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20 Cards in this Set

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Imagine a "Y" between S1 and S2 to give S1YS2, indicating that systole(SYS) occurs between the first(S1) and S2) heart sounds. TRUE/FALSE
TRUE. Heart sounds normally result from valve closure.
What actually causes the first heart sound?
It reflects the closure of the atrioventricular(tricuspid and mitral) valves during systole.
What is reflected in the 2nd heart sound?
It reflects closure of the semilunar(pulmonary and aortic) valves during systole.
What can be said of the 3rd and 4th heart sounds?
These sounds are not normally heard through the stethoscope, although the S3 may be heard in normal children and young adults.
S3 represents rapid passive ventricular filling. it is heard pathologically in older adults with ventricular failure as a ventricular gallop.
What does the S4 sound represent?
S4 represents rapid active ventricular filling, which occurs when the atria contract and empty in the latter part of ventricular diastole.
It may be heard in various cardiac diseases as in "atrial gallop".
The ventricles are generally stiff and resistant to dilation(ventricular hypertrophy) in an S4 murmur.
The aortic valve is open for a shorter time than is the mitral valve. TRUE/FALSE
TRUE. Because of the high pressure in the aorta, the aortic valve opens after the mitral valve closes, and closes before the mitral valve opens.
What is the significance of the a, c, and v atrial pressure waves?
The a wave reflects a rise in atrial pressure during late diastolic atrial contraction.
The c wave occurs after closure of the AV valves during systole.
The v wave arises from atrial filling during systole.
What is the clinical significance of the "a" wave?
It is commonly transmitted to the jugular vein, where it can be observed on the patients neck at the bedside, preceeding the common carotid artery pulse.
There may be a very large a wave in pulmonary artery stenosis.
When else may a waves be seen?
Giant irregular a wave pulses may occur in third degree heart block, where atrial contraction may occur at the same time as right ventricular contraction.
The tricuspid valve remains closed during right atrial contraction.
Why is a systolic wave seen in the neck?
It is seen in tricuspid insufficiency at about the same time as cardiac sound S1, due to regugitation of blood back into the right atrium during systole.
Most of the filling of the ventricles occurs during the first third of diastole, and most of the emptying of the ventricles occurs during the first third of systole. TRUE/FALSE
TRUE. In aortic valve deficiency, the backflow insufficiency murmur is loudest during the first part of diastole.
The insufficiency murmurs are relatively high pitched, due to the high velocity of blood flow.
In mitral and aortic stenosis, why is there a little murmur immediately after S1 and S2.
This is the case because S1 and S2 represent closure of the mitral and aortic valves respectively, whereas these murmurs begin with the opening of the mitral valve(mitral stenosis).
Events on the right side of the heart occur roughly at the same time as corresponding events on the left side. TRUE/FALSE
TRUE.
What is the splitting of the second heart sound?
The pressure in the pulmonary artery(about 16mm Hg) is markedly less than that in the aorta(about 100mm Hg).
The tricuspid and mitral valves close at essentially the same time, the aortic and pulmonary valves do not quite do so, leading in inspiration to splitting of the second heart sound.
The aortic valve normally closes slightly before the pulmonary valve. TRUE/FALSE
TRUE. This might be expected given the large back pressure of the aorta.
What is responsible for this closure time?
This difference is most pronounced(closure time) during inspiration, where the negative pressure during inspiration increases the inflow to the right side of the heart and decreases inflow from the lungs to the left atrium and ventricle.
Regarding the above explanation, what happens with this increased volume within the right ventricle?
There is consequently a decrease volume of the left ventricle, and this results in a more prolonged right ventricular contraction, and hence a delay in a closure of the pulmonary valve during inspiration.
During expiration, the closure sounds during S2 should coincide.
How does the splitting sequence relate to right bundle branch block?
The right ventricle is slow in contracting and there is a delay in pulmonary valve closure, leading to a wide split in the S2 sound.
What happens in left bundle branch block regarding S2 splitting?
The left ventricle is slow in contracting and there is a paradoxical split of S2, in which the aortiv valve closes after the pulmonary valve during both expiration and inspiration.
Delay of closure of the pulmonary valve with consequent sound splitting effects, may also be observed in pulmonary stenosis. TRUE/FALSE
TRUE. Blood takes extra time to get through the pulmonary valve, whereas closure of the aortic valve may be delayed in aortic stenosis.