Bates Chapter 16 Cardiovascular Questions And
Answers Graded A+
Pathologic Midsystolic Hypertrophic Cardiomyopathy murmur presentation? -
ANSWER --Left 3rd et 4th IC Space
-Radiation down the left sternal border to apex, possibly base but NOT THE
NECK
-Intensity variable, Medium pitch, Harsh Quality
-Intensity decreases w/ squatting et valsalva release phase (increases venous
return), increases w/ standing et Valsalva strain phase (Decreases left ventricular
volume)
Pathologic Midsystolic Hypertrophic Cardiomyopathy murmur Associated
Findings? - ANSWER --Carotid upstroke rises quickly unlike aortic stenosis
-The apical impulse is sustained.
-S2 may be single
-An S4 usually present at Apex (unlike mitral regurgitation)
-Usually benign but progresses in 25% to syncope, ischemia, AfIB, dilated
cardiomyopathy et heart failure, et stroke w/ increased risk of sudden death
Pathologic Midsystolic Hypertrophic Cardiomyopathy murmur Mechanism? -
ANSWER --Unexplained diffuse or focal ventricular hypertrophy w. myocyte
disarray et fibrosis assoc w/ unusually rapid ejection of blood from left ventricle
during Systole
-Outflow tract obstruction of flow may coexist
-Associated distortion of the mitral valve may cause mitral regurgitation
Point of maximal impulse (PMI) - ANSWER -the point where the apex of the
heart touches the anterior chest wall and heart movements are most easily observed
and palpated
Where is the best location to palpate Point of maximal impulse (PMI)? -
ANSWER -Left border of the heart on 5th intercostal space, midclavicular line
, Midsystolic murmurs can be? - ANSWER --Innocent
-Physiologic
-Pathologic (Aortic Stenosis; Hypertrophic Cardiomyopathy; Pulmonic Stenosis
Innocent Midsystolic Murmur presentation? - ANSWER --Left 2nd to 4th IC B/T
L sternal border et Apex
-Minimal radiation Graded 1-, or 3 Soft to medium pitch
-usually disappears on sitting
-Assoc findings-norm splitting, no ejection sounds, no diastolic murmur, no
palpable evid of ventricular enlargement, occas both innocent and pathologic are
present
-Mechanism-Turbulent flow prob generated by ventricular ejection of blood into
the aorta from left et occas the right ventricle.
-Very common in children, young adults, possibly older adults.
-There is no underlying coronary vascular disease
Physiologic Midsystolic murmur presentation? - ANSWER ---Left 2nd to 4th IC
B/T L sternal border et Apex
-Minimal radiation Graded 1-, or 3 Soft to medium pitch
-usually disappears on sitting
-Turbulence d/t temporary increase in blood flow in predisposing conditions such
as anemia, pregnancy, fever, HYPERTHYROIDISM
Pathologic Midsystolic Aortic Stenosis Murmur presentation? - ANSWER --S2
may be decreased
-Heard at right 2nd et 3rd IC spaces
-Often radiates to carotids down the Left sternal border even to Apex. If severe
may radiate to 2nd et 3rd IC Spaces
-Intensity Sometimes soft but often loud w/ thrill
-Medium harsh crescendo-decrescendo may be higher at apex
-Heard best w/ pt sitting et leaning forward
Pathologic Midsystolic Aortic Stenosis Murmur Associated findings? - ANSWER
--As this worsens, murmur peaks later in systole and A2 decreases w/ intensity
-A2 may be delayed w/ a slow rise, small amplitude, et decreased volume
,-The hypertrophied left ventricle may produce a sustained apical impulse et an S4
d/t decreased compliance.
-After age 40 yrs, there may be dilated aorta et murmur of aortic regurgitation.
-Subendocardial ischemia d/t poor coronary perfusion distal to the valve causes
angina et syncope
Pathologic Midsystolic Aortic Stenosis Murmur Mechanism? - ANSWER --
Significant stenosis causes turbulent flow across the valve et increases left
ventricular afterload
-The most common cause is valve calcification in older adults at times progressing
from nonobstructing sclerosis (present in 25%) to stenosis
-2nd most common cause is a congenital bicuspid aortic valve often not recognized
until adulthood
In supine pts, the PMI is approximately? - ANSWER -1 to 2.5 cm (not always
palpable even in healthy pts with a normal heart
A PMI >2.5 cm is evidence of? - ANSWER -Left ventricular hypertrophy (LVH),
often seen in hypertension or dilated cardiomyopathy
In some pts, the precordial impulse may not be palpable at the apex of the heart.
For ex in pts with? - ANSWER -COPD
In COPD, the most prominent palpable impulse or PMI may be in the? -
ANSWER -Xiphoid or epigastric area due to right ventricular hypertrophy
Displacement of the PMI lateral to the midclavicular line or >10cm lateral to the
midsternal line occurs in? - ANSWER -Left ventricular hypertrophy (LVH). et in
ventricular dilation from MI or heart failure
The mitral and tricuspid valves are called? - ANSWER -Atrioventricular valves
The aortic and pulmonic valves are called? - ANSWER -Semilunar Valves
, In most adults the diastolic sounds of S3 and S4 are pathologic and are correlated
with? - ANSWER -Systolic et diastolic heart failure, respectively
An S3 corresponds to? - ANSWER -An abrupt deceleration of inflow across the
mitral valve
An S4 corresponds to? - ANSWER -Increased left ventricular end diastolic
stiffness which decreases compliance
Systole is the period of? - ANSWER -ventricular contraction, when the left
ventricle ejects blood into the aorta
Diastole is the period of? - ANSWER -ventricular relaxation
During systole, the aortic valve is? - ANSWER -opened, allowing ejection of
blood from the Left Ventricle into the aorta. The mitral valve is closed.
During diastole, the aortic valve is? - ANSWER -Closed, preventing regurgitation
of blood to flow from the aorta back into the left ventricle
The production of S1 is? - ANSWER -Closure of the mitral valve and tricuspid
valve in the right side of the heart
In some pathologic conditions an early _______________ accompanies opening
of the aortic valve - ANSWER -systolic ejection sound
Normally, maximal left ventricular pressure corresponds to systolic or diastolic
pressure? - ANSWER -systolic blood pressure
Aortic valve closure, as well as the closure of pulmonic valves produces which
heart sound? - ANSWER -second heart sound-S2
The opening of the mitral valve may be audible as? - ANSWER -pathologic
opening snap (OS) if valve leaflet motion is restricted as in mitral stenosis
Answers Graded A+
Pathologic Midsystolic Hypertrophic Cardiomyopathy murmur presentation? -
ANSWER --Left 3rd et 4th IC Space
-Radiation down the left sternal border to apex, possibly base but NOT THE
NECK
-Intensity variable, Medium pitch, Harsh Quality
-Intensity decreases w/ squatting et valsalva release phase (increases venous
return), increases w/ standing et Valsalva strain phase (Decreases left ventricular
volume)
Pathologic Midsystolic Hypertrophic Cardiomyopathy murmur Associated
Findings? - ANSWER --Carotid upstroke rises quickly unlike aortic stenosis
-The apical impulse is sustained.
-S2 may be single
-An S4 usually present at Apex (unlike mitral regurgitation)
-Usually benign but progresses in 25% to syncope, ischemia, AfIB, dilated
cardiomyopathy et heart failure, et stroke w/ increased risk of sudden death
Pathologic Midsystolic Hypertrophic Cardiomyopathy murmur Mechanism? -
ANSWER --Unexplained diffuse or focal ventricular hypertrophy w. myocyte
disarray et fibrosis assoc w/ unusually rapid ejection of blood from left ventricle
during Systole
-Outflow tract obstruction of flow may coexist
-Associated distortion of the mitral valve may cause mitral regurgitation
Point of maximal impulse (PMI) - ANSWER -the point where the apex of the
heart touches the anterior chest wall and heart movements are most easily observed
and palpated
Where is the best location to palpate Point of maximal impulse (PMI)? -
ANSWER -Left border of the heart on 5th intercostal space, midclavicular line
, Midsystolic murmurs can be? - ANSWER --Innocent
-Physiologic
-Pathologic (Aortic Stenosis; Hypertrophic Cardiomyopathy; Pulmonic Stenosis
Innocent Midsystolic Murmur presentation? - ANSWER --Left 2nd to 4th IC B/T
L sternal border et Apex
-Minimal radiation Graded 1-, or 3 Soft to medium pitch
-usually disappears on sitting
-Assoc findings-norm splitting, no ejection sounds, no diastolic murmur, no
palpable evid of ventricular enlargement, occas both innocent and pathologic are
present
-Mechanism-Turbulent flow prob generated by ventricular ejection of blood into
the aorta from left et occas the right ventricle.
-Very common in children, young adults, possibly older adults.
-There is no underlying coronary vascular disease
Physiologic Midsystolic murmur presentation? - ANSWER ---Left 2nd to 4th IC
B/T L sternal border et Apex
-Minimal radiation Graded 1-, or 3 Soft to medium pitch
-usually disappears on sitting
-Turbulence d/t temporary increase in blood flow in predisposing conditions such
as anemia, pregnancy, fever, HYPERTHYROIDISM
Pathologic Midsystolic Aortic Stenosis Murmur presentation? - ANSWER --S2
may be decreased
-Heard at right 2nd et 3rd IC spaces
-Often radiates to carotids down the Left sternal border even to Apex. If severe
may radiate to 2nd et 3rd IC Spaces
-Intensity Sometimes soft but often loud w/ thrill
-Medium harsh crescendo-decrescendo may be higher at apex
-Heard best w/ pt sitting et leaning forward
Pathologic Midsystolic Aortic Stenosis Murmur Associated findings? - ANSWER
--As this worsens, murmur peaks later in systole and A2 decreases w/ intensity
-A2 may be delayed w/ a slow rise, small amplitude, et decreased volume
,-The hypertrophied left ventricle may produce a sustained apical impulse et an S4
d/t decreased compliance.
-After age 40 yrs, there may be dilated aorta et murmur of aortic regurgitation.
-Subendocardial ischemia d/t poor coronary perfusion distal to the valve causes
angina et syncope
Pathologic Midsystolic Aortic Stenosis Murmur Mechanism? - ANSWER --
Significant stenosis causes turbulent flow across the valve et increases left
ventricular afterload
-The most common cause is valve calcification in older adults at times progressing
from nonobstructing sclerosis (present in 25%) to stenosis
-2nd most common cause is a congenital bicuspid aortic valve often not recognized
until adulthood
In supine pts, the PMI is approximately? - ANSWER -1 to 2.5 cm (not always
palpable even in healthy pts with a normal heart
A PMI >2.5 cm is evidence of? - ANSWER -Left ventricular hypertrophy (LVH),
often seen in hypertension or dilated cardiomyopathy
In some pts, the precordial impulse may not be palpable at the apex of the heart.
For ex in pts with? - ANSWER -COPD
In COPD, the most prominent palpable impulse or PMI may be in the? -
ANSWER -Xiphoid or epigastric area due to right ventricular hypertrophy
Displacement of the PMI lateral to the midclavicular line or >10cm lateral to the
midsternal line occurs in? - ANSWER -Left ventricular hypertrophy (LVH). et in
ventricular dilation from MI or heart failure
The mitral and tricuspid valves are called? - ANSWER -Atrioventricular valves
The aortic and pulmonic valves are called? - ANSWER -Semilunar Valves
, In most adults the diastolic sounds of S3 and S4 are pathologic and are correlated
with? - ANSWER -Systolic et diastolic heart failure, respectively
An S3 corresponds to? - ANSWER -An abrupt deceleration of inflow across the
mitral valve
An S4 corresponds to? - ANSWER -Increased left ventricular end diastolic
stiffness which decreases compliance
Systole is the period of? - ANSWER -ventricular contraction, when the left
ventricle ejects blood into the aorta
Diastole is the period of? - ANSWER -ventricular relaxation
During systole, the aortic valve is? - ANSWER -opened, allowing ejection of
blood from the Left Ventricle into the aorta. The mitral valve is closed.
During diastole, the aortic valve is? - ANSWER -Closed, preventing regurgitation
of blood to flow from the aorta back into the left ventricle
The production of S1 is? - ANSWER -Closure of the mitral valve and tricuspid
valve in the right side of the heart
In some pathologic conditions an early _______________ accompanies opening
of the aortic valve - ANSWER -systolic ejection sound
Normally, maximal left ventricular pressure corresponds to systolic or diastolic
pressure? - ANSWER -systolic blood pressure
Aortic valve closure, as well as the closure of pulmonic valves produces which
heart sound? - ANSWER -second heart sound-S2
The opening of the mitral valve may be audible as? - ANSWER -pathologic
opening snap (OS) if valve leaflet motion is restricted as in mitral stenosis
