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What is S1?
Marks beginning of systole. Mitral and tricuspid valves closed. Best heard at apex w/ diaphragm. The "Lub" of Lub dub. Blood being ejected from the ventricles into the lungs and body.
What is S2?
The beginning of diastole. The aortic and pulmonic valves are closed. Best heard at base with diaphragm. The "dub" of Lub dub. Blood moves from atria to ventricles.
What is a physiologic split S2?
Widening of the mormal interval b/w aortic and pulmonic components of the 2nd heart sound. Caused by a delay in the pulmonic component. Best heard in pulmonic region. Split increases on inspiration.Found in majority of adults < 30. Benign.
What is a pathologic split S2?
Either fixed split, no change with inspiration or a paradoxical split that narrows or closes with inspiration. Paradoxical split often found in conditions that delay aortic closure, such as LBBB.
What is a pathologic S3 heart sound?
Marker of ventricular overload and/or systoloc dysfuntion.Heard in early diastole, as if it is "hooked" onto the back of S2. Low pitch, best heard with bell.
What is S4 heart sound?
Marker of poor diastolic function, found in porly controlled HTN or recurrent myocardial ischemia. Heard late in diastole like it is "hooked" onto the fromt of S1. Soft, low pitch, best heard with bell. Poor relaxation of a stiff myocardium. Forceful filling creates vibration.
What is a stenotic valve?
A valve that has failed to open properly. It is narrowed.
What is a regurgitant valve?
A valve that fails to close adequately. Incompetent valves cause regurgitant murmurs.
What are the systolic murmurs?
- MR. PASS
- Mitral Regurgitation Physiologic (benign)
- Aortic Stenosis Systolic
What are the diastolic murmurs?
- Mitral Stenosis
- Aortic Regurgitation
What is a grade I murmur?
Very faint, intermittant.
What is a grade II murmur?
Quiet but immediatley heard.
What is a grade III murmur?
Moderately loud without thrill. About as lound as S1 or S2.
What is a grade IV murmur?
Loud with a thrill.
What is a grade V murmur?
Very loud with thrill.
What is a grade VI murmur?
Audible without stethoscope.
What is a harsh murmur?
Heard well w/ both bell & diaphragm. I.e. the murmur of aortic stenosis.
What is a rumbling murmur?
Low sound. Heard best w/ bell. I.e. the murmur of mitral stenosis.
What is a blowing murmur?
High, best heard with diaphragm. I.e the murmur of aortic regurgitation.
What is a musical murmur?
It has a vibratory quality, such as in a still murmur.
How do you tell the difference b/w benign or pathologic systolic murmurs?
Benign murmurs will have negative cardiac hx, <= grade III/IV, no radiation, S1/S2 intact, no heave or thrill, normal PMI, and softens or disappears with supine to standing position change. Pathologic will be opposite.
What is Grade 1 hypertensive retinopathy?
Narrowing of terminal branches. No vison changes or permanent findings. Reversible.
What is Grade 2 hypertensive retinopathy?
Narrowing of vessels w/ severe local constriction. No vision change or permanent findings. Reversible.
What is Grade 3 hypertensive retinopathy?
Signs of 1 & 2 changes + striate hemorrhages & soft exudates. Potential for visual change and permanent findings.
What is Grade 4 hypertensive retinopathy?
Signs of 1, 2, & 3 retinopaty + papilledema. Potential for visula changes and permanent damage.
What is normal BP accorsing to the JNC7?
What is prehypertension according to the JNC7?
What is Stage 1 HTN?
What is Stage 2 HTN?
What is BP goal for adults w/ DM and/or chronic renal dz?
What are BP goals for those w/ renal dz and > 1g/24hr proteinuria per National Kidney Foundation?
What are teh JNC7 lifestyle modification recommendations?
- Weight reduction 5-20mm/Hg reduc per 10kg loss.
- DASH diet 8-14mm/Hg
- Na reduction 2-8mm/Hg
- Aerobic activity 4-9mm/Hg
- Moderation of ETOH intake 2-4mmHg