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29 Cards in this Set
- Front
- Back
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28. S1- What is happening and where is it loudest?
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a. Mitral and tricuspid valve closure
b. Loudest at mitral area. |
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29. S2- What is happening and where is it loudest?
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a. Aortic and pulmonary valve closure
b. Loudest at sternal border. |
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30. S3 What is happening and when?
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a. In early diastole during rapid ventricular filling phase.
b. Associated with ↑ filling pressure and more common in dilated ventricles (but normal in children and pregnant women). |
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31. S4- What is happening and when?
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a. “atrial kick” in late diastole
b. High atrial pressure. c. Associated w/ventricular hypertrophy. d. Left atrium must push against stiff LV wall. |
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32. JVP a wave?
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a. Atrial contraction. A = atrial.
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33. JVP C wave?
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a. RV contraction (closed tricuspid valve bulging into atrium).
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34. JVP V wave?
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a. ↑ right atrial pressure due to filling against closed tricuspid valve.
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35. S2 splitting and what increases it?
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a. Aortic valve closes before pulmonic.
b. S2 splitting is increased w/inspiration (increases the difference). |
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36. What is wide splitting of S2 (So wide distance between A2 and P2) associated with?
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a. Pulmonic stenosis or RBBB.
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37. What is fixed splitting associated with?
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a. ASD.
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38. What is Paradoxical splitting associated w/?
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a. Aortic stenosis or LBBB.
b. So P2 occurs before A2. |
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39. What causes normal splitting?
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a. Inspiration leads to drop in intrathoracic pressure, which ↑ capacity of pulmonary circulation.
b. Pulmonic valve closes later to accommodate more blood entering the lungs. c. Aortic valve closes earlier because of ↓ return to the left heart. |
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40. When is wide splitting heard?
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a. In conditions that delay RV emptying (pulmonic stenosis, right BBB).
b. Delay in RV emptying causes delayed pulmonic sound (regardless of breath). c. An exaggeration of normal splitting. |
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41. When is Fixed splitting heard?
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a. ASD.
b. ASD leads to left-to-right shunt and therefore ↑ flow through pulmonic valve such that, regardless of breath, pulmonic closure is greatly delayed. |
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42. When is Paradoxical splitting heard?
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a. In conditions that delay LV emptying (aortic stenosis, left BBB).
b. Normal order of valve closure is reverse so that P2 sound occurs before delayed A2 sound. c. Therefore, on inspiration, the later P2 and earlier A2 sounds move closer to one another, “paradoxically” eliminating the split. |
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43. When do Right-sided heart sounds intensify?
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a. With inspiration
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44. When do Left-sided heart sounds intensify?
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a. Expiration.
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45. Mitral/Tricuspid regurg (MR/TR) characteristics?
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a. Holosystolic, high-pitched “blowing murmur”
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46. Where is Mitral regurg loudest and what enhances it?
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a. Loudest at apex and radiates towards axilla.
b. Enhanced by maneuvers that ↑TPR (e.g., squatting, hand grip) or LA return (e.g. expiration). |
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47. Causes of MR?
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a. Ischaemic heart disease
b. Mitral valve prolapse c. LV dilation. |
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48. Where is Tricuspid regurg loudest and what enhances it?
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a. Loudest at tricuspid area and radiates to right sternal border.
b. Enhanced by maneuvers that ↑ RA return (e.g. inspiration) |
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49. Causes of Tricuspid regurg?
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a. RV dilation or endocarditis.
b. Rheumatic fever can cause both. |
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50. Aortic Stenosis murmur type?
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a. Crescendo-decrescendo systolic ejection murmur following ejection click.
b. (Ejection click due to abrupt halting of valve leaflets). |
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51. Aortic Stenosis characteristics?
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a. Left ventricular pressure is much greater than aortic pressure during systole.
b. “Pulsus parvus et tardus”- Pulses weak compared to heart sounds. c. Can lead to syncope. d. Often due to age-related calcific aortic stenosis or bicuspid aortic valve. |
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52. Where does aortic stenosis radiate to?
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a. Carotids/apex.
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53. VSD (Ventricular Septal defect) murmur- characteristics and where is it loudest?
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a. Holosystolic!!! (same as MR/TR)
b. Harsh-sounding murmur instead of blowing. c. Loudest at tricuspid area. |
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54. Mitral Prolapse Murmur type?
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a. Late systolic crescendo murmur w/midsystolic click.
b. (MC due to sudden tensing of chordae tendineae). |
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55. Mitral prolapse?
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a. Most frequent valvular lesion.
b. Usually benign. Can predispose to infective endocarditis. c. Can be caused by myxomatous degeneration, rheumatic fever, or chordae rupture. |
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56. What enhances mitral prolapse murmurs?
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a. Maneuvers that ↑ TPR (e.g. squatting, hand grip).
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