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57 Cards in this Set
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heart sound? Due to the increased capacitance of the pulmonary vascular bed P2 closure can be delayed causing a 2 distinct sounds to be heard. In an adult it is heard during inspiration only.
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split S2 = A2 and P2 inspiration - S1 A2 P2 Expiriration - S1 S2
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P-wave
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atrial depolarization
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QRS wave
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ventricular depolarization
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Q wave
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downward deflection from septal depolarization
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R wave
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upward deflection from ventricular depolarization
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S wave
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downward deflection following R wave
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T wave
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ventricular repolarization
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CARDIAC OUPUT
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= HEART RATE X STROKE VOLUME
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STROKE VOLUME =
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VOLUME OF BLOOD EJECTED WITH EACH HEART BEAT DEPENDS ON THREE CRITICAL FACTORS:
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THE LOAD THAT STRETCHES THE CARDIAC MUSCLE BEFORE CONTRACTION
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PRELOAD
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ABILITY OF THE CARDIAC MUSCLE TO SHORTEN
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MYOCARDIAL CONTRACTILITY
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DEGREE OF VASCULAR RESISTANCE TO VENTRICULAR CONTRACTION (TONE OF THE WALLS OF AORTA- LARGE ARTERIES AND PERIPHERAL VASC TREE)
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AFTERLOAD
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Pathologic increases in Preload is called ?
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volume overload
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Pathologic increases in Afterload is called
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pressure overload
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peak pressure in the cardiac cycle
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Systolic Blood Pressure
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lowest trough IN BP
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Diastolic Blood Pressure
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difference between systolic and diastolic blood pressures
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Pulse Pressure
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Principle factors influencing BP
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1. LV stroke volume 2. Distensibility of Aorta 3. Peripheral Vasc Resistance 4. Vol of blood in Art. System
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When does venous pressure fall
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when LV output is low - hypovolumia
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Pressure in the jugular veins reflects _____ ________pressure (also known as ________ __________ Pressure)
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R. atrial - Central Venous
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IJ pulsations consists of 2 peaks and 2 troughs
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•a wave rise in atrial pressure seen in atrial contraction just before 1st heart sound and carotid pulse •x descent atrial relaxation and ventricular contraction •v wave when tricuspid valve closes and the R. atrium begins to fill the pressure rises •y wave tricuspid valve opens blood flows into the R. ventricle and pressure falls
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JUGULAR VENOUS WAVES a wave ->______ contraction -> D or S x wave atrial relaxation systole v wave atrial filling diastole y wave atrial emptying diastole
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atrial - D
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JUGULAR VENOUS WAVES x wave ->______ ________ -> D or S
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atrial relaxation - S
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JUGULAR VENOUS WAVES V wave ->______ ________ -> D or S
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atrial filling diastole
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JUGULAR VENOUS WAVES y wave ->______ ________ -> D or S
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atrial emptying diastole
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All of the follow are generally described as: myocardium- pericardium- Aorta- trachea- large bronchi- parietal pleura- esophagus- chest wall- neck- gallbladder- stomach.
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Chest pain
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normal BP
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120 / 80
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pre-hypertension BP
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systolic 120-139mmHg or diastolic 80-90mmHG
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how is carotid pulse described
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-Quality of upstroke -Amplitude strength of upstroke -Contour speed of upstroke duration and summit- speed of down stroke -Thrills or bruits Diaphragm or bell
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4 components of heart exam
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inspection - palpatation - percusssion - ausculation
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PALPATE POINT OF MAXIMUM IMPULSE
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Place patient in supine or L. lateral decubitus Location: usually in 5th ICS in MCL Diameter: usually 2.5 cm Amplitude: small brisk Duration: takes up to 2/3 of systole.
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parasternal lift or heave can be apparent
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RVH
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when would it be helpful to percuss the heart
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IN OBESE OR LARGE A-P DIAMETER PATIENTS
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4 main areas to listen to when auscultation of the heart
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1. R. 2nd ICS aortic post 2. L. 2nd ICS pulmonic post 3. L. lower sternal border 4th ICS tricuspid valve 4. L. midclavicular line 5th ICS mitral valve
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What part of the stetheoscope is used for high pitched sounds press firmly against the chest S1- S2- AI- MR- clicks- Ej- OS- friction rubs
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diaphragm
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What part of the stetheoscope is used for low pitched- light pressure
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Bell
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When ascultating the heart when is the diaphram of the stethoscope uses?
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when listening for S1 and S2
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When ascultating the heart when is the bell of the stethoscope uses
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lower left sternal boarder and apex of heart
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when pt lyies in left lateral decubitus positon what does that indicate?
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aortic insufficiency murmur or S3 and S4.
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What do the following relate to? Timing Shape Location Radiation Intensity Pitch Quality
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7 attributes of heart murmurs
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falls between S1 and S2 ( murmurs that coincide with carotid upstroke)
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systolic
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falls btween S2 and S1
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diastolic
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Where are mumurs located?
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-Sternal -Apex -Midclavicular line -Midaxillary line
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How is a murmur transmitted (radiation)?
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carotids- axilla- non-radiating
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how is the quality of a murmur described
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-blowing -harsh -rumbling -musical
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what inc mumur of HCOM and dec mumur of Aortic Stenosis (S)?
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standing and Valsalva maneuver
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How does standing and Valsalva maneuver effect mitral valuve prolapse?
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move the click heard in Mitral Valve Prolapse earlier in systole and the murmur would lengthen. The decrease in LV volume would increase the prolapse and increase the click sound. Squatting would do the opposite.
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What increases the intensity of the murmur?
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standing and Valsalva maneuver
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caused by: CARDIAC TAMPONADE AND COPD
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PULSES PARADOXICUS
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How is a PULSES PARADOXICUS performed?
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1. Inflate cuff 30mmHg above when pulse disappears 2. Slowly deflate cuff listening for the korotkoff sounds 3. Watch patient inspire and look for a drop greater than 10mmHg
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-Seen in Constrictive Pericarditis -Look for filling of IJ with inspiration. -Would expect to see flattening of the jugular veins in inspiration due to a decrease in intrathoracic pressure.
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KUSSMALS SIGN
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YOU (WILL or WILL NOT) GET A KUSSMALS SIGN IN CARDIAC TAMPONADE
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will not
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type of split S2? delayed closure of Pulm Valve- RBBB- Pulm stenosis- Mitral regurgitation
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wide split
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what type of split S2? doesn’t vary with respiration ASD- RV failure
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fixed split
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-High pitched sound -Use diaphragm to listen -Present in 5% of people -Location: apex L. lower sternal border
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systolic click
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-Can be normal in children and young adults up to the age of 40 -Normal to hear in pregnancy -Pathologic sound in older patients-due to decrease in myocardial contractility -An early diastolic sound -Dull low pitched sound use Bell of stethoscope -“Kentucky” galloping sound -Classic clinical scenario-Congestive Heart Failure
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S3
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-Can be normal in esp. in trained athletes and in older age. -More commonly heard in pathologic heart- increased resistance to ventricular filling due to decreased compliance of the L. ventricle -Occurs just before S1 (late diastole) -Dull- low in pitch- heard better with bell of stethoscope -“Tennessee” galloping sound -Classical clinical scenario is s/p Myocardial Infarction
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S4
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