Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
118 Cards in this Set
- Front
- Back
In a tall, slender person, the heart tends to hang more
|
Vertically and positioned centrally
|
|
In a more stocky and short person the heart thends to lie more
|
To the left and positioned horizontally
|
|
The heart may be positioned to the right, either rotated or displaced (mirror image of what is expected)
|
Dextrocardia
|
|
When the heart and stomach are placed to the right and the liver to the left this habitus is termed
|
situs inversus
|
|
Thin outermost muscle layer of the heart that extends onto the great vessels
|
Epicardium
|
|
Primary muscle mass of the heart consists of the
|
Right and left ventricles
|
|
Most of the anterior surface of the heart is formed by the
|
Right ventricle
|
|
Poster to the right ventricle but extends around to the anterior is the
|
Left Ventricle
|
|
Apical impulses caused by the ventricular contraction and thrust are felt here
|
5th left intercostal space at the midclavicular line
|
|
Coronary arteries and veins are found below this layer
|
Serous pericardium (visceral layer epicardium)
|
|
The most posterior aspect of the heart is formed by the
|
Left atrium
|
|
Dimensions of the heart
|
12 cm long; 8 cm wide at the widest point; 6 cm AP diameter
|
|
The only intracardiac pathways of a normal heart
|
Atrioventricular and semilunar valves
|
|
AV valves
|
Tricuspid and mitral valve
|
|
Semilunar vavles
|
Pulmonic and aortic
|
|
Contraction of the ventricles open these valves
|
Semilunar valves
|
|
Ventricle contraction shuts these vavles
|
AV valves
|
|
Phase of cardiac cycle when ventricles contract
|
Systole
|
|
Energy-requiring phase of cardiac cycle when ventricles dilate
|
Diastole
|
|
First heart sound (S1; "lubb") is caused by
|
AV vavle closure
|
|
Usual sound of valves opening
|
None
|
|
Closure of these valves causes the second heart sound (S2, "dubb")
|
Semilunar vavles
|
|
Components of the S2
|
A2 (aortic valve) and P2 (pulmonic valve)
|
|
S3 is a heart sound caused by
|
Filling of the ventricles
|
|
S4 is a heart sound caused by
|
Ejection of blood from the contraction of the atria
|
|
Heart sound heard during isometric contraction
|
S1
|
|
Heart sound heard during isometric relaxation
|
S2
|
|
Cardiac phase of rapid ejection and reduced ejection phase
|
Systole
|
|
P wave represents
|
Atrial depolarization
|
|
Normal PR interval
|
0.12 - 0.20 secs
|
|
PR interval represents
|
Time from stimulation of the atria to stimulation of the ventricles
|
|
QRS complex represents
|
Ventricular depolarization
|
|
Normal interval of QRS complex
|
< 0.10 secs
|
|
T wave represents
|
Ventricular repolarization
|
|
Closure of the ductus arteriosus usually occur within (hrs)
|
24-48 hrs
|
|
Relative size of the adult ventricular sizes
|
Left is twice as big as right ventricle
|
|
Age when ventricular size approximate to that of an adult's?
|
1 year
|
|
Usually adult heart position is rached by this age
|
7 years
|
|
Blood volume increase during pregnancy
|
40-50%
|
|
Time when blood volume returns to normal postpardum (wks)
|
3-4 weeks
|
|
During pregnancy, cardiac output increases by
|
30-40%
|
|
After delivery, cardiac output returns to normal after (wks)
|
2 weeks
|
|
Cardiac output reaches highest level by (wks)
|
25 to 32 weeks of gestation
|
|
Vavles most affected by fibrosis and sclerosis in older adults
|
Mitral vavle and aortic cusps
|
|
Common EKG changes in older patients
|
1st degree AV block, bundle branch blocks, ST-T wave abnormalities, premature systole (atrial and ventricular), left anterior hemiblock, left ventrcular hypertophy and atrial fibrilation
|
|
A sudden, sharp, relatively brief non-radiating pain, occurs most often at rest and is unrelated to exertion and mya not have a discoverable cause
|
Precordial catch
|
|
Possible causes of chest pain
|
Cardiac
Aortic Pleuropericardial Pain GI disease Pulmonary disease Musculoskeletal Psychoneurotic (illicit drug use) |
|
Exercise intensity of getn' it on
|
Moderately Heavy (climbing 1-2 flights of stairs, lifting full cartons, long walks)
|
|
Risk factors for cardiac disability that would increase chances by app. 8x > if none is present
|
Hyperlipidemia
Smoking DM |
|
Upon palpation of your patient's PMI, you feel an apical impulse that is more forceful and widely distributed, last throughout systole or is laterally and downwardly displaced which may indicate...
|
Left ventricular hypertrophy
|
|
You feel lift along the left sternal border which may be caused by...
|
Right ventricular hypertrophy
|
|
An apical impulse displaced to the right without a loss or gain in thrust suggests...
|
dextrocardia, diaphragmatic hernia, distned stomach or a pulmonary abnormality
|
|
A fine palpable, rushing vibration or palpable murmur
|
Thrill
|
|
Most likely place to feel a thrill on the chest of your patient
|
Over the base of the hear in the area of the right or left second intercostal space
|
|
A thrill might indicate these problems
|
Defect in the closure of one of the semilunar valves, pulmonary hypertension or atrial septal defect
|
|
Location of the carotid pulse in relation to the jaw
|
Medial and inferior to the angle of the jaw
|
|
Grade level of a thrill
|
Grade IV of more
|
|
Thrills that are found at these sitse during systole may indicate these probable causes:
- Suprasternal notch and/or 2nd & 3rd right rib space - Suprasternal notch and/or 2nd & 3rd left rib space -4th left intercostal space -Apex -Left lower sternal border -Left upper sternal border often with extensive radiation |
- Suprasternal notch and/or 2nd & 3rd right rib space = Aortic stenosis
- Suprasternal notch and/or 2nd & 3rd left rib space = Pulmonic stenosis -4th left intercostal space = Ventricular Septal Defect -Apex = Mitral Regurge -Left lower sternal border = Tetralogy of Fallot -Left upper sternal border often with extensive radiation = Patent ductus arteriosus |
|
Thrills that are found at these sitse during diastole may indicate these probable causes:
- Right sternal border - Apex |
- Right sternal border = Aortic Regurgitation or Aneurysm of ascending aorta
- Apex = Mitral stenosis |
|
Amount of pressure when using the diaphragm of your stethoscope, and bell?
|
Firm pressure with diaphragm
Light pressure with the bell |
|
5 traditionally designated asucultatory areas (whatcha listening to?):
- 2nd right rib space at the sternal border - 2nd left rib space at the sternal border - 3rd left rib space at sternal border - 4th left rib space along sternal border - 5th left rib space at the MCL |
- 2nd right rib space at the sternal border = Aortic valve area
- 2nd left rib space at the sternal border = Pulmonic valve area - 3rd left rib space at sternal border = Second pulmonic valve area - 4th left rib space along sternal border = Tricuspid area - 5th left rib space at the MCL = Mitral area |
|
Heart sound that usually splits during inspiration
|
S2
|
|
S2 marks the initiation of this cardiac event
|
Diastole
|
|
S2 spliet is best heard in this auscultatory area
|
Pulmonic area
|
|
S1 is best heard at this location of the heart
|
The apex
|
|
S1 is the result from closure of these valves and indicates this cardiac event
|
AV valves close during systole
|
|
S2 is heard best over this area of the heart
|
The base
|
|
S3 is best evaluated at this location of the heart (Ventricular gallop)
|
Apex
|
|
S4 is best evaluated at this location of the heart (Atrial gallop)
|
Apex
|
|
Auscultatory area best for S1 split
|
Tricuspid
|
|
Events that might produce louder S1
|
- Increased in blood velocity (anemia, fever, hyperthyroidism, anxiety, exercise)
- Mitral stenosis |
|
Events that might produce softer S1
|
- Complete heart block
- fibrillation - increased overlying tissue, fat, or fluid - Pulmonary hypertension - Fibrosis or calcification of mitral valve preventing it from closing as forcibly |
|
Events that might produce louder S2
|
- Systemic hypertension, syphilis of aortic valve, exitement, exercise
- Pulmonary hypertension, mitral stenosis, CHF |
|
Events that might produce softer S2
|
- Arterial hypotension
- Aortic stenosis - Pulmonic stenosis - Overlying tissue, fat or fluid |
|
Why does physiological splitting of S2 occur?
|
- Pressures are higher and depolarization occurs earlier on the left side of the heart
- Ejection times on the right are longer and the pulmonic valve closes later than the aortic vavle |
|
RBBB splits S1 or S2?
|
Both
|
|
When splitting is unaffected by respiration
|
Fixed Splitting - Occurs with delatyed closure of the pulmonic vavle when output of the right ventricle is greater than that of the left
|
|
Splitting that occurs when closure of the aortic vavle is delyed so that the P2 occurs first followed by A2
|
Paradoxic (Reversed) Splitting - The interval between P2 and A1 is heard during expiration and disappears during inspiration
|
|
Reasons why S3 would be louder
|
-Increased ventricular filling
-Decreased compliance -S3 is best hear when patient is in the left lateral recumbent |
|
Words that most resemble rhythms in which S3 or S4 is heard
|
ken-TUCK-y = S3
TEN-nes-see = S4 |
|
Ejection clicks are made by
|
Semilunar Valves
|
|
Mid-to-late nonejection systolic clicks are made by
|
Mitral valve
|
|
The pulmoniary ejection click is best heard on ____ and is seldom heard on ____
|
Expiration, Inspiration
|
|
Pericardial friction rub may be heard widely but is more distinct toward the
|
Apex
|
|
Origin of murmur:
Inspiration increases murmur Expiration decreases murmur |
Right-sided chambers
|
|
Origin of murmur:
Vasalva and squatting to standing (rapidly for 30 secs) increases murmur Standing to squatting rapidly and passive leg elevation to 45 degs (supine) decreases murmur |
Hypertrophic cardiomyopathy
|
|
Origin of murmur:
Handgrip increases murmur |
Mitral Regurgitation
|
|
Origin of murmur:
Transient arterial occulsion (brachial artery) increases murmur Inhalation of amyl nitrate decreases murmur |
Ventricular septal defect
|
|
Describe maneuvers that can distinguish aortic stenosis
|
No maneuver distinguishes this murmur; the diagnosis can be made by exclusion
|
|
Age and expected heart rates:
Newborn, 1 year, 3 years, 6 years and 10 years |
Newborn
1 year: 120-170 bpm 3 years: 80-160 bpm 6 years: 75-115 bpm 10 years: 70-110 bpm |
|
This accounts for most acquired murmurs in children
|
Rheumatic Fever
|
|
This murmur occurs in active healthy children between the ages of 3 to 7 yrs; often described as musical
|
A Still murmur
|
|
Systolic ejection murmurs may be heard over the pulmonic area in 90% of pregnant women, Murmur should not be louder than grade ___?
|
Grade II (Quiet but clearly audible)
|
|
How is mitral stenosis detected?
|
Heard with bell at the apex, with patient in left lateral decubitus position
|
|
Where can you best hear aortic stenosis? (you hear a crescendo-decrescendo sound) along the left sternal border and to carotid with palpable thrill)
|
Heard over aortic area; ejection sound at second right intercostal border; the more severe the stenosis, the later the peak of the murmur in systole
|
|
Where would you detect a subaortic stenosis?
|
Heard at apex and along left sternal border
|
|
Where is pumonic stenosis heard?
|
Over pulmonic area; it radiates to left and into neck; thrill in 2nd and 3rd left rib space
|
|
Triscuspid is best heard over this area
|
Heard with bell over tricuspid area
|
|
Mitral regurgitation is best heard here
|
Heard best at apex; loudes there, transmitted into left axilla
|
|
Where can you detect a mitral valve prolapse and describe the sound?
|
Heard at apex and left lower sternal border when patient is upright; late systolic murmur preceded by midsystolic clicks
|
|
How would you listen for an aortic regrugitation murmur?
|
Heard with diaphragm, patient sitting and leaning forward; ejection click heard in 2nd intercostal space; Austin-flint murmur heard with bell
|
|
Low-pitched, rumbling murmur at apex common in aortic regurgitation
|
Austin-Flint murmur
|
|
How would you listen for a tricspid regurge murmur?
|
Heard at left lower sternum, occasionally radiating a few centimeters to left
|
|
Physical finding:
Displacement of the apical impulse can be well lateral to MCL and downward; PMI is >2 cm |
Left Ventricular Hypertrophy
|
|
Physical finding:
Lifts along the left sternal border in the 3rd and 4th rib spaces; occasional systolic retraction at the apex |
Right Ventricular hypertrophy
|
|
Findings:
Triphasic friction rub (ventricular systole, early diastolic ventricular filling and late diastolic atrial systole); 90% of patients with this disease present with these findings |
Pericarditis
|
|
Presentation:
Edema, ascites, dyspnea; Heart sounds are muffled, bp drops and pulse weakened and rapid and paradoxic pulse becomses exaggerated |
Cardiac Tamponade
|
|
Common causes of tamponade
|
Pericarditis, aortic dissection and trauma
|
|
Enlargement of the right ventricle secondary to pulmonary malfunction
|
Cor Pulmonale
|
|
Desirable level of total cholesterol
|
200 mg/dL
|
|
Desirable level of LDL
|
100 mg/dL
|
|
Cardiac defects of the tetrology of Fallot
|
Ventricular Septal Defect
Pulmonary Stenosis Dextroposistion of the aorta (overriding aorta) Right Ventricular Hypertrophy |
|
Clinical presentation of tetrology of Fallot
|
Paroxysmal dyspnea with loss of consciousness
Central cyanosis Parasternal heave and precordial prominence Single S2 is heard Systolic ejection murmur is heard over the 3rd rib space |
|
Holosystolic Murmur
Murmur is loud, coarse, high-pitched and best heard along the left sternal border in the 3rd-5th rib spaces |
Ventricular Septal Defect
|
|
Neck vessels dilated and pulsate and the pulse pressure is wide
A harsh, loud, continuous murmur is often heard at the 1st-3rd rib spaces and the lower sternal border Murmur is machine-like quality and usually does not change with posture |
Patent Ductus Arteriosis
|
|
Causes a systolic ejection murmur that is diamond shaped, often loud, high pitch and harsh
Best heard over the pulmonic area S2 split may be fairly wide |
Atrial Septal defect
|
|
Major Manifestations of rheumatic fever according to Jones Criteria
|
Carditis
Polyarthritis Chorea Erythema marginatum Subcutaneous nodule |
|
Usually silent and painless until it produces sudden heart failure, strok or dysrhythmias
|
Mitral insufficiency
|