CV Integration Lab

Question 1

How does venous return change during inspiration?

Answer 1

• increases return to RV
• decrease in return to LV
• these changes lead to altered murmur intensity
  
  • inspiration increases intensity of right sided murmurs

Question 2

How do insp/exp affect S3 and S4?

Answer 2

• increase with insp
• decrease with exp

Question 3

How does opening snap in TS change with expiration and inspiration? MS?

Answer 3

• TS - diminishes with exp; increases with insp
• MS - increases with exp; decreases with insp

Question 4

When might you hear a loud S1? soft? variable intensity?

Answer 4

1. Hyperdynamic (fever, exercise), MS, Atrial myxoma (rare)
2. Low CO (rest, heart failure), Tachycardia, Severe mitral reflux (caused by destruction of valve)
3. Atrial fibrillation, Complete heart block

Question 5

If you hear P2 audible at apex, what should be on your ddx?

Answer 5

• significant pulmonary HTN
• ASD

Question 6

Define the following:

1. Cardiogenic Shock
2. Distributive Shock
3. Hypovolemic Shock

Answer 6

1. Shock that is caused by failure of the heart as a pump to deliver adequate perfusion to peripheral tissues
2. Shock that is caused by failure of the arterial circulatory bed to maintain adequate perfusing pressure to peripheral tissues
3. Shock that is caused by significant reduction in circulating vascular volume, resulting in reduced perfusing pressure to peripheral tissues

Question 7

What are causes of a split S2?

Answer 7

Question 8

What influences Stroke Volume?

Answer 8

• LV preload/afterload
• Myocardial contractility

Question 9

Answer 9

nothing to add - just figured i should put this in here because of the questions he put by it

Question 10

If you see a pt with unexplained sinus tachycardia and hypotension, you should think of …

Answer 10

shock

* If you see a patient with shock who has bradycardia or a lower-than-expected heart rate, consider ways to increase the heart rate

Question 11

What two things should you measure in pt with suspected shock to help with prognostic info/therapy guidance?

Answer 11

1. arterial blood gases
2. lactate levels

Question 12

The dx of pericarditis requires at least 2 of what criteria?

Answer 12

• typical chest pain
• pericardial friction rub
• widespread ST segment elevation
• new or worsening pericardial effusion.

Question 13

If you suspect pericarditis, what is the most important next step?

Answer 13

• assess its hemodynamic impact, both clinically and echocardiographically, looking for evidence of cardiac tamponade, which is a medical emergency.

*Clinical features of cardiac tamponade include dyspnea, hypotension, tachycardia, jugular venous distention, and pulsus paradoxus of >10 mmHg

Question 14

If a pt has sharp pleuritic chest pain that improves when they sit up and lean forward, you should think …

Answer 14

acute pericarditis

*dyspnea, palpitations, diaphoresis, + sx of underlying cause may also be present

*characteristic finding is pericardial friction rub

Question 15

Where is the best place to hear a pericardial friction rub?

Answer 15

scratchy sound best heard with diaphragm over left sternal border

Question 16

What ECG changes are present with pericarditis? CXR? Echocardiograph?

Answer 16

1. ST elevation and/or PR depression
2. normal in acute; cardiomegaly with clear lung fields in pericardial effusion; pericardial calcification in constrictive
3. normal in acute (unless there is pericardial effusion - great tool to see this)