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114 Cards in this Set
- Front
- Back
Heart function
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Circulate blood through the body and lungs, in two separate circulations
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Heart position
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In mediastinum, to the left of midline, just above diaphragm, cradled between medial and lower borders of the lungs, behind the sternum and 3-6 costal cartilages
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Precordium
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Area of the chest overlying the heart
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Dextrocardia
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Heart is a mirror image of the normal heart
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Situs inversus
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Heart and stomach are placed to the right and the liver to the left
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Pericardium
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tough, double-walled, fibrous sac encasing and protecting the heart, several mL of fluid between the two layers for low friction
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Epicardium
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thin outermost muscle layer, covers the surface of the heart and extends into the great vessels
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Myocardium
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thick muscular middle layer, responsible for pumping action
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Endocardium
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innermost layer, lines the chambers of the heart and cover the heart valves and small muscles that open and close the valves
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Atria
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small, thin-walled structures acting as reservoirs for blood returing to the heart from the veins throughout the body
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Ventricles
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large, thick-walled chambers the pump blood to the lungs and body, primary muscle mass of the heart
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Anterior surface of the heart
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right ventricle
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Left border of the heart
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left ventricle
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Apical impulse
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created by the pumping of the left ventricle, felt in the 5th left intercostal space at the midclavicular line
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Right border of the heart
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right atrium
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Posterior aspect of the heart
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left atrium
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Size of heart
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12 cm long, 8 cm wide at widest point, 6 cm AP diameter
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Atrioventricular valves
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tricuspid and mitral valves
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Tricuspid valve
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three cusps, separates right atrium from right ventricle, open on atrial contraction, close on ventricular contraction
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Mitral valve
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two cusps, separate left atrium from left ventricle, open on atrial contraction, close on ventricular contraction
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Semilunar valves
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each have three cusps, pulmonic and aortic valves
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Pulmonic valve
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separates the right ventricle from the pulmonary artery, open on ventricular contraction, closed when ventricles relax
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Aortic valve
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lies between the left ventricle and aorta, open on ventricular contraction, closed when ventricles relax
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Systole
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ventricles contract, ejecting blood from the left ventricle into the aorta and from the right ventricle into the pulmonary artery, pressure change forces mitral and tricuspid valves to close, produces S1 heart sound (the lubb)
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Diastole
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ventricles dilate, which draws blood in as the atria contract
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S1
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lubb, produced by the closing of the mitral and tricuspid valves at the start of systole, ventricular pressure increases to close those valves while also opening the aortic and pulmonary valves
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S2
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dubb, produced by the closing of the aortic and pulmonary valves when ventricular pressure falls, has two components- A2 and P2, as ventricular pressure falls, mitral and tricupsid valves open
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S3
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produced by the passive filling of the ventricles during diastole
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S4
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produced by the atrial contraction to completely fill the ventricles during diastole
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Splitting
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occurs because the pressure on the right side is lower than the left, so the right side sounds occur slightly behind the left side sounds
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SA
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site of electrical impulse generation and pacing, located in wall of right atrium
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AV node
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located in atrial septum, receives impulse from SA node, impulse is delayed and then passes down bundle of His to Purkinje fibers
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Ventricular contraction
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initiated at the apex and proceeds toward the base
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ECG
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graphic recording of electrical activity during the cardiac cycle, records electrical current generated by movement of ions in and out of the myocardial cell membranes
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Depolarization
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spread of stimulus through the heart muscle
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Repolarization
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return of stimulated heart muscle to resting state
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P wave
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spread of stimulus through the atria, atrial depolarization
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PR interval
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time from initial stimulation of the atria to initial stimulation of the ventricles, 0.12-0.20 seconds
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QRS complex
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spread of stimulus through theventricles, ventricular depolarization, less than 0.1 seconds
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ST segment and T wave
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return of stimulated ventricular muscle to a resting state, ventricular repolarization
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U wave
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small deflection sometimes seen just after T wave
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QT interval
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time elapsed from onset of ventricular depolarization until the complete repolarization, varies with cardiac rate
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Foramen ovale
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fetal circulation from right atrium to left atrium to bypass the lungs
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Ductus arteriosis
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fetal circulation from the right ventricle to the aorta to bypass the lungs, closes 24-48 hours after birth
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Ventricle size ratio
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2:1 left:right, achieved by 1 year of age
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Fetal heart size
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lies more horizontal, apex is in 4th left intercostal space, reaches adult position by 7 years
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Maternal circulation
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blood volume increases 40-50% due to increased plasma volume (which increases 50% with single pregnancy, 70% with twins), left ventricle increases in thickness and mass, blood volume returns to normal 3-4 weeks after delivery, cardiac output increases 30-40% and returns to normal 2 weeks after delivery, position of heart is more horizontal
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Elderly circulation
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heart size decreases (except in HTN/heart disease), LV wall thickens and valves fibrose and calcify, heart rate slows, stroke volume decreases, cardiac ouput during exercise declines by 30-40%, endocardium thicken, myocardium is less elastic, irritability is increased (response to stress is less efficient), tachycardia is poorly tolerated, return to normal heart rate takes longer, first degree AV block, BBB, ST-T waves abnormalities, premature systole, L anterior hemiblock, L ventricular hypertrophy and atrial fibrillation
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Anginal chest pain
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substernal, provoked by effort, emotion, eating; relieved by rest and nitroglycerin; accompanied by diaphoresis, occasionally nausea
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Pleural chest pain
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precipitated by breathing or coughing; described as sharp; present during respiration; absent when breath is held
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Esophageal chest pain
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burning, substernal, occasional radiation to shoulder; nocturnal occurrence, when lying flat; relief with food, antacids, sometimes nitroglycerin
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Peptic ulcer chest pain
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infradiaphragmatic and epigastric; nocturnal occurrence and daytime attacks relieved by food; unrelated to activity
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Biliary chest pain
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usually under R scapula, prolonged in duration; occurs after eating; will trigger angina more often than mimic it
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Arthritis/bursitis chest pain
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usually lasts for hours; local tenderness or pain with movement
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Cervical chest pain
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associated with injury; provoked by activity, persists after activity; painful on palpation of movement
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Musculoskeletal chest pain
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intensified or provoked by movement, particularly twisting or costochondral bending; long lasting; associated with focal tenderness
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Psychoneurotic
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associated with anxiety; poorly described; located in intramammary region
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Light exercise
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walking 10-15 steps, preparing simple meal, retrieving newspaper from outside door, pulling down bedspread, brushing teeth
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Moderate exercise
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making the bed, dusting and sweeping, walking a short block, office filing
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Moderately heavy exercise
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climbing one or two flights of stairs, lifting full cartons, long walks, sex
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Heavy exercise
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jogging, vigorous athletics, cleaning the entire house, raking leaves, mowing lawn, shoveling snow
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Cardiac disease risk factors
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gender (men more at risk, women after menopause and with oral contraceptives), hyperlipidemia, elevated homocysteine, smoking, FH, DM, obesity, sedentary lifestyle, personality type
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Cholesterol recommendations
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total cholesterol less that 200, LDL of 100, LDL with previous MI/DM of 70
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Apical impulse
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5th intercostal space, MCL, usually less than 1 cm
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Heave or lift
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apical impulse that is more vigorous than expected
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Lift on left sternal border
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caused by right ventricular hypertrophy
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Apical impulse loss of thrust
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overlying fluid or air, displacement beneath the sternum
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Displacement of apical impulse to right
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dextrocardia, diaphragmatic hernia, distended stomach or pulmonary abnormality
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Thrill
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fine, palpable, rushing vibration, palpable murmur, often over the base of the heart in the right or left 2nd intercostal space; indicates turbulence or a disruption of the expected blood flow related to defect in semilunar valves, pulmonary HTN or atrial septal defect
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Thrill
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murmur of IV or more can be felt
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Aortic stenosis thrill
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felt in systole at suprasternal notch or 2nd and 3rd R intercostal spaces
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Pulmonic stenosis thrill
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felt in systole at suprasternal notch or 2nd and 3rd L intercostal spaces
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Ventricular septal defect thrill
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felt in systole at 4th intercostal space
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Mitral regurgitation thrill
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felt in systole at apex
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Tetralogy of Fallot thrill
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felt in systole at L lower sternal border
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Patent ductus arteriosus thrill
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felt in systole at L upper sternal border, often with extensive radiation
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Aortic regurgitation thrill
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felt in diastole at R sternal border
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Aneurysm of ascending aorta thrill
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felt in diastole at R sternal border
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Mitral stenosis thrill
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felt in diastole at apex
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Percussion
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CXR is a better tool for determining size of the heart, change from resonant to dull from axilla to sternum in intercostal spaces indicates position of the heart
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Where are heart sounds best heard?
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in areas where the blood flows after it passes through the valve
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Aortic valve
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2nd R intercostal space at R sternal border
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First pulmonic valve
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2nd L intercostal space at L sternal border
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Second pulmonic valve
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3rd L intercostal space at L sternal border
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Tricuspid valve
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4th L intercostal space along lower L sternal border
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Mitral valve
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apex of the heart in 5th L intercostal space at MCL
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S1 and carotid
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S1 corresponds with the rise (upswing) of the carotid pulse
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Split S2
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best heard in pulmonic area during inspiration
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Bacterial endocarditis
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bacterial infection of the endothelial layer of the heart and valves; seen in individuals with valvular defects, congenital or acquired, and IV drug users; symptoms- fever, fatigue, murmur, sudden onset of CHF; signs- neurologic dysfunctions, Janeway lesion, Osler nodes
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Janeway lesion
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small erythematous or hemorrhagic macules appearing on the palms and soles
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Osler nodes
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appear on the tips of fingers and toes, caused by septic emboli
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Congestive heart failure
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heart fails to propel blood forward with its usual force, resulting in congestion in the pulmonary or systemic circulation; seen in patients with decreased cardiac output, can be L (systolic or diastolic) or R sided; symptoms- fatigue, orthopnea, breathing difficulty, SOB, edema; signs- develop gradually or suddenly, systolic has narrow pulse pressure, diastolic has wide pulse pressure
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Diastolic CHF
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result of advanced glycation cross-linkage collagen, creating a stiff ventricle unable to dilate actively, occurs in older adults and patients with DM whose tissue is exposed to glucose
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L sided heart failure
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dyspnea, orthopnea, tachycardia, decreased systolic or pulse pressure, third heart sound, crackles in lungs, abdominojugular reflux, edema may or may not be present
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Pericarditis
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sudden inflammation of the pericardium; if is persists a pericardial effusion may increase and result in cardiac tamponade; symptoms- sharp/stabbing chest pain, worse with movement or inspiration, most severe when supine, relieved when leaning forward; signs- scratchy, grating, triphasic friction rub, compromises ventricular systole, early diastolic ventricular filling and late diastolic atrial systole, easily heard L of sternum in 3rd and 4th intercostal spaces
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Cardiac tamponade
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excessive accumulation of effused fluids or blood between the pericardium; constrains cardiac relaxation- impairs access of blood to R heart, causes- pericarditis, malignancy, aortic dissection and trauma; symptoms- anxiety, restlessness, chest pain, difficulty breathing, discomfort (relieved when sitting upright or leaning forward), syncope, pale gray or blue skin, palpitations, rapid breathing, swelling of abdomen or arms or neck veins, signs- Beck's triad, may scar and constrict- limiting cardiac filling, heart sounds are muffled, BP drops, pulse is weak and rapid, paradoxic pulse is exaggerated
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Beck's triad
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jugular venous distention, hypotension and muffled heart sounds
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Cor pulmonale
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enlargement of the R ventricle secondary to pulmonary malfunction; usually chronic, chronic cause- COPD, acute causes- massive PE and ARDS, alterations in pulmonary circulation leads to pulmonary arterial HTN which puts load on R ventricular emptying; symptoms- fatigue, tachypnea, exertional dyspnea, cough, hemoptysis, signs- evidence of pulmonary disease, wheezes and crackles, increased chest diameter, labored respirations with chest wall retractions, distended neck veins with prominent A or V waves, cyanosis, L parasternal systolic heave, loud S2 in pulmonic region
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Myocardial infarction
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ischemic myocardial necreosis caused by abrupt decrease in coronary blood flow to a segment of the myocardium; mostly affects L ventricle, causes- atherosclerosis and thrombosis; symptoms- deep substernal or visceral pain that radiates to the jaw, neck and L arm, may be mild; signs- dysrhythmias, S4 is present, distant heart sounds, soft systolic blowing apical murmur, thready pulse, BP varies with HTN in early phases
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Myocarditis
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focal or diffuse inflammation of the myocardium; cause- infection agents, toxins or autoimmune diseases like amyloidosis; symptoms- initial are vague, fatige, dyspnea, fever, palpitations; signs- cardiac enlargement, murmurs, gallops, tachycardia, dysrhythmias, pulsus alternans
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Conduction disturbances
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either proximal to the bundle of His or diffusely throughout the conduction system; causes- ischemic, infiltrative or neoplastic, antidepressants, digitalis, quinidine, symptoms- transient weakness, syncope, gray-out may precede the event, strokelike episodes, rapid or irregular heartbeat, signs- labile heart rates, rhythm disturbances
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Causes of syncope
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C-cardiac; valve stenosis, Stokes-Adams attack, conduction disturbances, A- arteriovenous; steal syndromes, N- nervous; psychologic, autonomic, vagal, coughing, A- anemia; altered blood CO, D- drugs, diabetes, alcohol poisons, A-altitude, acute fevers
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Sick sinus syndrome
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arrhythmias caused by a malfunction of the sinus node; causes- secondary to HTN, arteriosclerotic heart disease, rheumatic heart or idiopathic, symptoms- fainting, transient dizziness, light-headedness, seizures, palpitations, angina; signs- dysrhythmias, CHF
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Tetralogy of Fallot
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4 cardiac defects- VSD, pulmonic stenosis, dextroposition of the aorta and R ventricular hypertrophy; surgery is recommended, symptoms- dyspnea with feeding, poor growth, exercise intolerance, paroxysmal dyspnea with loss of consciousness and central cyanosis, signs- parasternal heave and precordial prominence, systolic ejection murmur over 3rd intercostal space, radiating to L side of neck, single S2 heard, older children have clubbing
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Ventricular septal defect
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opening between the L and R ventricles, 30-50% close spontaneously in 2 years, symptoms- recurrent respiratory infections, rapid breathing, poor growth, CHF, signs- arterial pulse is small, jugular venous pulse is unaffected, holosystolic murmur- loud, coarse, high-pitched, best heard at L sternal border in 3-5 intercostal spaces, lift along L sternal border and apical area, smaller defect- louder murmur, more easily felt thrill
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Patent ductus arteriosus
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failure of the ductus arteriosus to close after birth, increases pressure in pulmonary circulation and increased workload of R ventricle, symptoms- small may be asymptomatic, larger- dyspnea on exertion, signs- dilated and pulsatile neck vessels, wide pulse pressure, harsh loud continuous murmur in 1-3 intercostal spaces and lower sternal border, machine-like quality, murmur unaltered by postural change
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Atrial septal defect
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congenital defect in the septum dividing the L and R atria, symptoms- often asymptomatic, heart failure in adults, signs- diamond shaped systolic ejection murmur- loud, high pitched and harsh heard over pulmonic area, accompanied by brief, rumbling, early diastolic murmur, does not radiate, systolic thrill and parasternal thrust, S2 is widely split
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Acute rheumatic fever
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systemic connective tissue disease occuring after streptococcal pharyngitis or skin infection; may cause valve involvement of mitral or aortic, valve becomes stenotic and regurgitant, 5-15 years most commonly affected, prevention- adequate treatment of infection; symptoms- fever, inflamed swollen joints, flat or slightly raised, painless rash with pink margins and pale centers and ragged edge (erythema marginatum), aimless jerky movements (Sydenham chorea or St. Vitus dance), small painless nodules beneath skin, chest pain, palpitations, fatigue, SOB; signs- murmurs of mitral regurgitation and aortic insufficiency, cardiomegaly, friction rub, CHF
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Kawasaki disease
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condition causing inflammation in walls of small and medium arteries throughout the body, including coronaries; AKA mucocutaneous LN syndrome, 80% affect infants and children under 5; symptoms- high fever longer than 5 days, conjunctivitis, cracked red and inflamed lips, strawberry tongue, white coating on tongue or prominent papillae, cervical lymphadenopathy, erythema of palms and soles, joint pain and swelling, irritability, tachycardia
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Atherosclerotic heart disease
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caused by deposition of cholesterol, other llipids and a complex inflammatory process, leads to wall thickening and narrowing of the lumen; symptoms- may be asymptomatic, angina, SOB, palpitations, FH, signs- dysrhythmias and CHF
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Mitral insufficiency/regurgitation
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abnormal leaking of blood through the mitral valve, from L ventricle to L atrium; symptoms- acute has decompensated CHF, SOB, pulmonary edema, orthopnea, PND, decreased exercise tolerance, chronic compensated may be asymptomatic, sensitive to small changes in volume, prone to develop CHF; signs- high-pitched pansystolic murmur radiating to axilla, may have third heart sound
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Angina
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pain caused by myocardial ischemia, oxygen demand exceeds supply, can be recurrent; symptoms- substernal pain or intense pressure radiating to neck, jaws and arms, SOB, fatigue, diaphoresis, faintness, syncope; signs- tachycardia, tachypnea, HTN, diaphoresis, crackles, reduction in S1 intensity, S4
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Senile cardiac amyloidosis
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amyloid, fibrillary protein produced by chronic inflammation or neoplastic disease, deposition in the heart, contractility is reduced, causes heart failure; symptoms- palpitations, lower extermity edema, fatigue, reduced activity tolerance; signs- pleural effusion, arrhythmia, lower extremity edema, dilated neck veins, hepatomegally or ascites, ECG/echo sows small, thickened L ventricle, R ventricle may be thickened
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Aortic sclerosis
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thickening and calcification of aortic valves, usually asymptomatic, midsystolic ejection murmur
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