CCRN Final
Exam Study
Guide:
Cardiovascula
r Insights and
Concepts
latest 2026
,
, lOMoAR cPSD| 65262174
CCRN STUDY GUIDE
Cardiovascular: 32% Heart Sounds
✴ S1 (“lub”)
• Closure of AV valves
• Marks end of diastole, beginning of systole
• Best heard at apex of ❤️ , 5th ICS mid-clavicular line (mitral area)
✴ S2 (“dub”)
• Closure of semilunar valves
• Marks end of systole and beginning of diastole
• Best heard art 2nd ICS right sternal border (aortic area)
• *Louder with PE
✴ Anatomic landmarks (APETM) (APE-TO-MAN)
• Aortic: 2nd ICS right sternal border
• Pulmonic: 2nd ICS left sternal border
• Erb’s point: 3rd ICS left sternal border
• Tricuspid: 5th ICS left sternal border
• Mitral: 5th ICS mid-clavicular line
✴ S3
• Caused by blood rushing into dilated ventricle
• Occurs early in diastole after S2
• May be heard before crackles in HF
• Best heard at apex with bell of stethoscope
• *Associated with PH, mitral, aortic, and tricuspid valve insufficiency
✴ S4
• Caused by atrial contraction of blood into a noncompliant ventricle
• Occurs right before S1
• Best heard at apex with bell of stethoscope
• *Associated with myocardial ischemia/infarct, ventricular hypertrophy, HTN, and ***aortic
stenosis
Murmurs
• IC-SO
• When the valve is closed, the problem is insufficiency/regurgitation
• When the valve is open, the problem is stenosis
• AV valves open during diastole/ close during systole
• SL valves open during systole/ close during diastole
• VSD murmur is heard during systole
, lOMoAR cPSD| 65262174
• The mitral valve is attached the muscle wall via papillary mm, therefore, myocardial
ischemia/ infarct can affect mitral valve function and lead to insufficiency
• Papillary mm function or infarct are best heard at apex
• VSD best heard at 5 ICS mid-clavicular border
• *VSD is associated with anterior MI and mitral valve disruption is associated with
inferior MI
• Both are surgical emergencies
Acute Coronary Syndrome
✴ 4 possibilities
• STEMI
• ST elevation
• Troponin (+)
• Unrelenting chest pain
• ST elevation in 2 or more contiguous leads
✴ NSTEMI
• Troponin (+)
• ST depression/ T wave inversion
• Unrelenting chest pain
✴ Unstable angina
• At rest/ unpredictable chest pain
• Pain may or may not be relieved by nitro
• ST depression/ T wave inversion
• Troponin (-)
✴ No acute change
Prinzmetal Angina
• Associated with ST elevation during pain
• Pain often relieved by nitro
• Occurs at the same time consistently
Management of Acute Chest Pain
• ECG within 10 minutes to determine severity of situation
• “OANM” (other acronym not MONA)
• Aspirin ASAP
• Anticoagulants: heparin or enoxaparin
• Antiplatelets
• Clopidogrel
• Abciximab
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Exam Study
Guide:
Cardiovascula
r Insights and
Concepts
latest 2026
,
, lOMoAR cPSD| 65262174
CCRN STUDY GUIDE
Cardiovascular: 32% Heart Sounds
✴ S1 (“lub”)
• Closure of AV valves
• Marks end of diastole, beginning of systole
• Best heard at apex of ❤️ , 5th ICS mid-clavicular line (mitral area)
✴ S2 (“dub”)
• Closure of semilunar valves
• Marks end of systole and beginning of diastole
• Best heard art 2nd ICS right sternal border (aortic area)
• *Louder with PE
✴ Anatomic landmarks (APETM) (APE-TO-MAN)
• Aortic: 2nd ICS right sternal border
• Pulmonic: 2nd ICS left sternal border
• Erb’s point: 3rd ICS left sternal border
• Tricuspid: 5th ICS left sternal border
• Mitral: 5th ICS mid-clavicular line
✴ S3
• Caused by blood rushing into dilated ventricle
• Occurs early in diastole after S2
• May be heard before crackles in HF
• Best heard at apex with bell of stethoscope
• *Associated with PH, mitral, aortic, and tricuspid valve insufficiency
✴ S4
• Caused by atrial contraction of blood into a noncompliant ventricle
• Occurs right before S1
• Best heard at apex with bell of stethoscope
• *Associated with myocardial ischemia/infarct, ventricular hypertrophy, HTN, and ***aortic
stenosis
Murmurs
• IC-SO
• When the valve is closed, the problem is insufficiency/regurgitation
• When the valve is open, the problem is stenosis
• AV valves open during diastole/ close during systole
• SL valves open during systole/ close during diastole
• VSD murmur is heard during systole
, lOMoAR cPSD| 65262174
• The mitral valve is attached the muscle wall via papillary mm, therefore, myocardial
ischemia/ infarct can affect mitral valve function and lead to insufficiency
• Papillary mm function or infarct are best heard at apex
• VSD best heard at 5 ICS mid-clavicular border
• *VSD is associated with anterior MI and mitral valve disruption is associated with
inferior MI
• Both are surgical emergencies
Acute Coronary Syndrome
✴ 4 possibilities
• STEMI
• ST elevation
• Troponin (+)
• Unrelenting chest pain
• ST elevation in 2 or more contiguous leads
✴ NSTEMI
• Troponin (+)
• ST depression/ T wave inversion
• Unrelenting chest pain
✴ Unstable angina
• At rest/ unpredictable chest pain
• Pain may or may not be relieved by nitro
• ST depression/ T wave inversion
• Troponin (-)
✴ No acute change
Prinzmetal Angina
• Associated with ST elevation during pain
• Pain often relieved by nitro
• Occurs at the same time consistently
Management of Acute Chest Pain
• ECG within 10 minutes to determine severity of situation
• “OANM” (other acronym not MONA)
• Aspirin ASAP
• Anticoagulants: heparin or enoxaparin
• Antiplatelets
• Clopidogrel
• Abciximab
2 of 63
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