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Clinical Medicine III > Block I: approach to CV Pt. > Flashcards

Block I: approach to CV Pt. Flashcards

1
Q

describe the order of blood flow

A
  1. deoxygenated blood from body
  2. sup/inf. VC
  3. R atrium
  4. tri-cupsid valve
  5. R ventricle
    1. semi-lunar pulmonary valve
  7. Pulmonary arteries
  8. lung for oxygenation
  9. Pulmonary veins
  10. L atria
  11. bicuspid valve
  12. L ventricle
  13. aorta
  14. systemic circulation
  15. becomes doexygenated at capillary beds, returns via venous flow to sup/inf VC and cycle restarts
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2
Q

blood is supplied to heart tissue via coronary arteries during what phase of the cardiac cycle?

A

diastole (resting/filling phase)

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3
Q

the [] of the aorta supplies the heart with the L and R coronary arteries

A

first 2 branches of aorta

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4
Q

what major artery branches from the L coronary artery

A

Left Anterior Descending (LAD)

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5
Q

[]% of flow from the atria to the ventricles is passive

A

70, addtl. 30% from atrial contraction/atrial kick

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6
Q

outflowing systemic arteries function on a [] pressure system

A

high, need to perfuse tissue to oxygenate

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7
Q

there is a [] pressure system in systemic venous return

A

low

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8
Q

outflowing pulmonary arteries function on a [] pressure system

A

high

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9
Q

there is a [] pressure system on pulmonary venous return

A

low

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10
Q

as systole begins, ventricular contraction [] pressure in ventricles

A

raises pressure

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11
Q

as [] begins, ventricular contraction increases pressure in ventricles

A

raises

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12
Q

the increase in ventricular pressure during systole causes [] on the valves

A

forces mitral and tricupsid valves CLOSED to prevent backflow into atria during high pressure

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13
Q

what is happening at the moment where the S1 sound is being made

A

“lub”

Mitral and tricuspid valves are being forced shut during ventricular contraction
-prevents backflow of blood into atria during contraction

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14
Q

what does S1/lubb indicate

A

beginning systole

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15
Q

what are the two components of the S1 sound?

A
  1. mitral vavle closing

2. closure of tricuspid valve

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16
Q

what happens after ventricular systole?

A

as blood leaves ventricles, the preassure in ventricles falls BELOW that of pulomary and aortic artery
-allows aortic and pulmonic valves to close , causing the S2 sound

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17
Q

what is happening during S2

A

pressure in ventricles falls below aorta and pulmonic arteries
which forces the two semilunar valves (aortic, pulmonic) shut

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18
Q

what are the two components of the S2 sound

A
  1. A2: aortic semu lunar valve closing

2. P2: pulmonic semi lunar valve closing

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19
Q

the S2 sound indicates what

A

end of systole, beginning of diastole

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20
Q

what happens as ventricular pressure falls below atrial pressure in diastole

A

mitral and tricuspid valves open to allow blood blow back intro ventricles (diastole)

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21
Q

what is between S1 and S2

A

systole

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22
Q

what is between S2 and S1

A

diastole

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23
Q

filling of ventricles sometimes produces an [] sound

A

S3

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24
Q

[] may be the first clinical sign of congestive heart failure

A

S3 sound (of ventricular filling)

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25
Q

the [] can sometimes be heard as a 4th heart sound

A

atrial kick

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26
Q

what is happening during atrial diastole

A

all heart relaxed, atrial fill with blood from sup/inf CV and pulmonary arteries

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27
Q

what is happening during atrial systole

A

after 70% passive fillling, atria contract to push remaining 30% into ventricles “atrial kick” [sometimes S4 sound]

M1 and T1 valves open

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28
Q

what is happening during ventricular systole

A
  1. pressure builds in ventricles
  2. M1,T1 closure due to pressure build up (prevents back flow) [S1]
  3. ventricles contract
  4. semi lunar (aortic, pulmonary) valves open
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29
Q

what is happening during ventricular diastole

A
  1. pressure falls in ventricles
  2. pulmonic and aortic valves close (S2: A2, P2)
  3. M1, T1 valves open for passive filling of ventricles (can prod. S3 if CHF, or S4 if atrial kick)
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30
Q

what is another name for EDV

A

pre-load

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31
Q

[] is the fiber length of ventricles prior to the onset of the contraction, i.e. the amount of stretch during diastole

A

EDV, pre-load

*think balloon getting filled with air

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32
Q

[] is the resistance of L ventricular ejection and outflow i.e. stress of ventricular wall at the end of systole

A

after load

*think squeezing mouthpiece of balloon while letting air out

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33
Q

what is the P wave on an EKG

A

atrial contraction (kick, sometimes S4 sound)

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34
Q

what is the QRS complex on EKG

A

ventricular contraction

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35
Q

what is the T wave on EKG

A

diastole, recovery

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36
Q

where is the apical impulse best felt

A

lower L chest, can be palpated

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37
Q

how is a vigorous apical impulse described

A

heave, lift

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38
Q

what might a sustained/enlarged apical impulse indicate

A

myocardial hypertrophy/dysfunction

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39
Q

if an apical impulse is very prominent and NOT sustained, what might this indicate

A

volume overload or high output states

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40
Q

additional pulsations in apical impulse may reflect []

A

regional abrnomalities of L ventricular contraction

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41
Q

a parasternal lift indicates []

A

R ventricular hypertrophy, pulmonary HTN, L atrial enlargement

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42
Q

what is the PMI, where is it best felt?

A

Point of Maximum impulse: point at which apical impulse is most readily seen/felt

5th intercostal space in around mid-clavicular line

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43
Q

[] is a fine, palpable rushing vibration felt over the precordium

A

thrill

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44
Q

[] is likened to putting your hand on a purring cat

A

thrill

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45
Q

[] has the same significance as murmurs

A

thrills

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46
Q

thrills have the same significance as []

A

murmurs

47
Q

[] is a result of eddies from blood coursing through abnormal heart or arteries and leads to a vibration transmitted to peripheral structures

A

thrill/murmur

48
Q

[] is more sensitive to vibrations

A

ear

49
Q

most murmurs are accompanied by []

A

thrills

50
Q

valve sounds are best heard in the area [] the direction of blood flow

A

away

51
Q

specific heart sounds are best heart over areas where [] in relation to the valve

A

over ares where blood flows after it passes through a valve

52
Q

where is the aortic valvue auscultated

A

2nd intercostal space, along R sternal border

53
Q

where is the pulmonic valve auscultated

A

2nd intercostal space, along L sternal border

54
Q

where is the 2nd pulmonic sound auscultated

A

3rd intercoatal space along L sternal border

“erb’s point”

55
Q

where is the tricuspid valve best heard

A

4th L intercostal space, lower L sternal border

56
Q

there is the mitral valve best heard

A

5th L intercostal space, mid-clavicular line

similar to PMI

57
Q

describe Lub/S1 sound

A
  1. indicates systole

2. is sound of M1, T1 being forced closed by increasing ventricular pressure as ventricles contract

58
Q

S1 correlates to the [] on EKG

A

QRS complex

59
Q

where is S1 best heart

A

apex of heart

60
Q

[] occurs simultaneously with carotid pulse

A

S1

61
Q

[] is usually louder than S2

A

S1

62
Q

S2/dubb description

A

is the sound of pulmonic and aortic valves (A2, P2) closing, marks end of systole and begining diastole
can sometimes be split
-A2 closes slightly before P2

63
Q

why might an S2 be split

A

normal, because pressures are higher and depolarization occurs earlier in L heart

64
Q

where is S2 best heard?

A

erb’s point

3rd IC space along LSB

65
Q

when might S2 sounds be accentruated

A

conditions that cause abnormal delay in pulmonic valve closure

  1. increased vol. in R ventricle
    - ventricular septal defect
    - atrial septal defect
  2. chronic R ventricular outflow obstruction
    - pulmonic stenosis
  3. acute/chronic dilation of R ventricle due to sudden rise in pressure
    - PE
66
Q

period between S1-S2 is []

A

systole

67
Q

S2-S1 is []

A

diastole

68
Q

events occur slightly later in [] side of heart

A

R

-pressure lower

69
Q

what is an S3 sound

A

ventricular filling

-quiet difficult to hear

70
Q

when does S3 occur

A

right after S2

71
Q

in intesnt S3 sound may be described as a []

A

gallop

72
Q

S3 occurs during what phase of cardiac cycle?

A

diastole, heart in early diastole after S2

73
Q

[] is caused by deceleration of blood flowing into ventricles when ventricles reaches its final stage of filling

A

S3 “atrial kick”

74
Q

where is S3 best heard

A

apex of heart, with patient laying on L side

75
Q

when may an S3 sound be heard in a patient (disease states)

A
  1. pregnancy
  2. CHF
  3. MI
  4. myocardial contusion
  5. volume overload of ventricle
  6. mitral valve regurgitation
76
Q

what is an S4 sound

A
  1. second phase of ventricular filling

2. vibration in valves, papillae, and ventricular walls

77
Q

an intense S4 sound may be galled a []

A

gallop

78
Q

when does S4 occur

A

before S1, at the end of diastole

79
Q

[] is caused by vibrations of L ventricular muscle of mitral valve & left ventricular flow tracts as a result of forceful atrial contraction into distended ventricle

A

S4

80
Q

when might an S4 be heard in a patient? (disease states)

A
  1. decreased vascular compliance due to HTN
  2. CAD
  3. aortic stenosis
  4. cardiomyopathy
  5. profond anemia
  6. pregnancy
  7. thyrotoxicosis
81
Q

what is the most common cause of an S4 gallop

A

decreased ventricular compliance due to HTN

82
Q

cardiac valves generally open []

A

noiselessly, unless thickened, roughed or altered

83
Q

a snap sound indicates []

A

MITRAL valvular stenosis

84
Q

a click sound indicates []

A

SEMILUNAR valve stenosis

85
Q

mid-to-late non-ejection systolic clicks may indicate []

A

mitral valve prolapse

86
Q

[] is a high frequency sound that occurs shortly after S1 in mid, early, late systole

A

click

87
Q

what are clicks and when are they best heard?

A
  1. high frequency sound that
  2. shortly after S1
    - mid-late systole
88
Q

clicks indicate []

A

mitral valve prolapse

89
Q

[] is a sustained noise that is audible during times of systole, diastole or both

A

murmur

90
Q

a systole murmur occurs when

A

between S1 and S2

-when ventricles are contracting

91
Q

what causes a systolic murmur

A

forward flow across aortic of pulmonic valve

regurgitant flow from mitral/tricuspid valve

92
Q

what is holosystolic?

A

systolic murmur merges with first sound

93
Q

what is pansytolic?

A

systolic murmur that occurs throughout entire systolie

94
Q

when does a diastolic murmur occur

A

between S2-S1

when ventricles are relaxed and filling during diastole

95
Q

what are some abnormalities that may cause a diastolic murmur

A
  1. aortic reguritation
  2. pulmonic regurgitation
  3. mitral stenosis
  4. tricuspid stenosis
96
Q

diastolic murmus are [] pathologic

A

ALWAYS

97
Q

why are diastolic murmurs always pathologic

A
  1. include mitral valve stenosis and aortic valve regurgitation
98
Q

murmurs with thrills are [] significant

A

ALWAYS

99
Q

[] begins after S1 and ends before S2 with a peak in early-mid systole

A

ejection

100
Q

when does ejection peak?

A

occurs after S1 and ends before S2, peaks in early-mid systole

101
Q

what causes an ejection

A

aortic/pulmonic valve stenosis

happens as blood leaving/ejecting from heart

102
Q

what is a grade 1 murmur

A

very faint

103
Q

what is a grade 2 murmur

A

quiet

104
Q

what is a grade 3 murmur

A

moderately loud

105
Q

what is a grade 4 murmur

A

loud with palpable thrill

106
Q

what is a grade 5 murmur

A

very loud, easily pablpable

107
Q

what is a grade 6 murmur

A

very loud, audible with stethescope off chest

108
Q

a very faint murmur is grade []

A

1

109
Q

a quiet murmur is grade []

A

2

110
Q

a moderately loud murmur is grade []

A

3

111
Q

a loud murmur with palpable thrill is grade []

A

4

112
Q

a very loud murmur that is easily palpable is grade []

A

5

113
Q

a very loud murmur that is audible with stethescope off chest is a grade [] murmur

A

6

Clinical Medicine III (5 decks)

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