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37 Cards in this Set

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Most common cause of split S1?
Right Bundle Branch Block

Less Common:
ASD
Tricuspid Stenosis
Generally, what maneuvers increase preload to right and left heart, respectively, making murmurs worse on those sides?
L heart - expiration

R heart - Muller maneuver -> patient attempt to inspire while mouth and nares are held closed
What heart functions are represented by:
-a wave
-c wave
-v wave
a = (a)trial contraction
c = RV (c)ontraction
v = filling against closed (v)alve
Describe the grading of murmurs.
1 = barely audible by expert
2 = quiet but audible
3 = not loud but easily heard
4 = loud w/ THRILL
5 = heard w/ tilted diaphragm
6 = heard w/ diaphragm off chest
Scale of 1 ot 6
Where do you find:
-Roth spots
-Osler nodes
-Janeway lesions
Roth -> (r)etinal hemorrhages

Osler nodes -> finger/toe pads

Janeway -> palms and soles
Si/Sx of rheumatic fever?
J oint
O-itis
N odes
E rythema Marginatum
S yndenham's chorea
JONES
Aschoff bodies are the pathognomonic histological finding of what condition?
Rheumatic fever -> granulomas throughout body, especially myocardium surrounding blood vessels.
Which of the following is potentially normal: S3 or S4?
S3, in young folks or pregnant women in their third trimester
What conceptually causes S3?
Volume overload of either ventricle.
What are some specific causes of S3? (3)
CHF
Mitral regurge
Tricuspid regurge
What is the conceptual cause of S4?
Stiff left ventricle
What is a potential (and controversial) specific cause of S4?
Cardiac hypertrophy from exercise -> must be distinguished from hypertrophic cardiomyopathy, which is dangerous for athletes
What are some pathological causes of S4? (4)
HTN
MI
Aortic Stenosis
Hypertrophic Cariomyopathy
What causes pulsus bisfiriens? (3)
Aortic regurge w/ stenosis
Pure aortic regurge
HOCM
A patient w/ aortic regurge has fingernails w/ pulsatile color changes when pressure is applied to them. Eponym?
Quincke pulse
A patient w/ aortic regurge has head that bobs with heartbeat. Eponym?
de Musset sign
Distinguish:
-pulsus bisfiriens
-pulsus alternans
-pulsus bigeminus
Pulsus bisfiriens = double wave pulse (AI, HOCM)

Pulsus alternans = regularly alternating amplitude (decompensation, tamponade)

Pulsus bigeminus = irregularly alternating amplitude (PVCs)
What condition is associated with "pulsus parvus et tardus"?
Aortic stenosis
What is a pericardial knock? What condition is it associated with?
An early-to-mid diastolic sound, associated with constrictive pericarditis.
What is the Kussmaul sign?
Inspiratory distension of neck veins.
What conditions are the Kussmaul sign associated with? (4)
Superior vena cava syndrome
RV infarct
Constrictive pericarditis
Tricuspid Stenosis
Right heart diastolic dysfuction
What is the tracheal tug sign? What condition is it assoicated with?
The ability to palpate the aortic pulse by grasping the trachea, ass'd with AORTIC DISSECTION.
What two murmurs are increased with standing or the Valsalva maneuver?
HOCM
MVP
What maneuver increases mitral regurge?
Hand grip
Patient has leukocytosis, pleural effusion, pericarditis, and fever 3 days to 6 weeks after an MI. Dx? Rx?
Dx: Dressler syndrome, aka post-MI syndrome.

Rx: ASPIRIN!
Where are S3 and S4 best heard?
S3 = APICAL low-pitched sound
S4 = APICAL low-pitched sound

NOT THE BASE OF THE HEART!
S3 represents passive
ventricular filling.

S4 represents active
ventricular filling.
Squatting (or passive leg raising) increase which murmurs? (3)
1) VSD, VSD, VSD
2) Aortic regurge
3) Mitral regurge
These maneuvers increase ventricular filling, so they exacerbate the same murmurs that amyl nitrite improves.
Causes of wide splitting of S2? (3)
1) Mitral regurge -> Pulm HTN
2) Pulmonic stenosis
3) Right bundle branch block*

* - RBBB also cause split S1
Pulmonic is slowest to close. These three conditions make the pulmonic valve close even slower.
What murmurs do amyl nitrite improve?
1) VSD, VSD, VSD
2) Aortic regurge
3) Mitral regurge
These maneuvers decrease ventricular filling, so they improve the same murmurs that squatting exacerbates.
Causes of fixed splitting of S2? (1)
ASD
Classic cause...
Cause of paradoxical splitting of S2?
Left bundle branch block
Paradoxical splitting represents a fixed delay in left venticular contraction.
Normal pattern of split S2?
Normal: inspiratory split
Paradoxical: Expiratory split
Cause of paradoxical splitting of S2?
Left bundle branch block
Paradoxical splitting represents a fixed delay in left venticular contraction.
Normal pattern of split S2?
Normal: inspiratory split
Paradoxical: Expiratory split
ASD effects on S1 and S2
1) Split S1
2) Fixed splitting of S2
ASD murmur
Systolic
Crescendo-decrescendo
2nd left IC space
Causes of VSD? (2)
1) MI
2) congenital