Cardio Resp Exam 2

Aortic stenosis is a condition characterized by narrowing of the aortic valve, which obstructs blood flow from the left ventricle to the aorta. This obstruction causes turbulent blood flow and creates a murmur. The murmur is typically heard best at the base of the heart and can radiate to the carotid arteries in the neck. This occurs because the carotid arteries are located close to the aortic valve and can transmit the sound of the murmur. Therefore, aortic stenosis is the most likely cause of a murmur that radiates to the carotids.

The S2 heart sound occurs with the closure of the aortic valve. This sound is produced when the aortic valve shuts after the ejection of blood from the left ventricle into the aorta. The closure of the aortic valve creates a brief pause in the blood flow, resulting in the S2 sound.

S4 is due to forceful atrial ejection. During inspiration, the negative intrathoracic pressure increases venous return to the right atrium, causing increased atrial contraction and forceful ejection of blood into the ventricles. This forceful atrial ejection creates a sound known as S4, which is heard best at the apex of the heart. The patient's position, either supine or in the left lateral decubitus position, enhances the transmission of this sound. S4 is not typically associated with valvular disease or misfiring of the cardiac conduction system, but rather with the rapid ventricular filling that occurs during forceful atrial ejection.

The S1 heart sound occurs with the closure of the mitral valve. This sound is produced when the ventricles contract and the mitral valve closes, preventing the backflow of blood into the left atrium. The closure of the mitral valve creates a sharp sound that can be heard as the first heart sound.

Mitral regurgitation is the most likely cause of the murmur radiating to the left axilla. Mitral regurgitation occurs when the mitral valve does not close properly, causing blood to flow back into the left atrium during ventricular contraction. This regurgitation of blood creates a turbulent flow, resulting in a murmur. The location of the murmur radiating to the left axilla suggests that the regurgitation is occurring in the mitral valve, as the left axilla is in close proximity to the left side of the chest where the mitral valve is located.

The given description of a diastolic rumble or opening snap heard best at the apex is characteristic of mitral stenosis. Mitral stenosis is a condition where the opening of the mitral valve is narrowed, causing blood flow from the left atrium to the left ventricle to be restricted. This leads to turbulent blood flow and the described murmur.

S3 is a normal heart sound that occurs during the rapid filling of the ventricles. It is heard best at the apex of the heart upon inspiration when the patient is in specific positions like supine or left lateral decubitus. Valvular disease refers to abnormalities in the heart valves and is not specifically related to S3. Misfiring of the cardiac conduction system refers to abnormal electrical impulses in the heart and is not directly related to S3. Forceful atrial ejection is not a known cause of S3. Therefore, the most appropriate explanation for S3 is rapid ventricular filling.

During inhalation, the 'split S2' sound is heard best at the 2nd intercostal space (ICS) along the left sternal border. This is because during inhalation, the pulmonary valve closes slightly later than the aortic valve, causing a brief separation of the two components of the second heart sound (S2). This split sound is most audible at the 2nd ICS, left sternal border, as it corresponds to the location of the pulmonary valve.

Grade 2 murmurs are characterized by being louder than grade 1 murmurs. In this case, the murmur is described as quiet, but once the stethoscope is placed on the chest, it becomes audible. This suggests that the murmur is not completely silent, but still relatively soft. Therefore, it falls into the category of grade 2 murmurs.

Mitral valve prolapse is considered a late systolic murmur because it occurs during the later part of systole, when the mitral valve leaflets bulge back into the left atrium. This can cause a clicking or snapping sound, which is characteristic of a late systolic murmur. Atrial regurgitation, mitral regurgitation, and mitral stenosis are not typically associated with a late systolic murmur.

This murmur is heard best at the left 2nd - 4th ICS after exhalation and is a high-pitched, blowing sound. Aortic regurgitation is the most likely cause of this murmur as it is characterized by blood flowing back into the left ventricle from the aorta during diastole. This causes a regurgitant flow and creates a blowing sound. Aortic stenosis, mitral stenosis, and mitral regurgitation would not typically produce this specific murmur.

Rheumatic heart disease is a condition caused by untreated strep throat that leads to inflammation and damage of the heart valves. Aortic regurgitation occurs when the aortic valve does not close properly, causing blood to leak back into the left ventricle. Mitral stenosis is a narrowing of the mitral valve, which obstructs blood flow from the left atrium to the left ventricle. Both of these conditions are commonly associated with rheumatic heart disease due to the damage caused by the inflammation.

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Mitral valve prolapse is characterized by the abnormal movement of the mitral valve leaflets, causing them to bulge back into the left atrium during systole. This can result in a clicking sound that is heard at the apex of the heart. In contrast, mitral stenosis is associated with a diastolic murmur, mitral regurgitation is characterized by a systolic murmur, and aortic regurgitation is associated with a diastolic murmur heard at the aortic area. Therefore, the correct answer is mitral valve prolapse.

The correct answer is aortic stenosis and pulmonic stenosis. These two murmurs are considered midsystolic because they occur during the middle of systole, which is the contraction phase of the cardiac cycle. Aortic stenosis is a narrowing of the aortic valve, causing turbulent blood flow and a characteristic harsh systolic ejection murmur. Pulmonic stenosis is a narrowing of the pulmonic valve, also causing turbulent blood flow and a systolic ejection murmur. Both of these murmurs are heard between the S1 and S2 heart sounds.