Bates Chapter 16 Cardiovascular Questions And
ANSWERs Graded A+
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
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
, In children et young adults a third heart sound, S,3,? - ANSWER -May arise from
rapid deceleration of the column of blood against the ventricular wall
In older adults an S3 "S3 gallop" usually indicates? - ANSWER -Pathology
Although not often heard in normal adults, a fourth heart sounds S4, marks? -
ANSWER -Atrial contraction. It immediately precedes S1 of the next beat et can
also reflect a pathologic ventricular stiffness, as seen in HTN, or Myocardial
Infarction
Chest wall location: Right 2nd Intercostal space or cardiac apex, what is the
typical origin of sound? - ANSWER -Typical origin of sound et murmur: Aortic
Valve
Chest wall location: Left 2nd et 3rd intercostal spaces close to the sternum, but
also higher or lower levels, what is the typical origin of sound? - ANSWER Typical
origin of sound et murmur: Pulmonic Valve
Chest wall location: At or near the lower left sternal border, where is the typical
origin of sound? - ANSWER -Typical origin of sound et murmur: Tricuspid valve
Chest wall location: At or around the cardiac apex, where is the typical origin of
sound? - ANSWER -Typical origin of sound et murmur: Mitral Valve
What are Small weak pulses? - ANSWER -Pulse pressure is diminished, pulse feels
weak and small. The upstroke may feel slowed, the peak prolonged.
Causes of small weak pulses include? - ANSWER -1. Decreased stroke volume, as
in heart failure, hypovolemia, and severe aortic stenosis and
2. Increased peripheral resistance, as in exposure to cold and severe heart failure
What are Large bounding pulses? - ANSWER -Pulse pressure in increased, and the
pulse feels strong and bounding
ANSWERs Graded A+
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
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
, In children et young adults a third heart sound, S,3,? - ANSWER -May arise from
rapid deceleration of the column of blood against the ventricular wall
In older adults an S3 "S3 gallop" usually indicates? - ANSWER -Pathology
Although not often heard in normal adults, a fourth heart sounds S4, marks? -
ANSWER -Atrial contraction. It immediately precedes S1 of the next beat et can
also reflect a pathologic ventricular stiffness, as seen in HTN, or Myocardial
Infarction
Chest wall location: Right 2nd Intercostal space or cardiac apex, what is the
typical origin of sound? - ANSWER -Typical origin of sound et murmur: Aortic
Valve
Chest wall location: Left 2nd et 3rd intercostal spaces close to the sternum, but
also higher or lower levels, what is the typical origin of sound? - ANSWER Typical
origin of sound et murmur: Pulmonic Valve
Chest wall location: At or near the lower left sternal border, where is the typical
origin of sound? - ANSWER -Typical origin of sound et murmur: Tricuspid valve
Chest wall location: At or around the cardiac apex, where is the typical origin of
sound? - ANSWER -Typical origin of sound et murmur: Mitral Valve
What are Small weak pulses? - ANSWER -Pulse pressure is diminished, pulse feels
weak and small. The upstroke may feel slowed, the peak prolonged.
Causes of small weak pulses include? - ANSWER -1. Decreased stroke volume, as
in heart failure, hypovolemia, and severe aortic stenosis and
2. Increased peripheral resistance, as in exposure to cold and severe heart failure
What are Large bounding pulses? - ANSWER -Pulse pressure in increased, and the
pulse feels strong and bounding
