Bates Chapter 16 Cardiovascular Actual Questions
And Answers Updated 2025
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In dextrocardia, the PMI is Right side
located on the left or right
side?
-Left 2nd et 3rd IC Spaces
Pathologic Midsystolic -Radiation-if loud toward the left shoulder et neck
Pulmonic Stenosis Murmur -Intensity soft to loud, if loud assoc w/ thrill
presentation? -Pitch Medium, crescendo-decrescendo
-Quality-Often harsh
-JVP usually norm but may have a prominent wave
-R Ventricular impulse often sustained
Pathologic Midsystolic
-An early pulmonic ejection sound is present in mild
Pulmonic Stenosis Murmur
to mod stenosis
Associated Findings?
-In severe stenosis S2 is widely split et P2 softens
-May hear a right-sided S4 over the left sternal border
-Primarily congenital disorder with valvular,
supravalvular, or subvalvular stenosis
Pathologic Midsystolic
-stenosis impairs flow across the valve increasing R
Pulmonic Stenosis Murmur
Ventricular afterload.
Mechanism?
In atrial septal defect increased flow across the
pulmonic valve may mimic pulmonic stenosis
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-Left 3rd et 4th IC Space
-Radiation down the left sternal border to apex,
Pathologic Midsystolic possibly base but NOT THE NECK
Hypertrophic -Intensity variable, Medium pitch, Harsh Quality
Cardiomyopathy murmur -Intensity decreases w/ squatting et valsalva release
presentation? phase (increases venous return), increases w/ standing
et Valsalva strain phase (Decreases left ventricular
volume)
-Carotid upstroke rises quickly unlike aortic stenosis
-The apical impulse is sustained.
Pathologic Midsystolic -S2 may be single
Hypertrophic -An S4 usually present at Apex (unlike mitral
Cardiomyopathy murmur regurgitation)
Associated Findings? -Usually benign but progresses in 25% to syncope,
ischemia, AfIB, dilated cardiomyopathy et heart
failure, et stroke w/ increased risk of sudden death
-Unexplained diffuse or focal ventricular hypertrophy
w. myocyte disarray et fibrosis assoc w/ unusually
Pathologic Midsystolic
rapid ejection of blood from left ventricle during
Hypertrophic
Systole
Cardiomyopathy murmur
-Outflow tract obstruction of flow may coexist
Mechanism?
-Associated distortion of the mitral valve may cause
mitral regurgitation
the point where the apex of the heart touches the
Point of maximal impulse
anterior chest wall and heart movements are most
(PMI)
easily observed and palpated
Where is the best location Left border of the heart on 5th intercostal space,
to palpate Point of midclavicular line
maximal impulse (PMI)?
-Innocent
Midsystolic murmurs can -Physiologic
be? -Pathologic (Aortic Stenosis; Hypertrophic
Cardiomyopathy; Pulmonic Stenosis
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