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  1. S1 is closing of ____ and ____ valves at transition from ____ to _____.
    mitral and tricuspid

    transition from diastole to systole
  2. S2 is closing of ___ and ____ at transition from ____ to _____
    • aortic and pulmonic valves
    • transition from systole to diastole
  3. S1- intensity is predominately determined by its ____ valve component

    therefore S1 is loudest at the ____.

  4. Intensity of S1 is related to that of the ____ closing
    Mitral valve
  5. Loud S1 could be from
    short PR interval

    mild mitral stenosis

    hyper dynamic states
  6. Soft S1 could be from
    long PR interval

    Severe mitral stenosis




    Pericardial effusion
  7. Variable S1 could be from
    AV dissociation

    atrial fibrillation

    Large pericardial effusion (ausculatory altertans)

    Severe LV dysfunction (ausculatory altertans)
  8. S2 is easiest heard at the _____

    normally ___ during inspiration
    upper sternal border

  9. abnormalities of the S2 split

    a wide split could be from
    RBBB, preexcitation of LV, pulm htn, massive PE, severe MR, constrictive pericarditis
  10. abnormalities of the S2 split

    fixed split could be from
    • ASD
    • Severe RV failure
  11. abnormalities of the S2 split

    Reversed split
    LBBB, preexcitation of RV, aortic stenosis/regurgitation, LV outflow tract obstruction
  12. abnormalities of the S2 split

    absent A2
    severe aortic valve dz
  13. A loud P2 is suggestive of ...
    pulm htn
  14. S3 is described as a ___ sound

    easiest to hear at ___ in ____
    low pitched, early diastolic sound

    easiest to hear at the apex with pt in the left lateral decubitus
  15. S3

    heard in ___ women, in those over 40 it is usually indicative of _____ failure

    LV failure
  16. S4

    a low pitched late diastolic sound

    it is always _____
  17. Gallops

    Ventricular gallop is ___

    Atrial gallop is ___

    Summation gallop is ____


  18. Clicks aortic ejection click

    Location best heard-___
    effect of standing-___
    • very early systole
    • high
    • can be heard equally well everywhere
    • none
  19. Clicks MVP click

    Location best heard-___
    effect of standing-___
    • mid systole
    • high
    • apex
    • click will occur earlier in systole
  20. pathologic sounds

    opening snap
    low pitched early diastolic sound heard in mitral stenosis
  21. pathologic sounds

    pericardial knock
    a sound similar to S3 that can be heard in constrictive pericarditis
  22. pathologic sounds

    tumor plop
    a low frequency early diastolic sound heard in atrial myxoma (tumor!)
  23. decreased blood viscosity
  24. decreased diameter of vessel, valve, or oriface
    • valvular stenosis
    • coarctation of the aorta
    • ventricular septal defect
  25. increased velocity of blood through normal structures
    hyperdynamic states(sepsis, hyperthyroidism)
  26. characteristics of murmurs
    systolic murmurs
    • flow
    • aortic/pulmonic stenosis
    • mitral/tricuspid regurgitation
    • ventricular septal deftect
    • aortic outflow tract obstruction
  27. characteristics of murmurs
    • aortic/pulmonic regurgitation
    • mitral/tricuspid stenosis
  28. characteristics of murmurscontinuous
    patent ductus arteriosus
  29. characteristics of murmursradiation
    location where the murmur is audible, despite not being directly over the heart
  30. characteristics of murmurs
    radiationcarotid arteries-___
    right thorax-___
    left axilla-___
    • aortic stenosis
    • tricuspid regurgitation
    • mitral regurgitation
  31. characteristics of murmurs
    shape (three shapes)
    uniform (holosystolic)-___
    • systole
    • diastole
    • both
  32. The first heart sound (S1) comes from what closing?
    Mitral valve followed by the Tricuspid valve
  33. The second heart sound (S2) comes from what closing?
    The aortic valve followed by the pulmonic valve
  34. The third heart sound (S3) comes from what?
    It is the result of the rapid filling of the left ventricle following the opening of the mitral valv e.
  35. What does it mean pathophysiologically to have an S3?
    physiological in young people or regular population with high flow states

    pathological in patients with CHF and dilatation in ventricles
  36. The fourth heart sound (S4) comes from what?
    blood being forced into a stiff noncompliant left ventricle
  37. A patient with an S4 could be from what pathologies?
    HTN, Ischemia, outlet structures, or hypertrophic or infiltrated my case.
  38. Most murmurs are louder in the ____ position
    Recumbent Due to increased venous return
  39. Mitral murmurs are best heard mitral thrills our best felt when the patient is on the ____ side
    Left side. This brings the apex of the heart closer to the chest wall.
  40. Normally the point of maximal impulse is palpated along the ____ line.
    Mid clavicular line
  41. Pulsus altertans is characterized by a regular rhythm with a ____ and ____
    Alternating strong and weak ventricular contractions. It is thought to be the result of alternation in the left ventricular stroke volume.
  42. Thrills are palpable _____.  How do you feel for a thrill?
    Murmurs. Because the junction of the fingers in the hand is more sensitive to low-frequency events and then the fingertips, their best felt with the palm of the hand.
  43. Where is the thrill for aortic stenosis Palpated ?
    Crosses the palm of the hand toward the right of the neck
  44. Where is the thrill of pulmonicstenosis felt?
    The location crosses the palm of the hand toward the left of the neck.
  45. Where is the thrill of ventricular septal defect felt?
    The location of thrill for VSD is located third and fourth intercostal space, left sternal border.
Card Set:
2014-11-04 00:28:34
cards exam
heart sounds
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