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Details Title: Cardiology 1 Description: *Cardio I Examing The Heart Total Flash Cards: 137 Created: 07/11/2005 23:24:30	To study from this set of flash cards, or to create your own your own study flash cards, register HERE. If you are already a registered user, CLICK HERE.
Cards Term Paradoxical Splitting of S2: Which Murmurs are Known to have Paradoxical Splitting of S2? Definition HOCM, L BBB, R. VENT. PACING, AS, PS (Remember: "HL RAP") Term Pulse Waves: Large Left a-waves Attenuated y-decent Definition Mitral Stenosis Term Pulse Waves: Large Right v-waves Definition "TR" Tricuspid Regurgitation Term Pulse Waves: Large Right Jugular a-waves Definition Pulmonary Stenosis PS Term Pulse Waves: Pulses Thready Definition Acute Aortic Regurgitation "AAR" Term Pulse Waves: Corigan Pulse or Waterhammer Pulse Definition Chronic Aortic Regurgitation "CAR" Term Pulse Waves: Slowed Carotid Upstroke Definition Aortic Stenosis "AS" Term Pulse Waves: Brisk Caroid Upstroke 2/3 are Bifid Definition H.O.C.M. "(HCM/HOCM)" Term Pulse Waves: Large Left v-waves Definition Acute Mitral Regurgitation "AMR" Term Murmurs and Clicks: List All the Murmurs with Clicks Definition AS/PS = ejection click.... MVP/CAR= Mid Systolic Click.... Mitral Stenosis = Only Diastolic Click..... (MVP= Mitral Valve Prolapse).. (CAR= Chronic Aortic Regurg).. SEM= Systolic Ejection Murmur Term Murmurs and Clicks: MSC->SEM Definition MVP Mitral Valve Prolapse Term Murmurs and Clicks: MSC->Late SEM Definition CAR Chronic Aortic Regurgitation Term Murmurs and Clicks: Only diastolic click Opening Snap Definition MS Mitral Stenosis Term When Do MVP patients need antibiotic prophylaxis? Definition Only when associated with a murmur or myxomatous leaflets. Term Name two murmurs associated with clicks. "Click Murmur Syndrome" Definition MVP and Chronic AR (CAR) Term How do you tell the difference between an ejection click (seen with AS/PS) and a mid-systolic click (msc)? (seen with MVP/CAR) Definition EJECTION clicks are fixed and do not vary with the position of the patient. A MID-SYSTOLIC Click will vary all over systole with the change in the patients position. Term When does a Mid-Systolic Click and an Ejection click sound the same? Definition When Standing. In the Supine position a mid-systolic click (msc) will occur later in systole. Term There is only one DIASTOLIC CLICK what is the murmur associated with it? Definition Mitral Stenosis (the opening snap) Term What is the most common valve problem seen in the office? Definition MVP (Remember MVP has a systolic click) Term Which MVP patients have an increased risk of infective endocarditis and sudden death? Definition The same ones that need antibiotic prophylaxis. Only with associated murmur or myxomatous leaflets. Term List some Cardiac causes for Cerebral Embolic Events: Definition 45%= A-Fib... 15%= MI... 10% =Vent. Aneurysm... 10% =Mechanical Valves... 10% =Valvular Heart Disease... Other = Patent Foramen Ovale...Dilated Cardiomyopathy which leads to Thrombus. Term When do you anticoaulate patients with Heparin/Coumadin? Definition MI...Cardiomyopathy...Mechanical Valve...Rheumatic Valve Disease Term What is the #1 cause of Acute Mitral Regurge? ("AMR") Definition Endocarditis Term Beside Endocarditis list two other causes of AMR...Acute Mitral Regurge... Definition Papillary Muscle Rupture secondary to MI...and Ischemia of the Tip of the Papillary Muscle which can induce the chordae tendineae to pull free causing an Acute Mitral Regurg simulating a Ruptured chordae tendineae. Term Word Association:...Diastolic Rumble... Definition Mitral Stenosis Term Word Association:...SHORT Diastolic Rumble... Definition Acute Aortic Regurgitation Term Word Association:...Ejection Click with no specific murmur... Definition Pulmonary Stenosis Term Word Association:...LLSB/Systolic Definition Tricuspd Regurgitation (TR) Term Word Assoociation:...LSB/Diastolic Definition Tricuspid Stenosis (TS) Term Where is S1 best heard? Definition Loudest over the APEX and LLSB Term When is S1 INcreased? Definition Mitral Stenosis with Pliable Leaflets...with INcreased Diastolic Flow Rate. Term When is S1 DEcreased? Definition Acute Aortic Regurgitation...with a LONG PR interval. Term What do you call the sound made when the Mitral and Tricuspid valves close? Definition S1 Term What do you call the sound made when the Aortic and Pulmonary valves close? Definition S2 Term Where is S2 the loudest? Definition Base and LUSB Term When S2 is heard in the APEX...what does this indicate? Definition ASD or Pulmonary HTN. Term When is S2 increased...with Inspiration or Expiration? Definition S2 increases with inspiration.....decreases with expiration. Term What is another term for "Ventricular Galop"? Definition S3 Term HOW is S3 Best Heard? Definition Aply the BELL lightly to the Apex (LVS3) and the LLSB (RVS3) Term Is S3 Hight or Low Frequency? Definition LOW (This is the reason for using the BELL) Term What is another name for "Atrial Galop"? Definition S4 Term Forceful Atrial Contractions will cause this sound... Definition S4 Term List murmurs associated with a S3... Definition MR...VSD...AR...HOCM...Restrictive Cardiomyopathy...Constrictive Pericarditis Term List Murmurs associated with a S4... Definition AS...HOCM...AR-acute...Dilated Cardiomyopathy...LVH Term Is a Diastolic Murmur ever Normal? Definition NO! A systolic Murmur may be innocent however a Diastolic Murmur is always guilty!! Term Word Association...DE-crescendo LOW pitched RUMBLE Definition Mitral Stenosis Term What is "Lutembacher"s syndrome? Definition Mitral Stenosis (usually rheumatic) associated with:....Atrial Septal Defect. Term Word Association...Right Ventricular Heave Definition Pulmonic Regurgitation Term This murmur will radiate to the Axilla if a central jet is present.... Definition Mitral Reguritation (MR) Term Word Association...Late Systolic Parasternal Lift on Palpation...Which Murmur is this? Definition Mitral Reguritation Term Palpable Thrill...think of Definition VSD Term Left Second ICS think of... Definition Pulmonic Vavle Term How do you describe the "Innocent Murmur"? Definition Soft...Crescendo-Decrescendo...best heart at the BASE...MID-Systolic...NO radiation...NO maneuvers...NO associated findings! Term This Murmur is loudest at the BASE...Radiates to the Carotids...Decreased with Hand Grip...Increased with Standing...Late Peaking Definition The pulse is probably Bi-Fid also and this is HOCM. Term This Murmur is loudest at the LEFT Sternal Border...Radiates to the Lower RIGHT Sternal border...Increases with Inspiration...Prominent V-wave in neck. Definition Tricuspid Reguritation Term What type of splitting of S2 usually occurs with a pulmonary embolus? Definition Fixed S2 splitting. Term Pulsus Bisferiens is seen with... Definition AR and HOCM. ...Bifid pulse with two aortic peaks. Term What is Pulsus Alternans and what is it associated with? Definition Bigeminal premature ventriculr contractions (PVC's)...and severe LV dysfunction.... Alternately Strong and Weak Pulses @ Regular Intervals. Sometime detected in the Brachial Radial Pulses by deflating the BP cuff where the Pulse Sounds double with the cuff release. Term What is a Dicrotic Pulse? Definition An exaggerated Dicrotic Wave following the Dicrotic Notch...caused by the Aortic Valve Closure...Associated with LOW Cardiac Output...Low Peripheral Resistance....Seen in Heart Failure and Hypo volemic shock. Term What is a normal RA pressure? Definition <5 Term What is a normal PA pressure Definition 20/10 Term What is a normal PCWP? Definition around 5-9 but <12 Term When do you see Large a-Waves? Definition MS...PS...TS...Severe noncompliant RVH Term What produces a rapid X and Y decent? Definition Constrictive Pericarditis Term What produces a rapid X decent? Definition Tamponade Term Large a and v wave with R heart failure... Definition Pulmonary HTN ...(from any cause of chronic RHF) Term Large v-waves, with + Kussmaul's sign... Definition RV Infarction Term Large V waves, (No Kussmaul's sign)... Definition Tricuspid Regurgitation Term Large a waves, slow y descent, but POSITIONAL and may have a "plop" sund with change in position.... Definition Right Atrial Myxoma Term Rapid X Descent, Pulsus Paradoxus... Definition Tamponade Term Rapid X and Y Descents, Kussmaul's sign, may have a diastolic knock.... Definition Constrictive Pericarditis Term Rapid X and Y descents, Kussmaul's sign, but NO KNOCK and other manifestations of a Pirmary Illness.... Definition Restrictive Cardiomyopathy Term Large, possibly unilaterally, nonpulsatile, neck veins: may have facial edema and cyanosis... Definition Superior Vena Cava Syndrome Term Large Nonpulsatile neck veins, severe dyspnea and chest pain, unilateral lack of breath sounds. Definition Tension Pneumothorax Term Irregular cannon a waves Definition AV dissociation Term Knock, Knock, Knock (Diastolic)...who is there? Definition Constrictive Pericarditis Term What is this:...a patient with an EJECTION CLICK and a PROMINENT A WAVE, which is caused by backflow during atrial contraction against an inadequately emptied right ventricle. Definition Pulmonic Stenosis...is virtually always congenital, and it typically does NOT progress. Term Pulmonic regurgitation is usually secondary to what? Definition PR is usually 2ndary to Pulmonary HTN (primary, cor pulmonale, MS, etc.) but it may be a primary vave lesion (congenital, rheumatic heart disease, endocarditis, carcinoid). Pulmonary artery pressure is > 60 mmHg in pts with secondary pulmonic regurgitation. Term Describe the Ebstein anomaly: Definition the Tricuspid septal leaflet is REDUNDANT and positioned LOWER in the ventricle than normal...so the RA appears HUGE and the RV small. Tricuspid regurg (TR) murmur is common. It is occasionally associated with both PSVT and WPW syndrome. Term the Tricuspid septal leaflet is redundant and positioned lower in the ventricle than normal.. Definition Ebstein Anomaly Term This is occasionally associated with both PSVT ans WPW syndrome... Definition Ebstein Anomaly Term When is valve surgery indicated for any valve problem...? Definition If symptomatic at rest! Term What is the procedure of choice in pulmonic valve stenosis? Definition Balloon valvuoplasty. Term Balloon valvuloplast is the procedure of choice for what? Definition Pulmonic valve stenosis but it is used on Mitral and infrequently on Aortic valves also. Term Is there arterial embolization associated with Balloon valvuloplasty? Definition NO Term Which is generally better?... Valve Replacement or Valve repair? Definition Valve Repair Term What is the best surgical treatment for Mitral Regurgitation (MR)? Definition Valve Reconstruction when ever possible because it has 1/2 the surgical risk of MV prosthesis. Reconstruction is valve repair and or annuloplasty with an annuloplasty ring, and is especially likely to be done with MVP due to rheumatic fever. Term Bigimini & Severe LV dysfuction you see this pulse pattern in.... Definition Pulses Alternans Term What is the difference between a Dicrotic pulse and Bisferiens pulse? Definition Dicrotic pulse (which is a pulse with exaggerated dicrotic wave) literally means twice beating pulse, like bisferiens pulse. However, the dicrotic pulse has the second pulse during diastole, while the bisferiens pulse has the second pulse during systole. Term What is a Dicrotic Pulse? Definition A pulse appearing in the blood pressure wave during the diastolic phase. Term Where is S2 loudest in Pulmonary HTN and ASD? Definition The APEX Term Where is S2 normally Loudest? Definition LUSB & Base Term Is LLSB associated with S1 or S2? Definition S1 Term Is LUSB associated with S1 ot S2? Definition S2 (Remember 2 is a higher number and S2 is upper sternal boarder left side)...However S2 is also more "basic" ie heard at the BASE and LUSB. Term Which is normally heard in the APEX...S1 or S2? Definition S1 (APEX & LLSB) Term List 4 possible causes of HoloSystolic (Pansystolic) Murmurs: Definition Holosystolic murmurs accompany (1) mitral or (2) Tricuspid REGURGITATION; (3)VSD; ..(4) and under certain circomstances aortopulmonary shunts. .....MR,TR,VSD,AP shunts Term What will increase the holosystolic murmurs of MR & VSD? Definition Exercise Term What will increase the Holosystolic murmur of Tricuspid Regurgitation (TR) associated with Pulmonary HTN? Definition The murmur of TR with Pulm HTN is increased with INspiration and is holosystolic. Term What percentage of Normal Patients with NO clinical heart disease have valvular regurgitation on echo? Definition 88% = Pulmonic...70% = Tricuspid and 45% Mitral. Aortic regurgitation is encountered much less frequently in normal persons, and its incidence increases with advancing age. Overinterpretation of the signifcance of mild regurgitation by echocardiographers is called "echocardiographic heart disease" (Harrisons) Term Holosystolic Murmurs: Definition MR..TR..AP-shunts..VSD Term What is another name for Mid-systolic Murmur? Definition Systolic Ejection Murmur is another name for midsystolic murmur. Systolic Ejection Murmurs are MIDsystolic. Term Name the "prototype" for the left-sided midsystolic murmur.... Definition Aortic Stenosis Term Where is the murmur of Valvular Aortic Stenosis usually loudest? Definition 2nd RIGHT ICS Term Where is the Mumur of SupraValvular Aortic Stenosis loudest? Definition 2nd Right ICS or even higher, with disproportionate radiation into the right carotid artery. Term Where is the murmur of HOCM usually loudest? Definition This midsystolic murmur originates in the left ventricular cavity and is usually maximal at the lower left sternal edge and apex. (LLSB & Apex) Term When is MR or less frequently TR heard as an ejection murmur (ie. Midsystolic)and not Holosystolic? Definition With papillary muscle dysfunction. Such murmurs due to papillary muscle dysfunction with mitral regurgitation are often confused with those originating in the aorta, particularly in elderly patients. Term When observing the jugular venous pulse...whic vein is ordinarily examined? Definition Internal Jugular Vein Term When observing the Jugular Venous Pulse which side (Left or Right) is used and why? Definition Right....the right innominate and jugular veins extend in an almost straight line cephalad to the superior vena cava, thus favoring transmission of hemodynamic changes from the right atrium, whereas the left innominate vein is not in a straight line and may be kinked or compressed by a variety of normal structures, by a dilated aorta, or by an aneurysm. Term At what angle should the patients position be to examine the JV pulse? Definition 45 degrees. However 60 - 90 degrees are required to see pulsations when the patients has high venous pressure. If the venous pressure is high place the patient higher...if the venous pressure is low place the patient lower. Term What muscle crosses the internal jugular vein? Definition Sternocleidomastoid muscle Term What are the visible difference between the Carotid arterial pulse and the Jugular venous pulse in the neck? Definition The arterial (Carotid) pulse has a single upstroke....The Venous (Jugular) has TWO PEAKS and TWO TROUGHS per cardiac cycle....The Carotid pulse does not change with the patient position....Compression of the root of the neck stops the Jugular but not the Carotid pulse....The Jugular usually disappears with a palpating finger. Term In the Jugular Venous Pulse what causes the A wave? Definition Right Atrial Systole Term In the Jugular Venous Pulse what causes the X wave? Definition Atrial Relaxation Term In the Jugular Venous Pulse what causes the C wave? Definition Is from the Carotid Arterial Pulse Term What wave is between the X and X' descent? Definition The C wave:... which occurs simultaneously with the carotid arterial pulse, is an inconstant wave in the jugular venous pulse and/or interruption of the X descent after the peak of the A wave. The continuation of the X descent after the C wave is referred to as the X' descent. Term In the Jugular Venous Pulse what causes the V wave? Definition The Tricuspid valve is CLOSED and the ventricle is contracting!...this increases the right atrial pressure and causes the V-wave. Term In the Jugular Venous Pulse what causes the Y descent? Definition The tricuspid valve reopens...This is the downslope of the V-wave. ...Caused by the decline in right atrial pressure when the tricuspid valve reopens. Term In the Jugular Venous Pulse what causes the Y TROUGH? (This is after the Y descent) Definition This is a period of relatively slow filling of the atrium or ventricle, "the diastasis period", a wave termed the H wave. Term In the Jugular Venous Pulse during Inspiration, what happens to the jugular venous pressure and the amplitude of the pulsations? Definition The pressure goes down but the amplitude of the pulsations go up! If the pressure goes up the you have Kussmaul sign!! (paradoxical rise in the height of the jugular venous pressure during inspiration. Term What do you call the waves created when the right atrium contracts against a closed tricuspid valve? Definition Cannon (amplified) A waves....caused by AV dissociation. Term Re: the Jugular Venous Pulse what causes the A wave and X descent to disappear? (they really should not do this!) Definition Atrial Fibrillation Term In the Jugular Venous Pulse what will cause Tall A waves? (Pt. with Sinus Rhythm) Definition Tricuspid Stenosis or Atresia....Right Atrial Myxoma....Reduced compliance / hypertrophy of the right ventricle...Pulmonary HTN.... (TS..TA..RVH..Pulm. HTN..)... any condition in which the resistance to right atrial contraction is increased. Term What does this describe?...a rapid and deep Y descent followed by a rapid rise to a diastolic plateau (H wave) without a prominent A wave...the X descent may or may not be prominent.>>>>> Definition Constrictive pericarditis... Term Which has the most prominent X descent...Constrictive pericarditis or Tamponade? Definition Tamponade. Term What causes systolic movements of the earlobes...a prominent V wave or C-V wave (fusion of the C and V waves in the absence or attenuation of an X descent)? Definition Tricuspid regurgitation (TR) Term What causes a steep Y descent (Jugular Venous Pulse)? Definition Ventricular Dilation, Elevated CVP, or any condition in which there is myocardial dysfunction. Term The venous pulse contour in this heart problem often takes on an M or W configuration? What is it>>>>> Definition Constrictive Pericarditis Term murmur of the 2nd R. IC space radiates to the carotid arteries... Definition Aortic Stenosis Term murmur loudest in the APEX...radiates to the LEFT STERNAL BORDER and base of the heart... Definition (MR)..Mitral Regurg...if it radiates to the base of the heart then the posterior mitral leaflet is predominantly involved. Term the RA appears HUGE and the RV small Definition Ebstein anomaly Term a rapid and deep Y descent followed by a rapid rise to a diastolic plateau Definition Constrictive pericarditis Term occurs simultaneously with the carotid arterial pulse, is an inconstant wave in the jugular venous pulse and/or interruption of the X descent after the peak of the A wave Definition The C wave Term Beginning of Isovolumic Contraction...Best seen in AV Block and LBBB...simultaneously with Tricuspid Valve Closure 2ndary to RV contraction.... Definition The C wave Term Atrial Diastole... Definition X decent Term X' descent... Definition Right Ventricular Contraction Term During Systole the Tricuspid Valve is Closed and there is Atrial Filling from the Vena Cava which causes the Atrial Pressure to Rise and generates this wave...Name this wave... Definition V wave Term Ventricular systole ends and the ventricle expands generating this wave...Name this wave... Definition Y descent