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Questions and Answers
What valves are open during systole?
What valves are open during systole?
What is the primary cause of the S1 heart sound?
What is the primary cause of the S1 heart sound?
During which phase of the cardiac cycle do the ventricles fill?
During which phase of the cardiac cycle do the ventricles fill?
What condition occurs when a valve that should be closed is open during the cardiac cycle?
What condition occurs when a valve that should be closed is open during the cardiac cycle?
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Which of the following is a consequence of valve stenosis?
Which of the following is a consequence of valve stenosis?
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During which heart sound are the aortic and pulmonic valves closing?
During which heart sound are the aortic and pulmonic valves closing?
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What is typically a cause of diastolic murmurs?
What is typically a cause of diastolic murmurs?
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How are normal heart sounds typically recognized during auscultation?
How are normal heart sounds typically recognized during auscultation?
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What is the characteristic sound pattern associated with aortic stenosis?
What is the characteristic sound pattern associated with aortic stenosis?
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Which clinical signs may indicate severe aortic stenosis?
Which clinical signs may indicate severe aortic stenosis?
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How does increasing preload affect the intensity of the murmur in aortic stenosis?
How does increasing preload affect the intensity of the murmur in aortic stenosis?
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Which of the following is a common cause of aortic stenosis in older patients?
Which of the following is a common cause of aortic stenosis in older patients?
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What does the term 'pulsus parvus et tardus' refer to in the context of aortic stenosis?
What does the term 'pulsus parvus et tardus' refer to in the context of aortic stenosis?
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Which of the following best describes the effect of increased afterload on the intensity of aortic stenosis murmur?
Which of the following best describes the effect of increased afterload on the intensity of aortic stenosis murmur?
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What is a potential consequence of severe cases of aortic stenosis?
What is a potential consequence of severe cases of aortic stenosis?
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Which demographic is likely to develop aortic stenosis due to a congenitally bicuspid aortic valve?
Which demographic is likely to develop aortic stenosis due to a congenitally bicuspid aortic valve?
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What is a common cause of tricuspid regurgitation?
What is a common cause of tricuspid regurgitation?
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Which statement correctly describes the clinical presentation of aortic regurgitation?
Which statement correctly describes the clinical presentation of aortic regurgitation?
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Which condition is NOT a cause of secondary tricuspid regurgitation?
Which condition is NOT a cause of secondary tricuspid regurgitation?
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What specific heart sound or pulse is associated with aortic regurgitation?
What specific heart sound or pulse is associated with aortic regurgitation?
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Which of the following conditions can lead to aortic regurgitation?
Which of the following conditions can lead to aortic regurgitation?
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What does 'atrialization of the right ventricle' refer to?
What does 'atrialization of the right ventricle' refer to?
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Which of the following is a characteristic change in aortic regurgitation when preload is increased?
Which of the following is a characteristic change in aortic regurgitation when preload is increased?
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Which characteristic is indicative of a hyperdynamic circulatory state in aortic regurgitation?
Which characteristic is indicative of a hyperdynamic circulatory state in aortic regurgitation?
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What is the primary cause of the midsystolic click heard in mitral valve prolapse?
What is the primary cause of the midsystolic click heard in mitral valve prolapse?
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Which of the following best describes the sound of the murmur associated with mitral valve prolapse?
Which of the following best describes the sound of the murmur associated with mitral valve prolapse?
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What effect does decreased preload have on the murmur of mitral valve prolapse?
What effect does decreased preload have on the murmur of mitral valve prolapse?
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Which connective tissue disorder is implicated in causing mitral valve prolapse?
Which connective tissue disorder is implicated in causing mitral valve prolapse?
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Where is the blowing holosystolic murmur associated with tricuspid regurgitation best heard?
Where is the blowing holosystolic murmur associated with tricuspid regurgitation best heard?
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What effect does inspiration have on the intensity of the tricuspid regurgitation murmur?
What effect does inspiration have on the intensity of the tricuspid regurgitation murmur?
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Which change in preload leads to a less intense murmur and an earlier midsystolic click in mitral valve prolapse?
Which change in preload leads to a less intense murmur and an earlier midsystolic click in mitral valve prolapse?
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Mitral valve prolapse can lead to which of the following complications?
Mitral valve prolapse can lead to which of the following complications?
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What occurs at the beginning of diastole?
What occurs at the beginning of diastole?
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Where is the aortic area located for auscultation?
Where is the aortic area located for auscultation?
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What is the main cause of heart murmurs?
What is the main cause of heart murmurs?
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What is the significance of the Angle of Louis?
What is the significance of the Angle of Louis?
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When does the physiologic splitting of S2 occur?
When does the physiologic splitting of S2 occur?
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What does regurgitation refer to in heart valves?
What does regurgitation refer to in heart valves?
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Which heart sound is typically louder at the apex?
Which heart sound is typically louder at the apex?
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What can lead to pathological splitting of S2?
What can lead to pathological splitting of S2?
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Study Notes
Normal Cardiac Cycle
- Systole (LUB) occurs when the ventricles contract, aortic and pulmonic valves open, and tricuspid and mitral valves close.
- Diastole (DUB) occurs when the atria contract, ventricles fill, tricuspid and mitral valves open, and aortic and pulmonic valves close.
Anatomy of the Heart
- Angle of Louis = Rib 2
- Auscultation points:
- Aortic Area: 2nd ICS at right sternal border
- Pulmonic Area: 2nd ICS at left sternal border
- Tricuspid Area: 4th ICS at left sternal border
- Mitral Area: 5th ICS at midclavicular line
Normal Heart Sounds
- S1: occurs at the beginning of systole and is caused by the closure of the atrioventricular valves.
- S1 is louder at the apex.
- S2: occurs at the beginning of diastole and is caused by the closure of the semilunar valves.
- S2 is louder at the base.
Physiologic Splitting of S2
- S2 physiologically splits with inspiration.
- Decreased intrathoracic pressure increases venous return, increasing blood volume in the right ventricle and causing the pulmonic valve to stay open longer.
- A2 is heard before P2.
- Best heard in the pulmonic area.
- Pathologic splitting can be wide, fixed, or paradoxical.
Pathological Splitting of S2
- Normally, P2 closes slightly after A2 during inspiration.
- Various pathological processes can affect the timing or sequence of valve closure.
Heart Murmurs
- Audible vibrations caused by increased turbulence of blood flow in the heart.
- Caused by valvular disease:
- Regurgitation: failure of a valve to close completely, allowing backflow of blood.
- Stenosis: failure of a valve to open completely, obstructing forward flow.
Systolic Murmurs
Aortic stenosis
-
Clinical presentation:
- Crescendo-decrescendo systolic murmur best heard at the right 2nd ICS near the sternal border that radiates to the carotids.
- Intensity increases with increased preload.
- Intensity decreases with increased afterload or decreased preload.
- Severe cases can develop paradoxical splitting of S2.
- Syncope, angina, and dyspnea on exertion (“SAD”).
- "Pulsus parvus et tardus": weak and slow pulse
-
Causes:
- Calcified valve:
- Age-related degeneration in older patients.
- Congenital bicuspid aortic valve in younger patients.
- Calcified valve:
Mitral Valve Prolapse
-
Pathophysiology: weakening of valve leaflets and chordae tendinae causing ballooning of valve leaflets into the left atrium during systole.
-
Clinical presentation:
- Late systolic crescendo murmur with midsystolic click (MC) best heard at the apex.
- MC is caused by sudden tension on chordae tendineae.
- Crescendo = regurgitant murmur.
- Intensity increases and MC is delayed with decreased preload.
- Intensity decreases and MC is earlier with increased preload.
-
Causes:
- Myxomatous degeneration:
- Increased deposition of mucopolysaccharides in the spongiosa layer of the valve.
- Connective tissue disorders such as Marfan syndrome (AD defective in fibrillin which crosslinks elastin).
- Myxomatous degeneration:
-
Can lead to mitral regurgitation.
Tricuspid Regurgitation
-
Clinical presentation:
- Blowing holosystolic murmur best heard at the left lower sternal border.
- Intensity increases with inspiration.
-
Causes:
- Pulmonary hypertension.
- Ebstein's anomaly:
- Downward displacement of the tricuspid valve into the RV, resulting in “atrialization of the RV”.
- Lithium exposure in utero.
- Infective endocarditis:
- IV drug user (don't "tri" drugs).
- Acute, often caused by Staphylococcus aureus.
Diastolic Murmurs
Aortic Regurgitation
-
Clinical presentation:
- Blowing early decrescendo diastolic murmur best heard at the left midsternal border that radiates to the apex.
- Intensity increases with increased afterload and increased preload.
- Intensity decreases with decreased preload.
- Widened pulse pressure, head bobbing, bounding pulse (water hammer pulse).
- Hyperdynamic circulatory state.
-
Causes:
- Congenital bicuspid aortic valve.
- Endocarditis.
- Aortic root dilation:
- Aneurysm = dilation of vessel greater than 50% normal
- Hypertension
- Connective tissue diseases
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Description
Explore the intricacies of the normal cardiac cycle, including the phases of systole and diastole. This quiz also covers the basic anatomy of the heart, heart sounds, and the significance of auscultation points. Test your understanding of cardiac physiology and anatomy.
