Bates Chapter 16 Cardiovascular Questions And
ANSWERs Graded A+
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
,causes of large bounding pulse include? - ANSWER -1. Increased stroke volume,
decreased peripheral resistance, or both as in, fever, anemia, Hyperthyroidism,
Aortic Regurgitation, arteriovenous fistulas, and Patent Ductus arteriosus 2.
Increased stroke volume bc of slow heart rates as in bradycardia et complete
heart block
3. Decreased compliance (increased stiffness) of aortic walls as in aging
atherosclerosis
Bisferiens pulse is? - ANSWER -Pulse is an increased arterial pulse with a double
systolic peak, detected during moderate compression of an artery.
Causes of bisferiens pulse include? - ANSWER -Pure aortic regurgitation,
combined aortic stenosis and regurgitation, et hypertrophic cardiomyopathy.
Pulsus Alternans is? - ANSWER -Pulse is completely regular but has alternating
strong et weak beats
What does pulsus alternans indicate? - ANSWER -Severe left ventricular failure
What does detection of pulsus alternans and Pulsus paradoxus require? -
ANSWER -Use of a BP cuff
Alternately loud et soft kortokoff sounds or sudden doubling of the apparent heart
rate as the cuff pressure declines signals what? - ANSWER -Pulsus Alternans
The carotid upstroke in aortic stenosis is? - ANSWER -Delayed
How does the carotid pulse present in cardiogenic shock? - ANSWER -Small,
thready (barely detectable), or weak
How does the pulse present in aortic regurgitation? - ANSWER -Bounding pulse
What does pressure on the carotid sinus cause? - ANSWER -reflex bradycardia or
drop in blood pressure
, Where are thrills in aortic stenosis transmitted to? - ANSWER -the carotid arteries
from the suprasternal notch or second right intercostal space
How can you place the pt to accentuate the finding of pulsus alternans? -
ANSWER -place pt in the upright position
What is Pulsus Paradoxus? - ANSWER -Greater than normal drop in systolic
pressure during inspiration
The pressure when Kortokoff sounds are first heard is the? - ANSWER -Highest
systolic pressure during the respiratory cycle
The pressure when sounds are heard throughout the cycle is the ? - ANSWER
Lowest systolic pressure.
A difference between these levels constitutes a paradoxical pulse? - ANSWER >=
10mm Hg to 12 mm Hg
What is paradoxical pulse found in? - ANSWER -Pericardial tamponade (life
threatening), Acute asthma, Obstructive pulmonary disease (COPD), Constrictive
pericarditis, Acute pulmonary embolism
Pulsus Alternans and Bigeminal pulse vary by? - ANSWER -Beat to beat
Pulsus Paradoxus varies with? - ANSWER -Respiration
Bigeminal Pulse is? - ANSWER -May mimic Pulsus Alternans, is caused by a
normal beat alternating with a premature contraction. The stroke volume of the
premature beat is diminished in relation to that of normal beats, and the pulse
varies in amplitude accordingly
In the healthy heart, the left ventricular impulse is usually the? - ANSWER -PMI,
generated by the movement of the ventricular apex against the chest wall during
contraction
, Normal left ventricular PMI classical descriptors? - ANSWER -Location: 4th or
5th Left intercostal space, midclavicular line
Diameter: Discrete, or <=2cm
Amplitude: Brisk and tapping
Duration: <=2/3 of systole
The right ventricular impulse? - ANSWER -Normally not palpable beyond
infancy and characteristics are indeterminate
Three additional types of ventricular impulses are? - ANSWER -Hyperkinetic;
Sustained; Diffuse
hyperkinetic ventricular impulse is? - ANSWER -transiently increased Stroke
Volume; does not necessarily mean heart disease; --Examples of Causes: Anxiety;
Hyperthyroid; severe anemia--Duration is <2/3 systole--the Amplitude is a more
forceful tapping
A Sustained ventricular Impulse is? - ANSWER -ventricular hypertrophy from
chronic pressure load (increased afterload)
Diffuse ventricular Impulse is? - ANSWER -Ventricular dilation from chronic
volume overload, or increased preload
Causes of hyperkinetic left ventricular impulse? - ANSWER -Pressure overload
from aortic stenosis, hypertension
1. Anxiety
2. Hyperthyroidism
3. Severe anemia
An S3 or ventricular gallop, may be pathologic or physiologic, In adults over 40,
an S3 is usually? - ANSWER -Pathologic, arising from high left ventricular filling
pressures and abrupt deceleration of inflow across the mitral valve at the rapid end
of the filling phase of diastole.
ANSWERs Graded A+
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
,causes of large bounding pulse include? - ANSWER -1. Increased stroke volume,
decreased peripheral resistance, or both as in, fever, anemia, Hyperthyroidism,
Aortic Regurgitation, arteriovenous fistulas, and Patent Ductus arteriosus 2.
Increased stroke volume bc of slow heart rates as in bradycardia et complete
heart block
3. Decreased compliance (increased stiffness) of aortic walls as in aging
atherosclerosis
Bisferiens pulse is? - ANSWER -Pulse is an increased arterial pulse with a double
systolic peak, detected during moderate compression of an artery.
Causes of bisferiens pulse include? - ANSWER -Pure aortic regurgitation,
combined aortic stenosis and regurgitation, et hypertrophic cardiomyopathy.
Pulsus Alternans is? - ANSWER -Pulse is completely regular but has alternating
strong et weak beats
What does pulsus alternans indicate? - ANSWER -Severe left ventricular failure
What does detection of pulsus alternans and Pulsus paradoxus require? -
ANSWER -Use of a BP cuff
Alternately loud et soft kortokoff sounds or sudden doubling of the apparent heart
rate as the cuff pressure declines signals what? - ANSWER -Pulsus Alternans
The carotid upstroke in aortic stenosis is? - ANSWER -Delayed
How does the carotid pulse present in cardiogenic shock? - ANSWER -Small,
thready (barely detectable), or weak
How does the pulse present in aortic regurgitation? - ANSWER -Bounding pulse
What does pressure on the carotid sinus cause? - ANSWER -reflex bradycardia or
drop in blood pressure
, Where are thrills in aortic stenosis transmitted to? - ANSWER -the carotid arteries
from the suprasternal notch or second right intercostal space
How can you place the pt to accentuate the finding of pulsus alternans? -
ANSWER -place pt in the upright position
What is Pulsus Paradoxus? - ANSWER -Greater than normal drop in systolic
pressure during inspiration
The pressure when Kortokoff sounds are first heard is the? - ANSWER -Highest
systolic pressure during the respiratory cycle
The pressure when sounds are heard throughout the cycle is the ? - ANSWER
Lowest systolic pressure.
A difference between these levels constitutes a paradoxical pulse? - ANSWER >=
10mm Hg to 12 mm Hg
What is paradoxical pulse found in? - ANSWER -Pericardial tamponade (life
threatening), Acute asthma, Obstructive pulmonary disease (COPD), Constrictive
pericarditis, Acute pulmonary embolism
Pulsus Alternans and Bigeminal pulse vary by? - ANSWER -Beat to beat
Pulsus Paradoxus varies with? - ANSWER -Respiration
Bigeminal Pulse is? - ANSWER -May mimic Pulsus Alternans, is caused by a
normal beat alternating with a premature contraction. The stroke volume of the
premature beat is diminished in relation to that of normal beats, and the pulse
varies in amplitude accordingly
In the healthy heart, the left ventricular impulse is usually the? - ANSWER -PMI,
generated by the movement of the ventricular apex against the chest wall during
contraction
, Normal left ventricular PMI classical descriptors? - ANSWER -Location: 4th or
5th Left intercostal space, midclavicular line
Diameter: Discrete, or <=2cm
Amplitude: Brisk and tapping
Duration: <=2/3 of systole
The right ventricular impulse? - ANSWER -Normally not palpable beyond
infancy and characteristics are indeterminate
Three additional types of ventricular impulses are? - ANSWER -Hyperkinetic;
Sustained; Diffuse
hyperkinetic ventricular impulse is? - ANSWER -transiently increased Stroke
Volume; does not necessarily mean heart disease; --Examples of Causes: Anxiety;
Hyperthyroid; severe anemia--Duration is <2/3 systole--the Amplitude is a more
forceful tapping
A Sustained ventricular Impulse is? - ANSWER -ventricular hypertrophy from
chronic pressure load (increased afterload)
Diffuse ventricular Impulse is? - ANSWER -Ventricular dilation from chronic
volume overload, or increased preload
Causes of hyperkinetic left ventricular impulse? - ANSWER -Pressure overload
from aortic stenosis, hypertension
1. Anxiety
2. Hyperthyroidism
3. Severe anemia
An S3 or ventricular gallop, may be pathologic or physiologic, In adults over 40,
an S3 is usually? - ANSWER -Pathologic, arising from high left ventricular filling
pressures and abrupt deceleration of inflow across the mitral valve at the rapid end
of the filling phase of diastole.
