
pulmonic stenosis
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thrill in systole at apex
lift at apex apical impulse displaced down and to the left S1 diminished, S2 accentuated, S3 at apex often present is indicative of what? |
mitral regurgitation
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pansystolic, often loud, blowing, best heard at apex, radiates well to left axilla
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mitral regurgitation
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engorged pulsating neck veins
liver enlarged lift at sternum thrill at left lower sternal border is indicative of what? |
tricuspid regurgitation
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soft, blowing, pansystolic, beast heard at left lower sternal border, increases with respiration
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tricuspid regurgitation
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diminished, often irregular arterial pulse
life at apex, diastolic thrill common at apex S1 accentuated, opening snap after S2 |
mitral stenosis
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low pitched diastolic rumble, best heard at apex, with person in left lateral position; does not radiate
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mitral stenosis
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diminished arterial pulse, jugular venous pulse prominent
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tricuspid stenosis
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diastolic rumble, best heard at left lower sternal border, louder in inspiration
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tricuspid stenosis
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bounding "water-hammer" pulse in carotid, brachial, and femoral arteries
blood pressure has wide pules pressure pulsations in cervical and suprasternal area, apical impulse displaced to left and down, apical impulse feels brief |
aortic regurgitation
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murmur starts almost simultaneously with S2, soft high pitched, blowing diastolic, decrescendo, best heard at third left interspace at base, as person sits up and leans forward, radiates down
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aortic regurgitation
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murmur has same timing and characteristics as that of aortic regurgitation, and is hard to distinguish on physical examination
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pulmonic regurgitation
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