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2410<3assess (exam1) Flashcards

1
Q

the __ is the area on the anterior chest that overlies the great vessel

A

prechordium

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2
Q

the __occupies most of the anterior cardiac surface

A

(R) ventricle

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3
Q

the __ of the heart refers to the proximal surface of the heart at the right & left 2nd ICS close to sternum

A

base

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4
Q

the __forms the left lateral margin of the heart

A

(L) ventricle

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5
Q

its tapered tip is referred to as the__ and produces the apical impulse AKA point of maximal intensity

A

apex

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6
Q

the __ & __ return o2 poor venous blood to the (R) side of <3

A

superior & inferior vena cava

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7
Q

the blood flows through the right __ through the __ & into the __

A

atrium, tricusid valve, (R) ventricle

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8
Q

the __ blood leaves the right ventricle through __ & carries the venous blood to the __

A

unoxygenated blood, pulmonic valve, pulmonic artery

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9
Q

the __ returns o2 rich blood to the __ through the __ into the __

A

pulmonic vein, (L) atrium, mitral valve, (L) ventricle

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10
Q

it is delivered to the body through the __ and into the __

A

aortic valve, aorta

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11
Q

position of <3

A

extends from 2 ICS to 5 ICS from (R) border of the sternum to LMCL

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12
Q 
describe position of:
cardiac valves
tricuspid
mitral
aortic
pulmonic
A

separates RA from RV
separates LA from LV
btw LV & aorta
btw RV & pulmonary artery

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13
Q

describe diastole

  1. valve
  2. pressure
  3. 1st & last phase
  4. end
  5. associated sound
A

ventricular relax

  1. AV valves are open
  2. atrial pressure > ventricular pressure
  3. 1st: early/protodiastolic filling
    last: atrial systole or presystole (atrial kick)
  4. end: atria contract pushing remainder of blood into ventricles
  5. normally silent
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14
Q

describe systole

  1. valve
  2. pressure
  3. 2 phases
A

ventricular contract

  1. (AV) mitral & tricuspid valve closed
  2. ventricular pressure> atrial pressure
  3. S1 phase S2 phase:
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15
Q

what are AV valves

A

(atrioventricular) mitral & tricuspid

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16
Q

what are SL valves

A

(semilunar) aortic & pulmonic

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17
Q

describe two phases of systole where best heard

A

S1 phase: CLOSURE OF AV valves signal sysole and -pressure in ventricles rise SL (aortic & pulmonic) valves open (heard @ apex)

S2 phase: @ end of systole, ventricular pressure decrease and SL valves close, CLOSURE OF SL valves signals end of systole ( heard @ base)

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18
Q

effects of respiraton on <3 & what is it called

A

moRe right Less left
decrease in intrathroacic pressure -> increase venous blood on (R) side of delays closure of pulmonic valve
less volume on (L) -> aortic valve closes early
SPLIT S2

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19
Q

Describe S3

  1. what happens
  2. when it happens
  3. valves
  4. best heard
A

protodiastolic phase (early diastole)

  • rapid filling
  • immediately after s2
  • AV valves opened-> blood rushing in ventricles
  • left lateral position apex
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20
Q

when will you hear S3

A
  • in people with heart failure or high cardiac output state or filling overlaod
  • can hear in young ppl w/ compliant vessels
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21
Q

Describe s4

  1. when
  2. aka
  3. whats happening
A

presystolic phase

  • occurs before s1, at end of diastole
  • presystole
  • ventricles are resistant to filling & atria push blood into noncompliant ventricles
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22
Q

define murmur & conditions that cause it

A

gentle blowing swishing sound
increase velocity, viscosity in blood
defects in valves
dilated chamber

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23
Q

developmental changes in infants & children

A

<3 is more horizontal
apex is higher (4th ICS MCL)
adult position by 7 yo

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24
Q

developmental changes in preg. women

A

blood volume increase by 30-40%
HR increase
BP low due to peripheral vasodilation

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25
developmental changes in aging adult
increase BP increase HR arrythmia increase increase incidence in <3dz
26
define angina & describe symptoms
chest pain | diaphroresis, pallor, palpitations, dyspnea, nausea, trachy<3
27
define DOE & PND
Dyspnea on exertion | paroxysmal nocturnal dyspnea (occurs with <3 fail)
28
what happens in PND
Pt lies down-> increase of volume of intrathoracic blood to weak <3 cant accomodate increase of blood, pt wakes up SOB
29
define hemoptysis | when is cardiac fatigue the worst
blood in sputum | evening
30
where are carotids palpated | where are carotids auscultated
base of neck | angle of jaw, mid cervicle, base of neck
31
why do we inspect JVP
Jugular venous pressure 1. can reflect central venous pressure 2. no cardiac valves separate the superior vena cava from RA 3. JVP gives good info about (R) side of <3
32
position of PT to assess JVP
1. 30-45 degrees 2. remove pillow 3. turn head slightly to (L) 4. look for pulsation in IJV EJV
33
how to estimate the JVP
1. use the angle of louis 2. with ruler on angle of louis align with pulsations 3. normal is = or < 2cm
34
hepatojugular reflex
holding hand in RUQ, push, which empties blood from liver into venous sysem, if heart can't pump JVP will rise will occur with <3 failure
35
w/ deep inspiration this <3 sound will sound like 2 distinct sounds
split s2
36
heard best with Diaphragm
s1 s2 split s2
37
tennes se
s4
38
heard every 4th beat
split s2
39
``` S3 what phase what part of steth is used where is it best heard best PT position does it vary with resp found normally in what kind of gallop which state is it associated with ```
``` early diastolic low pitched (bell) apex left lateral position no children, young people ventricular ken tucky ```
40
corresponds with carotid
s1
41
``` S4 what causes this sound when do you hear it what kind of sound when is it normally heard kind of gallop best heard where & PT position state association ```
``` ventricular filling heard before S1 soft low pitch (bell) adults after exercising atrial gallop @ apex left lateral position Tennes se ```
42
heard best at pulmonic valve area, what ICS
s2, split s2, 2nd LICS
43
occurs b/c of noncompliance
s3 s4
44
mitral valve precedes tricuspid but heard as one sound
s1
45
atrial gallop
s4
46
best heard at left lateral position
s3 s4
47
heard in young children and young adults
split s2 s3
48
often heard with fluid overload
s3
49
difference between split s2 & s3
split s2 every 4th but s3 every beat
50
how to assess prechordium and what are you checking for
using palmar/ulnar surface of hand, palplate apex and LSB base of heart, checking for thrills (palpable vibrations)
51
what causes heaves or lifts and where seen
thrusting of the ventricles during systole, happens with ventricular hypertrophy RV heave: sternal border LV heave: apex
52
norm position of apical impulse, abnorm and what does it indicate
norm: 4th or 5th ICS LMCL abnorm: lower & lateral to LMCL ->LV hypertrophy
53
``` auscultation of <3, where are most murmurs heard 2nd RICS 2nd LICS 3rd LICS 5th LICS 5th LICS MCL ```
3rd LICS Erb's point 1. aortic 2. pulmonic 3. erb's point 4. tricuspid 5. mitral
54
systolic murmur
heard btw s1 & s2
55
diastolic murmur
heard btw s2 & s1
56
pan-systolic or holo-systolic
heard throughout
57
3 loudness grades
I: barely audible IV: associated with thrill VI: loud with stethoscope slightly off chest
58
3 patterns of murmurs
crescendo: grows louder decrescendo: tapers diamond: crescendo & decrescendo
59
3 quality of murmurs
musical blowing harsh rumbling
60
where can murmur radiate (4 areas)
precordium neck back axillae
61
7 characteristics of innocent murmur
``` no pathology soft grade 2 or more midsystolic musical heard @ 2-3LICS decreases when sitting heard in children ```
62
characteristic of functional murmur
turbulence of blood in heart Occurs secondary to increased blood flow (anemia, fever, pregnancy, hyperthyroidism) Disappears when condition is corrected
63
order of exam for <3 & neck vessels
HR & BP Neck Vessels Precordium extremities (periph vasc assessment)
64
difference btw murmur & bruits
murmur: turbulence in blood flow in <3 bruits: turbulence of blood flow in atery
65
``` S1 1 axn of valves 2 sound produced 3 best heard (where & with what) 4 signals ```
1. Closure of the atrioventricular valves Tricuspid and Mitral (AV valves) 2. “Lub” of the lub-dub 3. Best heard at the apex & with the diaphragm 4 Signals beginning of systole
66
``` s2 1 axn of valves 2 sound produced 3 best heard (where & with what) 4 signals ```
1. Closure of the semilunar valves & Aortic and pulmonic 2. “Dub” of the lub-dub 3. Best heard at the base with the diaphragm 4 Signals the end of systole
67
define Protodiastolic
Early diastole is the passive filling phase of diastole
68
Atrial systole or Atrial kick
End of diastole -> atria contract and push last amount of blood into ventricles
69
Effects of respiration on S2
During inspiration, intrathoracic pressure is decreased. This increases venous blood return to the right side of the heart which increases the right ventricular stroke volume. The increased volume prolongs right ventricular systole and DELAYS closure of the pulmonic valve. Left side has less blood, thus aortic valve closes earlier than pulmonic valve. Can hear two components separately. Referred to as a split S2.
70
When is S3 normal & abnormal (3)
norm: children abnorm: Fluid overload, decreased compliance of the ventricle Can occur with high output states
71
When can you hear an S4
Normal after exercise | Abnormal: decreased compliance of the ventricles, hypertension
72
norm jvp
2 cm or less with pt. at 30 degrees
73
abnorm jvp
3 cm or more with pt. at 30 degrees
74
If you note an elevated JVP reading, you should perform_______________
hepatojuglar reflex
75
Heave or lift
Forceful thrusting seen on the chest wall. L ventricular lift -> apex Right ventricular lift -> sternal border
76
Diaphragm of the stethoscope (3 sounds)
Normal heart sounds, split S2, aortic or pulmonic valve murmurs
77
Bell of the stethoscope (3 sounds)
S3, S4 (also called diastolic sounds), mitral and tricuspid valve murmurs
78
How do you evaluate a murmur? (8)
``` Timing: diastolic or systolic Loudness: grade I through VI Pitch: high, medium or low Pattern: crescendo, decrescendo, diamond-shaped Quality: musical, blowing, harsh, rumbling Location Radiation Posture ```

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