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Cardiac phys

Cardio pass clues

QuestionAnswer
The normal heart sounds ausculated like S1, S2, S3, S4 are made when valves do what? Close-this is normal physio and expected in S1 and S2 all the time, ex. when you close a door it will make a noise.
What are the valves involved in S1? Mitral and Tricuspid
What are the valves involved in S2? Aortic and Pulmonic
Which of the heart sounds are heard on Inspiration(breathe in)? Tricuspid and Pulmonic
Which of the heart sounds are heard on Expiration (breathe out)? Mitral and Aortic
Which VALVES are involved during Diastole? Mitral and Tricuspid
Which Valves are involved during Systole? Aortic and Pulmonic
Which side of the heart is considered to be the "high" pressure side? Left side of the heart (Lt atria and Ventricle)
Which side of the heart is considered to be the "low" pressure side? Right side of the heart (Rt Atria and Ventricle)
What advantage would you have when a pt leans forward as you auscultate? You can now listen to the aortic (2nd ICS)and Pulmonic.
If the pt is leaning forward and you hear a heart sound on inspiration, which valve are you hearing? Pulmonic
If the pt is leaning forward and you hear a heart sound upon expiration, which valve are you hearing? Aortic
If you have your stethoscope on the chest Left of the sternum at about the 5th ICS and you hear a heart sound, which valve do you hear? Tricuspid-AP 2nd ICS Rt/Lt of sternum respectively and TM 3rd ICS Lt of sternum respectively with M. midclavicular...APT M see FA for illust.
At what point could the Mitral v. be best auscultated, anatomically? near the nipple on the left side with pt lying flat on back is best, but sitting is ok this is at the 3rd ICS laterally/mid clav around the nipple
You hear a loud S1 would that be systole or diastole? Diastole
You hear a loud S2 would that be systole or diastole Systole
What is happening to the valves with loud S1 or S2 in general? Slamming shut-recall S1 or S2 or even S3 and S4 are sounds made when the valves shut..always!
If you hear a loud heart sound on inspiration you suspect what? You can only say that the valves on the right side of the heart are slamming shut and those are the Tricuspid and Pulmonic, this would be a problem where the valves in quest are stenotic
If you hear a loud heart sound on expiration you suspect what? You can only say that the valves on the leftr side of the heart are slamming shut and those are the Mitral and Aortic, this would be a problem where the valves in quest are stenotic
If you hear a loud heart sound on S1, which valves are making that sound? Mitral or Tricuspid
If you hear a loud sound on S2, which valves are making that sound? Aortic or Pulmonic
If you hear an opening snap there is a loud sound on opening of a valve.Which valves would be the culprits if it was diastole where you hear the snap and what would be the cause of this snap? Mitral or Tricuspid and they would be stenotic
If a vignette tells you that there is an ejection click, which valves should you be paying attention? Aortic and Pulmonic
If a vignette mentions an ejection click upon expiration, which valve is affected? Aortic
If a vignette mentions an ejection click upon inspiration, which valve is affected? Pulmonic
What is going on in a midsystolic click, first, which valve(s) are being affected MC? It would very much be during an ejection phase and likely Mitral as the a very high volume of blood mid-way through ejection causes a high back press. causing the Mitral to be pushed against its normal position causing the click (parachuting valve)
Midsystolic click is essentially r/t to what problem of the affected valve? Mitral v. prolapse, seen in females ~7% d/t estrogen.
What is going on with a soft S1? We know the valves involved are closing and these are Mitral and tricuspid but they are soft so likely it would be a regurgitation or both valves not there...atresia both are cyanotic.
What is the MCC of mitral regurge? Mitral v. prolapse-broke the buckle
If you have a loud S1 what could you conclude? The S1 is made with valves closing and S1 deals with Mitral/Tricusp v. so it its loud means its slamming, so stiff valves or ventricle cx harder
Soft S2 would indicate what? S2 deals with the Aortic Pulmonic so it would be regurge or the valves are missing...atresia both are cyanotic
Loud S2 would indicate what? Valves involved-Aortic Pulmonic.stiff valves or pulm or systemic HTN. Stiff vavles = stenosis.
S2 splitting is what? Again Pulmonic and aortic v.means one valve is closing much later than other or 1 v. remains opened longer. MC affected v is Pulmonic. means increase in preload
what can cause and increase pre-load? inflate BP cuff, squatting, Valsalva, make fist.
Which valve MC is affected causing S2 split? Pulmonic- makes sense if you squat you increase bld to right side causing pulmonic to remain open longer to allow the bld to empty to lungs...physio
If you have a fixed S2 split that is what? You assume you have increased pre-load, could be valsvalva, fist, bp cuff inflate, suatting.
Physiological S2 is created when you do what? inhale...remember we are talking about the right side if you think inhale and the rt side has the pulmonic v...physio.
Eventually an S2 split should normalize, but if the S2 split is fixed and wide then the problem is? ASD-physio, you have blood shunted to the Lt from Rt(high to low press is Lt to Rt)so Rt atria has more volume there for opening pulm valve to let all the blood into lung
What causes an S3 heart sound? Volume overload-seen in transfusions, CHF, pick answer with volume increase in it, click move.
When is the only time an S3 is considered to be physiologic? During the time of adolescence but only in a female...estrogen effect-relaxation=dilation.
A drug can commonly cause an S3, which drug is this? Doxorubcin (adriamycin), dilated ventricles.
What commonly abused product (legal) can cause an S3, usually seen on Sun in the ER or Mon at PCP's office, only if pt compliant or married? ETOH binge or abuse. In abuse the wet berry berry is High output Cardiac heart failure,d/t too much fluid.
NOTES: EASY WAY TO REMEMBER RT SIDE VS LEFT SIDE OF HEART AS FAR AS INSPIRE VS EXPIRE. DEOXYGENATED BLOOD COMES IN TO RT SIDE OF HEART AND RT SIDE DEALS WITH INSPIRATION TO BRING IN O2 FOR DEOXYG BLOOD AND LT SAID PUSHES OUT OXYGENATED BLD AND LUNGS EXPIRE DEOXYG AIR. BLD IN AIR IN..INSPIRE, BLD OUT AIR OUT EXPIRE.
What constitutes a murmur? Turbulence inside the heart
What is MCC of a murmur? clue think very basic, ask yourself what could cause this murmur sound? incompetent valve or a regurgitant valve that when blood passes through it, it makes a blowing sound hence murmur. the valve should be open and it isn't quite open or it should be closed and it isn't quite closed
boards may describe a systolic murmur or call it a blowing sound on ejection. Which valves are MC implicated? Aortic/Pulmonic-yes but must be stenotic Tricusp/Mitrial-yes but must be incompetent or regurgitant or collapsed, involuted i.e. prolapsed.
If you hear a blowing sound outside of the heart it is called what? Bruit-in a vessel it is usually stenosis 70% of time.
Inside the heart a blowing sound is a murmur and it is d/t turbulence, the measurement is called what? Reynold's number-all this represents is a measurement of turbulence.
Important to never forget the rules of the heart sounds (S1, S2...) in murmurs is no different except things change because it is possible that all 4 valves of the heart could be involved. You must look at the clues given, i.e. blowing/murmur...you know its a murmur the clues will explain the quality of sound or explain turbulence. Snap/pop/bang...not murmurs. But always follow rules to know which side ur on
Knowing it is a systolic murmur can't delineate it to a specific valve the clues will guide you in other words the s/s the pt is having or the position pt is in helps. remember leaning forward is top of heart or atria, around left nipple is ventricle specifically mitral so rt heart, recall APT M
Which heart defect can cause a systolic murmur? VSD-left ventricle much stronger than right and the high volume shunted right increases press in that rt ventricle leading to tricuspid regurge.
Holosystolic murmur next
What is pulsus pardoxus? unable to get blood to right side of heart leads to JVD. a constrictive heart problem seen in tamponade.
kussmaul sign also seen in tamponade is what? Deep breathing d/t metabolic acidosis.
Holosystolic murmur with a thrill? VSD those with D non cyanotic initially
Diastolic thrill with fixed wide S2 splitting? ASD those with D non cyanotic initially
Continuous or machine thrill? PDA those with D non cyanotic initially
How do we close a PDA? endomethacin
Coarctation of aorta is seen in Turner's and is d/t what problem? failure of apoptosis dont forget rib notching with turner's
Egg shaped heart is what problem? TGA transpos of great arteries.
MC congenital heart disease during first month of life? TGA- egg shaped
MC congenital heart disease after first month of life? TOF this now becomes #1 because the TGA's have all died.
Transposition of great arteries is associated with which clue of the heart shape? Egg shaped
Tetralogy of Fallot, the prognosis will be determined by what condition? degree of pulmonic stenosis.
Mom that took Lithium while pregnant is most likely to affect NB how? Ebstein's anomaly
When a NB has a large Rt ventricle and a small Lt ventricle, what is that called and what likely caused it? Ebstein's anomaly d/t Lithium
MCC of aortic stenosis Aging- monckenburg's-calcification of aorta Tx to slow progress Ca channel blockers
MCC of aortic regurge Aging
MCC of Mitral stenosis? rheumatic fever by grp A beta hemolytic strept
MCC of mitral regurge? Mitral valve prolapse or Sub ac bacterial endocarditis or collagen disease. soft S1
MCC of tricuspid stenosis? Rheumatic fever and carcinoid syndrome the latter is r/t appendix and METS in carcinoid & only reason having an append hellps. recall stuff circulates and comes back to heart first thing it hits at heart is tricuspid valve.
MCC of tricuspid regurge? aortic endocarditis
MCC of all pulmonary diseases? always always congenital
pt with loud s2 leaning forward is what? aortic stenosis-expect press volume loop representing aortic stenosis.see notes cardio pg 14
pt with soft s2 on expiration, dx? Aortic regurges-volume increases expecte press volume loop to represent it. see notes cardio pg 14
Board may give you a drawing or tracings that will represent WPW syndrome.
pt with loud s2 leaning forward is what? aortic stenosis-expect press volume loop representing aortic stenosis.see notes cardio pg 14
pt with soft s2 on expiration, dx? Aortic regurges-volume increases expecte press volume loop to represent it. see notes cardio pg 14
Board may give you a drawing or tracings that will represent WPW syndrome. know the one MC tested is where SA node fibers do not pass to AV node they go directly to the Bundle of HIS.
What is the cardiac condition where the SA node fibers by pass the AV node and go directly to the Bundle of HIS? WPW syndrome
The wave created in WPW syndrome is called what? (this is seen on ECG) Delta wave
Treatment of WPW (definitive)is to do what? Cut those fibers going to HIS bundle step II & III
Created by: sxirsrick