Podcast
Questions and Answers
What type of murmurs often occur with regurgitant flow across the AV valves?
What type of murmurs often occur with regurgitant flow across the AV valves?
Pansystolic (Holosystolic) murmurs
What condition is often indicated by a late systolic murmur?
What condition is often indicated by a late systolic murmur?
Mitral valve prolapse
What do early diastolic murmurs typically reflect?
What do early diastolic murmurs typically reflect?
Regurgitant flow across incompetent semilunar valves
Middiastolic and presystolic murmurs reflect turbulent flow across which valves?
Middiastolic and presystolic murmurs reflect turbulent flow across which valves?
What type of murmurs do congenital patent ductus arteriosus and AV fistulas produce?
What type of murmurs do congenital patent ductus arteriosus and AV fistulas produce?
Where is a murmur best heard that often originates at or near the aortic valve?
Where is a murmur best heard that often originates at or near the aortic valve?
Where does the murmur of aortic stenosis often radiate to?
Where does the murmur of aortic stenosis often radiate to?
In mitral regurgitation, where does the murmur often radiate to?
In mitral regurgitation, where does the murmur often radiate to?
An identical degree of turbulence would cause a louder murmur in which type of person?
An identical degree of turbulence would cause a louder murmur in which type of person?
What is a fully described example of a murmur?
What is a fully described example of a murmur?
Right-sided heart murmurs generally increase with inspiration.
Right-sided heart murmurs generally increase with inspiration.
Left-sided heart murmurs generally increase with inspiration.
Left-sided heart murmurs generally increase with inspiration.
What does PMI stand for?
What does PMI stand for?
The PMI is located on the right side of the chest in __________.
The PMI is located on the right side of the chest in __________.
What does a PMI >2.5 cm indicate?
What does a PMI >2.5 cm indicate?
What conditions result in lateral displacement of the PMI?
What conditions result in lateral displacement of the PMI?
In most adults over age 40, the diastolic sounds of S3 and S4 are pathologic.
In most adults over age 40, the diastolic sounds of S3 and S4 are pathologic.
What does an S3 heart sound correspond to?
What does an S3 heart sound correspond to?
What does an S4 heart sound correspond to?
What does an S4 heart sound correspond to?
What occurs during systole?
What occurs during systole?
What happens during diastole?
What happens during diastole?
Which heart sound is produced by the closure of the mitral valve?
Which heart sound is produced by the closure of the mitral valve?
Which heart sound is produced by aortic valve closure?
Which heart sound is produced by aortic valve closure?
What are the two types of heart failure as categorized currently?
What are the two types of heart failure as categorized currently?
What are signs and symptoms of acute myocardial infarction (MI)?
What are signs and symptoms of acute myocardial infarction (MI)?
Acute coronary syndrome includes which conditions?
Acute coronary syndrome includes which conditions?
Causes of chest pain in the absence of coronary artery disease include?
Causes of chest pain in the absence of coronary artery disease include?
What condition presents with anterior chest pain often described as tearing or ripping?
What condition presents with anterior chest pain often described as tearing or ripping?
What should be done if there are symptoms of irregular heart action?
What should be done if there are symptoms of irregular heart action?
What may transient skips and flip-flops in a patient's history indicate?
What may transient skips and flip-flops in a patient's history indicate?
What are 'a waves' in Jugular Venous Pulsations associated with?
What are 'a waves' in Jugular Venous Pulsations associated with?
What does an absent 'a wave' indicate?
What does an absent 'a wave' indicate?
Increased 'v waves' occur in conditions such as?
Increased 'v waves' occur in conditions such as?
What does the examination of the carotid pulse include?
What does the examination of the carotid pulse include?
A unilateral pulsatile bulge is indicative of?
A unilateral pulsatile bulge is indicative of?
What may cause decreased carotid pulsations?
What may cause decreased carotid pulsations?
What happens when pressure is applied to the carotid sinus?
What happens when pressure is applied to the carotid sinus?
In cardiogenic shock, how does the carotid pulse feel?
In cardiogenic shock, how does the carotid pulse feel?
How is the carotid pulse described in aortic regurgitation?
How is the carotid pulse described in aortic regurgitation?
In aortic stenosis, how is the carotid upstroke described?
In aortic stenosis, how is the carotid upstroke described?
What is a paradoxical pulse?
What is a paradoxical pulse?
What do alternately loud and soft Korotkoff sounds signal?
What do alternately loud and soft Korotkoff sounds signal?
What is the highest systolic pressure during the respiratory cycle known as?
What is the highest systolic pressure during the respiratory cycle known as?
What does a difference of ≥10 mm Hg to 12 mm Hg in systolic pressure indicate?
What does a difference of ≥10 mm Hg to 12 mm Hg in systolic pressure indicate?
Where are thrills in aortic stenosis transmitted to?
Where are thrills in aortic stenosis transmitted to?
What usually causes bruits?
What usually causes bruits?
How common is asymptomatic carotid stenosis in the United States?
How common is asymptomatic carotid stenosis in the United States?
How does Mitral Stenosis present on auscultation?
How does Mitral Stenosis present on auscultation?
What does Aortic Regurgitation present as on auscultation?
What does Aortic Regurgitation present as on auscultation?
S1 is diminished in __________.
S1 is diminished in __________.
S2 is diminished in __________.
S2 is diminished in __________.
What does the presence of a thrill indicate?
What does the presence of a thrill indicate?
What is important to keep in mind when palpating impulses from the RV?
What is important to keep in mind when palpating impulses from the RV?
In dextrocardia, where is the heart situated?
In dextrocardia, where is the heart situated?
In full situs inversus, where are the major organs located?
In full situs inversus, where are the major organs located?
What percentage of adults can palpate the apex beat in the supine position?
What percentage of adults can palpate the apex beat in the supine position?
What may pregnancy or a high left diaphragm cause regarding apical impulse?
What may pregnancy or a high left diaphragm cause regarding apical impulse?
What conditions may lead to lateral displacement of the apical impulse?
What conditions may lead to lateral displacement of the apical impulse?
What does lateral displacement from the midclavicular line suggest?
What does lateral displacement from the midclavicular line suggest?
In the left lateral decubitus position, a diffuse PMI with a diameter >3 cm suggests?
In the left lateral decubitus position, a diffuse PMI with a diameter >3 cm suggests?
What might a hyperkinetic high-amplitude impulse signify?
What might a hyperkinetic high-amplitude impulse signify?
What does a diffuse sustained low-amplitude (hypokinetic) apical impulse indicate?
What does a diffuse sustained low-amplitude (hypokinetic) apical impulse indicate?
What does a brief early to mid-diastolic apical impulse represent?
What does a brief early to mid-diastolic apical impulse represent?
What does a sustained left parasternal movement beginning at S1 suggest?
What does a sustained left parasternal movement beginning at S1 suggest?
What may hyperinflation of the lungs prevent during examination?
What may hyperinflation of the lungs prevent during examination?
What does a prominent pulsation in the Pulmonic Area indicate?
What does a prominent pulsation in the Pulmonic Area indicate?
What may a pulsation in the Aortic Area suggest?
What may a pulsation in the Aortic Area suggest?
What characterizes a markedly dilated failing heart?
What characterizes a markedly dilated failing heart?
What position accentuates left-sided S3 and S4 heart sounds?
What position accentuates left-sided S3 and S4 heart sounds?
How can the soft diastolic decrescendo murmur of aortic regurgitation be best heard?
How can the soft diastolic decrescendo murmur of aortic regurgitation be best heard?
What happens to S2 when either A2 or P2 is absent?
What happens to S2 when either A2 or P2 is absent?
What does expiratory splitting of S2 suggest?
What does expiratory splitting of S2 suggest?
What causes persistent splitting of S2?
What causes persistent splitting of S2?
What does a loud P2 indicate?
What does a loud P2 indicate?
What is the most common extra heart sound?
What is the most common extra heart sound?
What do diastolic murmurs usually represent?
What do diastolic murmurs usually represent?
What do systolic murmurs suggest?
What do systolic murmurs suggest?
What should murmurs during pregnancy be evaluated for?
What should murmurs during pregnancy be evaluated for?
From where do midsystolic murmurs typically arise?
From where do midsystolic murmurs typically arise?
Study Notes
Point of Maximal Impulse (PMI)
- The PMI marks the cardiac apex, usually in the 5th intercostal space near the left midclavicular line.
- Displacement of PMI lateral to the midclavicular line indicates left ventricular hypertrophy (LVH) or myocardial dilatation.
- PMI size over 2.5 cm suggests LVH due to hypertension or aortic stenosis.
- Aortal conditions like situs inversus and dextrocardia can shift PMI to the right side.
Heart Sounds and Impacts
- Diastolic sounds S3 and S4 are often pathologic in adults over 40, linking to heart failure and myocardial ischemia.
- S3 indicates rapid filling of the left ventricle, while S4 occurs with stiff ventricle conditions.
- S1 and S2 are heart sounds marking valve closures; S1 occurs during ventricular contraction, whereas S2 marks relaxation.
Heart Failure Classifications
- Heart failure is categorized into preserved and reduced ejection fraction, impacting treatment approaches.
Myocardial Ischemia and Symptoms
- Classic acute myocardial infarction (MI) symptoms include exertional chest pain and discomfort, with atypical symptoms more common in older women.
- Acute coronary syndrome encompasses unstable angina and both ST-elevation and non-ST elevation MI.
Palpitation Indicators
- Signs of irregular heartbeats necessitate ECG to assess conditions like atrial fibrillation.
- Palpitation clues include skips, sudden onset of rapid beating, and regular rapid rates suggestive of heart dysfunction.
Jugular Venous Pulsations
- Prominent JVP a waves indicate increased resistance seen in conditions like tricuspid stenosis and severe AV block.
- Absent a waves signal atrial fibrillation, while increased v waves indicate tricuspid regurgitation or atrial septal defects.
Carotid Pulse Assessment
- Carotid pulse evaluation includes inspection of pulsations and palpation for thrills or bruits, essential for assessing cardiac function.
- Decreased carotid pulsations suggest diminished stroke volume due to shock or arterial occlusion.
- A bounding carotid pulse signals aortic regurgitation, while a delayed upstroke indicates aortic stenosis.
Various Murmurs and Their Significations
- Diastolic murmurs often signify valvular heart disease, while systolic murmurs can be physiological or suggest cardiopathies.
- Pansystolic murmurs are typical of regurgitant flow across AV valves, like in mitral regurgitation, while late systolic murmurs indicate mitral valve prolapse.
Auscultation Techniques
- Certain positions can accentuate heart sounds and murmurs: left lateral decubitus for left-sided S3 and S4, and sitting forward for aortic regurgitation detection.
- Notably, the second heart sound (S2) may be persistently single in serious valve diseases, indicating potential pathologies.
Importance of Blood Pressure Measurement
- Korotkoff sounds during blood pressure assessment provide insight into cardiac health; discrepancies can indicate underlying issues.
- A paradoxical pulse (10-12 mm Hg difference) signals potential cardiac tamponade or severe pulmonary conditions.
Additional Cardiac Conditions
- Bruxism and murmurs from conditions like patent ductus arteriosus exhibit continuous sounds, requiring careful evaluation in various patient populations.
- Thickening of the chest wall can obscure heart sounds, emphasizing the importance of proper patient positioning during assessments.
General Observations
- Various respiratory and positional changes can impact heart dynamics, indicating the importance of comprehensive evaluations for accurate diagnostics.
- Age and gender differences in symptom presentation necessitate tailored approaches in diagnosing and managing cardiac conditions.
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Description
This quiz covers essential concepts in cardiology, including the Point of Maximal Impulse (PMI), heart sounds, and classifications of heart failure. Understand the significance of PMI's location, the implications of heart sounds in adults, and the treatment considerations for different types of heart failure. Test your knowledge on myocardial ischemia and its symptoms.
