Anatomy and Physiology of the Heart

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Questions and Answers

What occurs during systole in the cardiac cycle?

Ventricles contract (correct)

Atria contract

Ventricles relax

Aortic and pulmonary valves close

Which valves are responsible for closing during the S1 heart sound?

Pulmonic and tricuspid valves

Tricuspid and mitral valves (correct)

Aortic and mitral valves

Aortic and pulmonic valves

What type of heart murmur occurs with stenotic lesions?

Systolic murmur (correct)

Continuous murmur

Diastolic murmur

Adventitious murmur

What does the intensity of a heart murmur correlate with?

Disease severity Signup and view all the answers

What is the primary cause of regurgitation in heart valves?

Valves not closing properly during systole Signup and view all the answers

During which phase of the cardiac cycle do the tricuspid and mitral valves open?

Early diastole phase Signup and view all the answers

Which murmur grade is characterized as being very faint and may not be heard in all positions?

Grade 1 Signup and view all the answers

Which heart sound is associated with the closing of the aortic and pulmonic valves?

S2 Signup and view all the answers

Which shape of murmur is characterized by an increase in intensity followed by a decrease?

Decrescendo Signup and view all the answers

Which dynamic auscultation maneuver is most likely to decrease the intensity of left-sided murmurs?

Valsalva Signup and view all the answers

What is the consequence of stenosis when valves should be open?

Pressure overload in the chamber Signup and view all the answers

Which of the following best describes diastole?

Atria contract and ventricles fill Signup and view all the answers

Where might the radiation of a heart murmur typically be felt?

Into the axilla Signup and view all the answers

What impact does expiration generally have on left-sided murmurs?

Increases their intensity Signup and view all the answers

What specifically causes the sound S1 in the heart?

Closure of atrioventricular valves Signup and view all the answers

Which characteristic does not apply to heart murmurs?

Color Signup and view all the answers

Where is the aortic area located for auscultation?

2nd ICS at right sternal border Signup and view all the answers

Which grade of murmur can be heard when the stethoscope is partly off the chest?

Grade 5 Signup and view all the answers

During which phase of the cardiac cycle does S2 occur?

Beginning of diastole Signup and view all the answers

What physiological event leads to the splitting of S2 during inspiration?

Increase in venous return Signup and view all the answers

Heart murmurs are primarily caused by which condition?

Increased turbulence of blood flow Signup and view all the answers

What does regurgitation in valvular disease refer to?

Failure to close completely allowing backflow of blood Signup and view all the answers

In which area is the splitting of S2 best heard?

Pulmonic area Signup and view all the answers

What pathological process can affect the splitting of S2?

Various conditions affecting valve closure timing Signup and view all the answers

Which maneuver worsens mitral valve prolapse and hypertrophic obstructive cardiomyopathy?

Valsalva/standing Signup and view all the answers

What effect does rapid squatting have on mitral valve prolapse?

Improves the condition Signup and view all the answers

Which pharmacologic maneuver affects only left-sided murmurs?

Hand grip Signup and view all the answers

Which type of murmur is almost always pathological?

Systolic murmurs Signup and view all the answers

What effect does hand grip have on aortic stenosis?

Improves the murmur Signup and view all the answers

Which of the following murmurs is a diastolic murmur?

Aortic regurgitation Signup and view all the answers

Which maneuver decreases left ventricular preload?

Valsalva Signup and view all the answers

What is the effect of rapid leg raise on heart murmurs?

Worsens most murmurs Signup and view all the answers

What type of murmur worsens with passive leg raising?

Holosystolic murmur best heard at the apex Signup and view all the answers

Which murmur best describes aortic stenosis during auscultation?

Crescendo-decrescendo murmur best heard at the right 2nd ICS Signup and view all the answers

What is a common clinical finding associated with mitral regurgitation?

Increased intensity with handgrip Signup and view all the answers

Which type of murmur is associated with mitral valve prolapse?

Late systolic murmur with a midsystolic click Signup and view all the answers

How does standing or performing Valsalva maneuver affect murmurs?

Decreases preload, improving most murmurs Signup and view all the answers

Which finding is associated with aortic regurgitation?

Early diastolic decrescendo murmur Signup and view all the answers

What is the quality of a murmur caused by tricuspid regurgitation?

Blowing Signup and view all the answers

Which heart sound characterizes mitral stenosis?

Decrescendo following an opening snap Signup and view all the answers

With which maneuver does the intensity of pulmonic stenosis murmurs increase?

Inspiration Signup and view all the answers

Which murmur increases with expiration?

Tricuspid stenosis Signup and view all the answers

What type of murmur can be described as continuous and machine-like?

Patent ductus arteriosus Signup and view all the answers

What is the pitch of the murmur typically associated with tricuspid stenosis?

Low Signup and view all the answers

Which type of heart murmur is increased with squatting?

Mitral valve prolapse Signup and view all the answers

Which clinical condition is associated with pulmonary hypertension?

Pulmonic regurgitation Signup and view all the answers

Which murmur is worsened by maneuvers that increase preload?

Both A and B Signup and view all the answers

Study Notes

Anatomy of the Heart

The angle of Louis is at rib 2.
The aortic area is at the 2nd ICS at the right sternal border.
The pulmonic area is at the 2nd ICS at the left sternal border.
The tricuspid area is at the 4th ICS at the left sternal border.
The mitral area is at the 5th ICS at the midclavicular line.

Cardiac Cycle

Systole is ventricular contraction, the aortic and pulmonic valves open, the tricuspid and mitral valves close.
Diastole is ventricular relaxation, the atria contract and ventricles fill, the tricuspid and mitral valves open, the aortic and pulmonic valves close.

Normal Heart Sounds

S1 (LUB) occurs at the beginning of systole and is caused by the closure of the atrioventricular valves.
S2 (DUB) occurs at the beginning of diastole and is caused by the closure of the semilunar valves.
S1 is louder at the apex of the heart.
S2 is louder at the base of the heart.

Physiologic Splitting of S2

S2 normally splits during inspiration.
This is because the decrease in intrathoracic pressure increases venous return, which increases blood volume in the right ventricle, causing the pulmonic valve to stay open longer.
A2 is heard before P2.
Splitting of S2 is best heard in the pulmonic area.

Pathologic Splitting of S2

P2 normally closes slightly after A2 during inspiration.
Various pathologic processes can affect the timing or sequence of valve closure.

Heart Murmurs

A heart murmur is an audible vibrations caused by increased turbulence of blood flow in the heart.
Causes: Valvular disease, regurgitation (backflow of blood), stenosis (obstruction of forward blood flow).

Characteristics of Murmurs

Timing: Systolic or diastolic.
Shape: Crescendo, decrescendo, plateau.
Location: 2nd, 4th or 5th ICS.
Radiation: Axilla, carotids.
Intensity: Grade I-VI.
Quality: Blowing, harsh, rumbling, musical.
Pitch: Low, medium, high.

Murmur Intensity

Murmur intensity does not correlate with disease severity.

Dynamic Auscultation Maneuvers

Respiration: Inspiration worsens right-sided murmurs, expiration worsens left-sided murmurs.
Valsalva/Standing: Decrease in left ventricular preload, decrease in left ventricular afterload, decrease in right ventricular preload.
Rapid Squatting/Leg Raise: Increase in left ventricular preload and right ventricular preload, no effect on afterload.
Hand grip: Increase in left ventricular afterload.

Systolic Murmurs

Aortic Stenosis: crescendo-decrescendo murmur heard at the right 2nd ICS, radiates to the carotids.
Pulmonic Stenosis: crescendo-decrescendo murmur heard at the left 2nd ICS, radiates to the left shoulder and neck.
Mitral Regurgitation: holosystolic murmur heard at the apex, radiates to the left axilla.
Mitral Valve Prolapse: Late crescendo murmur preceded by a midsystolic click heard at the apex.
Tricuspid Regurgitation: holosystolic murmur heard at the left lower sternal border, radiates to the right of the sternum.

Diastolic Murmurs

Aortic Regurgitation: Early decrescendo murmur heard at the left midsternal border, radiates to the apex.
Pulmonic Regurgitation: Early decrescendo murmur heard at the left 2nd ICS, radiates along the left sternal border.
Mitral Stenosis: Decrescendo murmur following an opening snap heard at the apex.
Tricuspid Stenosis: Decrescendo murmur following an opening snap heard at the left lower sternal border.

Rules to Remember

Inspiration worsens right-sided murmurs.
Hand grip worsens left-sided regurgitations.
Rapid squatting and leg raise increase preload.
Standing and Valsalva decrease preload.
Maneuvers that decrease preload improve most murmurs.
Maneuvers that increase preload worsen most murmurs (exceptions: MVP and HOCM).

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Description

This quiz covers the anatomy of the heart, including the location of cardiac auscultation areas and the cardiac cycle phases. It also discusses normal heart sounds and their characteristics, providing essential knowledge for understanding cardiovascular physiology.