Normal Cardiac Cycle and Anatomy of the Heart
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Normal Cardiac Cycle and Anatomy of the Heart

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Questions and Answers

What valves are open during systole?

  • Mitral and tricuspid
  • Tricuspid and pulmonary
  • Mitral and aortic
  • Aortic and pulmonary (correct)

    • What is the primary cause of the S1 heart sound?

  • Opening of the mitral and tricuspid valves
  • Closing of the aortic and pulmonic valves
  • Closing of the mitral and tricuspid valves (correct)
  • Opening of the aortic and pulmonic valves

    • During which phase of the cardiac cycle do the ventricles fill?

  • Diastole (correct)
  • Isovolumetric contraction
  • Systole
  • Ejection phase

    • What condition occurs when a valve that should be closed is open during the cardiac cycle?

    <p>Regurgitation</p> Signup and view all the answers

    Which of the following is a consequence of valve stenosis?

    <p>Constriction of blood flow through the valve</p> Signup and view all the answers

    During which heart sound are the aortic and pulmonic valves closing?

    <p>S2</p> Signup and view all the answers

    What is typically a cause of diastolic murmurs?

    <p>Mitral stenosis</p> Signup and view all the answers

    How are normal heart sounds typically recognized during auscultation?

    <p>By listening for the sounds in specific areas of the chest</p> Signup and view all the answers

    What is the characteristic sound pattern associated with aortic stenosis?

    <p>Crescendo-decrescendo systolic murmur</p> Signup and view all the answers

    Which clinical signs may indicate severe aortic stenosis?

    <p>Syncope, angina, and dyspnea on exertion</p> Signup and view all the answers

    How does increasing preload affect the intensity of the murmur in aortic stenosis?

    <p>Increases intensity</p> Signup and view all the answers

    Which of the following is a common cause of aortic stenosis in older patients?

    <p>Calcified valve due to age-related degeneration</p> Signup and view all the answers

    What does the term 'pulsus parvus et tardus' refer to in the context of aortic stenosis?

    <p>Weak and delayed upstroke of the carotid pulse</p> Signup and view all the answers

    Which of the following best describes the effect of increased afterload on the intensity of aortic stenosis murmur?

    <p>Decreases murmur intensity</p> Signup and view all the answers

    What is a potential consequence of severe cases of aortic stenosis?

    <p>Paradoxical splitting of S2</p> Signup and view all the answers

    Which demographic is likely to develop aortic stenosis due to a congenitally bicuspid aortic valve?

    <p>Younger patients</p> Signup and view all the answers

    What is a common cause of tricuspid regurgitation?

    <p>Pulmonary hypertension</p> Signup and view all the answers

    Which statement correctly describes the clinical presentation of aortic regurgitation?

    <p>Blowing early decrescendo diastolic murmur</p> Signup and view all the answers

    Which condition is NOT a cause of secondary tricuspid regurgitation?

    <p>Hypertension</p> Signup and view all the answers

    What specific heart sound or pulse is associated with aortic regurgitation?

    <p>Water-hammer pulse</p> Signup and view all the answers

    Which of the following conditions can lead to aortic regurgitation?

    <p>Congenital bicuspid aortic valve</p> Signup and view all the answers

    What does 'atrialization of the right ventricle' refer to?

    <p>Downward displacement of the tricuspid valve</p> Signup and view all the answers

    Which of the following is a characteristic change in aortic regurgitation when preload is increased?

    <p>The intensity of the murmur increases</p> Signup and view all the answers

    Which characteristic is indicative of a hyperdynamic circulatory state in aortic regurgitation?

    <p>Bounding pulse</p> Signup and view all the answers

    What is the primary cause of the midsystolic click heard in mitral valve prolapse?

    <p>Sudden tension on the chordae tendineae</p> Signup and view all the answers

    Which of the following best describes the sound of the murmur associated with mitral valve prolapse?

    <p>A late systolic crescendo murmur</p> Signup and view all the answers

    What effect does decreased preload have on the murmur of mitral valve prolapse?

    <p>Increases murmur intensity and delays midsystolic click</p> Signup and view all the answers

    Which connective tissue disorder is implicated in causing mitral valve prolapse?

    <p>Marfan syndrome</p> Signup and view all the answers

    Where is the blowing holosystolic murmur associated with tricuspid regurgitation best heard?

    <p>At the left lower sternal border</p> Signup and view all the answers

    What effect does inspiration have on the intensity of the tricuspid regurgitation murmur?

    <p>Increases murmur intensity</p> Signup and view all the answers

    Which change in preload leads to a less intense murmur and an earlier midsystolic click in mitral valve prolapse?

    <p>Increased preload</p> Signup and view all the answers

    Mitral valve prolapse can lead to which of the following complications?

    <p>Mitral regurgitation</p> Signup and view all the answers

    What occurs at the beginning of diastole?

    <p>Closure of semilunar valves</p> Signup and view all the answers

    Where is the aortic area located for auscultation?

    <p>2nd ICS at right sternal border</p> Signup and view all the answers

    What is the main cause of heart murmurs?

    <p>Increased turbulence of blood flow</p> Signup and view all the answers

    What is the significance of the Angle of Louis?

    <p>It corresponds to Rib 2.</p> Signup and view all the answers

    When does the physiologic splitting of S2 occur?

    <p>During inspiration</p> Signup and view all the answers

    What does regurgitation refer to in heart valves?

    <p>Incomplete valve closure allowing backflow</p> Signup and view all the answers

    Which heart sound is typically louder at the apex?

    <p>S1</p> Signup and view all the answers

    What can lead to pathological splitting of S2?

    <p>Various pathological processes</p> Signup and view all the answers

    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.

    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).

    • 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.

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