Term
| how can you tell the difference the first and second heart sound? |
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Definition
| you have to palpate the carotid artery as you auscultate. if you hear the sound before you hear the upstroke, you are in diastole. if you hear the sound as or after you feel the upstroke, you are in systole. (you are listening to the heart, not the carotids) |
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Term
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Definition
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Term
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Definition
| the closure of the mitral and tricuspid valves. usually they are heard separately even though the mitral comes slightly before the tricuspid |
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Term
| how can you separate s1 from s4? how does the s4 present? |
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Definition
| increased handgrip will accentuate s4 (the atrial sound), which increases afterload by increasing systemic vascular resistance - which the heart compensates for by increasing volume (if you increase pressure, you have to increase volume to overcome it - which is accomplished with stronger atrial contraction). the accentuated s4 will either present on top of the s1, making it louder, or as a separate sound |
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Term
| what is normal heart atrial contribution to CO? how does it change in a stiff non-compliant heart? what sound correlates with this? |
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Definition
| normal heart atrial contribution to the total CO is 10-15%, but in a stiff, noncompliant heart, you need more contribution from the atrium to overcome the increase in pressure it has to pump against |
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Term
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Definition
| in the L lateral position w/the bell |
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Term
| how do you accentuate s1? |
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Definition
| inspiration, which increases volume faster - thus causing the sound of the mitral and tricuspid valves closing to be louder (does not affect s4) |
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Term
| how do you know you're at s2? what is s2? |
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Definition
| s2 is the sound of the blood flowing back into the ventricles after the aorta/pulmonary valves shut. you know you're at s2 when the pt inspires and the sounds are split (p2 moves away) and when the pt expires, a2 and p2 occur together as s2. |
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Term
| what is wide splitting (p2 moves farther than normal away from a2 w/inspiration) generally due to? |
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Definition
| aortic regurgitation and patent ductus arteriosis |
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Term
| what is paradoxical splitting of s2? |
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Definition
| when expiration is a2 and p2 apart, and inspiration a2 and p2 simultaneously |
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Term
| what is the difference between an MVP click and an ejection click? |
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Definition
| w/MVP, the click will move closer to s2 (from its normal mid-systolic position), but an ejection fraction click (tightening of chordae tendinae getting ready for isovolumetric contraction) will not move |
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Term
| how does s1 sound compared to s4? |
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Definition
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Term
| what does s3 sound like? is it a normal heart sound? |
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Definition
| s3 sounds like "tennessee" and is heard during diastolic filling of an (abnormally) larger ventricle (which at bedside would appear displaced downward and posteriorly) |
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Term
| how does s1 sound compared to s4? |
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Definition
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Term
| how does s1 sound compared to s4? |
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Definition
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Term
| why does an enlarged heart cause shortness of breath? |
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Definition
| b/c the enlarged heart will pump less blood (lower capacity), require more O2, and cause some pulmonary edema |
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Term
| what does s3 sound like? is it a normal heart sound? |
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Definition
| s3 sounds like "tennessee" and is heard during diastolic filling of an (abnormally) larger ventricle (which at bedside would appear displaced downward and posteriorly and hypokinetic under your hand) |
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Term
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Definition
| s3's are accentuated by hand grip, which increases systemic vascular resistance, increasing pressure - which requires an increase in volume, which prolongs the diastolic filling phase. |
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Term
| which ventricle does the R hand grip affect? |
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Definition
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Term
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Definition
| s3's are always pathological (indicates increased volume of blood within the ventricle), and can be associated with dilated hearts, severe ischemic heart disease, uncontrolled HTN, previous MIs, valvular heart disease of volume overload, congenital anomalies, and dilated cardiomyopathy of any etiology |
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Term
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Definition
| HTN, aortic stenosis, IHSS (idiopathic hypertrophic subaortic stenosis), ischemic heart disease, mitral stenosis, sinus rhythm and aging |
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Term
| what are associated symptoms with MVP? what causes it? when might it occur? |
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Definition
| atypical chest pain that gets better w/exertion, dyspnea, palpitations, hypoglycemia, panic attacks, joint pain, depression, and constipation. MVPs are due to a "lazy valve" and can occur after exams, death of a parent, or breakup w/a significant other |
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Term
| why does the MVP mid systolic click then murmur move towards s2 with inspiration? |
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Definition
| volume is increased with inspiration, and the pressure differential between the LA and LV ventricle is decreased - causing the prolapse to occur later, moving it closer to s2 in systole |
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Term
| what would move the MVP mid systolic click towards s1? |
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Definition
| exhalation, valsalva, or standing all which decrease volume and increase the pressure gradient between the atrium and the ventricle |
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Term
| what are things which increase volume? |
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Definition
| inspiration, squatting, leg raising (increases) |
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Term
| what are things that decrease volume? |
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Definition
| expiration, valsalva, and standing up |
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Term
| what are murmurs related to the R-side of the heart? |
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Definition
| pulmonic regurgitation, tricuspid regurgitation, tricuspid stenosis (always paired with mitral stenosis), pulmonic stenosis |
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Term
| what are the 5 incidences where early to mid murmurs are non benign? how do pts co-present with these? |
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Definition
| tricuspid regurgitation, pulmonic stenosis, atrialseptal defect, acute mitral regurgitation, and idiopathic hypertrophic subaortic stenosis. pts will co-present with SOB and/or chest discomfort |
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Term
| how do you dx acute mitral regurgitation? chronic? |
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Definition
| listen at the apex and do a L handgrip, b/c the anterior papillary muscle is usually the only one left functional and mitral regurgitation is a left sided murmur. chronic would be more holosystolic and radiate to the axilla, though it would still increase with the hand grip |
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Term
| on what side of the heart is pulmonic stenosis heard? what intercostal space will have a click upon auscultation w/this? |
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Definition
| the R side. the 2nd L intercostal space will have a click associated w/it that will get softer or disappear w/inspiration, BUT the murmur will get longer |
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Term
| what are symptoms of R sided heart failure? what murmurs would be associated with this? |
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Definition
| weakness, fatigue, decreased appetite, swollen belly/legs, icteric eyes. right sided heart murmurs such as pulmonic stenosis, tricuspid regurgitation would be associated |
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Term
| what is a common symptom of L sided heart failure? what pathologies are associated with this? |
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Definition
| dyspnea. HTN, ischemic heart disease, MI, chronic systolic dysfunction, cardiomyopathy |
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Term
| what sided murmur is aortic stenosis? when is it heard? where is it heard? where does it radiate? what will increase it? are both the aortic and pulmonic components heard? |
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Definition
| aortic stenosis is a L sided murmur that occurs mid - late systole. it is heard at the base of the heart (at s4) at the 2nd R intercostal space. it radiates to the carotids w/bilateral carotid bruits and increases with handgrip. you only heard the pulmonic component, b/c the aortic component is so scarred/calcified, that you don't hear it (A2 is singular) |
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Term
| what is unique about atrial septal defects? what would an EKG show? |
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Definition
| harsh sound, and s2 doesn't move w/inspiration or expiration (ventricular septal defects will get longer with handgrip). an EKG would show a RBBB |
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Term
| how does a ventricular septal defect respond to handgrip? inspiration? |
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Definition
| a handgrip increases the murmur (higher pressure on L side pushes the blood backwards = sound of the murmur), inspiration (higher volume, thus higher pressure on R side) decreases the murmur |
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Term
| what does the murmur associated with patent ductus arteriosus sound like? what is it caused by? where is it heard best? |
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Definition
| PDA - a "machine gun" sound due to communications between the aorta and pulmonary artery, it is heard best on/over/under the L clavicle. it starts in systole and ends in diastole (through s1,s2 - only murmur that does this) |
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Term
| what are clues that indicate a possible patent ductus arteriosus? |
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Definition
| wide pulse pressure, volume overloaded state, a big heart, s3, SOB |
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Term
| what will increase the murmur associated with patent ductus arteriosus? |
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Definition
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Term
| what would cause an aortic regurgitation murmur to be heard on the L 2 intercostal space? |
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Definition
| endocarditis, bicuspid aortic valve, lupus erythematosus, rheumatoid arthrtis, and rheumatic fever |
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Term
| what would cause an aortic regurgitation murmur to be heard on the R intercostal space? |
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Definition
| HTN, syphilis, ankylosing spondylitis, ehler-danlos syndrome, pompe's disease, hurler's disease, hunter's disease, G6PD deficiency, and IBS |
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Term
| what does every murmur get? |
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Definition
| a handgrip and inspiration |
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Term
| how can you tell the difference between an aortic regurgitation and a pulmonic regurgitation b/c both have a murmur at the 2nd intercostal space? |
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Definition
| an aortic regurgitation will have a wide splitting of the 2nd heart sound (p2 moves farther than normal away from a2 w/inspiration) and the LV may be displaced downward and to the L, & hypokinetic to palpation due to chronic volume overloaded state BUT a pulmonic regurgitation may have an RV lift while the left side remains unaffected |
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Term
| what causes mitral stenosis? who commonly gets this? how do they present? |
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Definition
| rheumatic fever, which generally affects young women from southeast and central asia. they present with shortness of breath, lower extremity edema, palpitations, stroke and possibly a thrill or dilatation of pulmonary artery able to be felt if pt is standing |
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Term
| what does a heart affected by mitral stenosis look like? |
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Definition
| a small LV, big RV, big LA - generally R sided signs, b/c you can't get blood into the aorta so volume is going back down path of least resistance (low pressure) – into the lungs, venous system |
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Term
| how does mitral stenosis present audibly? |
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Definition
| a diastolic rumble - longer it is, the worse the disease is. there is also a click and an opening snap b/c of narrowing/tightening of cords, scarring, fibrosis, calcification (remember this is diastolic, not systolic, even though it sounds systolic) |
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Term
| how do you differentiate mitral stenosis from aortic regurgitation (b/c sometimes aortic regurg can be heard at the apex of the heart - austin flint)? |
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Definition
| aortic regurgitation is a L sided murmur that will respond to handgrip (lengthens it) however, even though mitral stenosis is a L sided murmur - it will not respond to L sided maneuvers |
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Term
| what kind of murmur is aortic regurg? |
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Definition
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Term
| can tricuspid regurgitation appear on its own? |
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Definition
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Term
| what is a heart rub? what is it caused by? |
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Definition
| a heart rub is systolic and diastolic sound; rubbing of pericardial layers against one another are associated w/ inflammation of heart sac. they can come from chronic renal failure, viral-like syndromes, open heart surgery, infarction |
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Term
| what does a heart rub sound like? |
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Definition
| mitral regurgitation, but it will respond to the movement of the pt |
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