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518 Exam 1 > Cardiac > Flashcards

Cardiac Flashcards

1
Q

What is the mediastinum?

A

a connective tissue–lined compartment located centrally in the thoracic cavity. It is bordered by the lungs on either side, the sternum anteriorly, and the thoracic vertebral bodies posteriorly. The mediastinum houses the heart and its great vessels—the aorta, pulmonary artery, and superior and inferior vena cavae—as well the esophagus, trachea, thoracic duct, and thoracic lymph nodes.

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2
Q

What is the most anterior structure of the heart?

A

Right atrium

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3
Q

Where is the PMI of the heart found?

A

At the cardiac apex, the tapered inferior tip of the left ventricle. It is typically located at the 5th intercostal space at the left midclavicular line

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4
Q

Where is the PMI located in dextrocardia?

A

On the right side of the chest

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5
Q

What is a PMI >2.5cm evidence of?

A

left ventricular hypertrophy

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6
Q

If the patient’s PMI is not at the apex, but rather at the xyphoid process or epigastric area, what might be causing this?

A

COPD, or right ventricular hypertrophy

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7
Q

What would cause the PMI to move laterally, placing it 10 cm or more lateral to the midsternal line?

A

left ventricular hypertrophy or ventricular dilation from myocardial infarction or heart failure

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8
Q

What are the two atrioventricular valves?

A

The mitral and tricuspid

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9
Q

What are the two semi lunar valves called?

A

aortic and pulmonic

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10
Q

what are s3 and s4 heart sounds? Are they normal? What do they indicate?

A

In most adults, the diastolic sounds of S3 (kentucky) and S4 (Tennessee) are pathologic, and are correlated with systolic and diastolic heart failure, respectively.

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11
Q

What does an s3 heart sound correspond with?

A

An S3 corresponds to an abrupt deceleration of inflow across the mitral valve.

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12
Q

What does an s4 heart sound correspond with?

A

An S4 corresponds to increased left ventricular end diastolic stiffness which decreases compliance.

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13
Q

What is the period of ventricular contraction called?

A

systole

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14
Q

what is the period of ventricular relaxation called?

A

diastole

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15
Q

What does the s1 sound correspond with?

A

Closure of the mitral valve and the tricuspid valve in the right side of the heart

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16
Q

What does the sound of s2 correspond with?

A

aortic valve closure, as well as closure of the pulmonic valves

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17
Q

When might you hear an audible “opening snap” of the mitral valve?

A

In restricted valve motion, as in mitral stenosis.

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18
Q

Where on the chest would you ascultate the aortic valve?

A

Right second intercostal space or cardiac apex

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19
Q

Where on the chest would you ascultate the sounds of the pulmonic valce?

A

Left second and third intercostal spaces close to the sternum, but also at higher or lower levels

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20
Q

Where on the chest would you ascultate the tricuspid valve?

A

At or near the lower left sternal border

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20
Q

Where on the chest would you ascultate the tricuspid valve?

A

At or near the lower left sternal border

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21
Q

Where on the chest would you ascultate the mitral valve?

A

At and around the cardiac apex

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22
Q

Where does the cardiac electrical impulse orginate?

A

the sinus node in the right atrium, near the junction of the vena cava

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23
Q

Explain ejection fraction

A

EF is the percentage of ventricular blood volume that is ejected with each heart beat, and is normally 60%

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24
Q

Explain stroke volume

A

The volume of blood ejected with each heart beat

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25
Q

What is cardiac output defined as?

A

Cardiac output, the volume of blood ejected from each ventricle in 1 minute, is the product of heart rate and stroke volume.

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26
Q

What are the two common manifestations of heart failure?

A

Heart failure with preserved ejection fraction and heart failure with reduced ejection fraction

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27
Q

What is preload?

A

The amount of blood that stretches the cardiac muscle before contraction. The volume of blood in the RV at the end of diastole is its preload for the next heartbeat.

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28
Q

What are some causes of increased preload?

A

Physiologic causes include inspiration and the increased volume of blood flow from exercising muscles. The increased blood volume of a dilated RV in heart failure also increases preload.

29
Q

What are some causes of decreased right ventricular preload?

A

Causes of decreased right ventricular preload include exhalation, dehydration, and pooling of blood in the capillary bed or the venous system

30
Q

What is myocardial contractility?

A

Myocardial contractility refers to the ability of the cardiac muscle, when given a load, to shorten. Contractility increases when stimulated by action of the sympathetic nervous system and decreases when blood flow or oxygen delivery to the myocardium is impaired, as occurs in MI.

31
Q

What is afterload?

A

Afterload refers to the degree of vascular resistance to ventricular contraction.

32
Q

What are four factors that affect blood pressure?

A

Left ventricular stroke volume
Distensibility of the aorta and the large arteries
Peripheral vascular resistance, particularly at the arteriolar level
Volume of blood in the arterial system

33
Q

What does jugular venous pressure (JVP) reflect?

A

Right atrial pressure

34
Q

What do absent A waves represent on an EKG?

A

atrial fibrillation

35
Q

What are concerning symptoms that would trigger you to do a cardiac exam?

A

Chest pain
Palpitations
Shortness of breath: dyspnea, orthopnea, or paroxysmal nocturnal dyspnea
Swelling (edema)
Fainting (syncope)

36
Q

How is the pain of aortic dissection commonly described?

A

Anterior chest pain, often tearing or ripping and radiating into the back or neck

37
Q

True of false: Women with acute coronary syndrome can present with atypical symptoms such as upper back or jaw pain, shortness of breath, nausea or fatigue

A

Both men and women with acute coronary syndrome usually present with the classic symptoms of exertional angina; however, women, particularly those over age 65, are more likely to report atypical symptoms that may go unrecognized, such as upper back, neck, or jaw pain; shortness of breath; paroxysmal nocturnal dyspnea; nausea or vomiting; and fatigue, making careful history-taking especially important.

38
Q

What might be the cause of a sudden onset of dyspnea

A

Sudden dyspnea occurs in pulmonary embolus, spontaneous pneumothorax, and anxiety.

39
Q

What is orthopnea?

A

Shortness of breath when the patient is supine that improves when the patient sits up

40
Q

How much fluid can interstitial tissue absorb before pitting edema appears?

A

Up to 5L

41
Q

Other than cardiac or pulmonary causes, what might cause pitting edema?

A

Causes are frequently cardiac (right or left ventricular dysfunction; pulmonary hypertension) or pulmonary (obstructive lung disease)20 but can also be nutritional (hypoalbuminemia), and/or positional.

42
Q

How can you help a patient with a risk of fluid retention to monitor fluid accumulation?

A

Consider asking patients who retain fluid to record daily morning weights because edema may not be obvious until several liters of extra fluid have accumulated; however, rapid weight gain (more than 1 to 2 lb/day) will occur prior to visible edema.

43
Q

How old would a patient have to be to have a JVP that is visible and accurate enough to give a reliable assessment?

A

12 year old

44
Q

What measurement of JVP would be considered “elevated above normal”?

A

> 3cm above the sternal angle, or 8cm in total distance above the right atrium

45
Q

Why is it important to ascultate the carotid artery prior to palpation?

A

As the presence of carotid atherosclerosis could potentially narrow the carotid arteries, it is important to auscultate the carotid arteries prior to palpating the carotid pulse.

The most feared complication of carotid artery palpation is the dislodgment of an atherosclerotic plaque, which could result in stroke.

46
Q

When palpating the carotid pulse, what finding might indicate aortic stenosis?

A

Delayed carotid upstroke

47
Q

When might the carotid pulse be weaky/thready? When might it be bounding?

A

The carotid pulse is small, thready (barely detectable), or weak in cardiogenic shock; the pulse is bounding in aortic regurgitation.

48
Q

What is pulsus alternans? What does it indicate?

A

Pulsus Alternans. In pulsus alternans, the rhythm of the pulse remains regular, but the force of the arterial pulse alternates because of alternating strong and weak ventricular contractions. Pulsus alternans almost always indicates severe left ventricular dysfunction.

49
Q

How can you assess for a paradoxical pulse?

A

As the patient breathes quietly, lower the cuff pressure to the systolic level. Note the pressure level at which the first sounds can be heard. Then drop the pressure very slowly until sounds can be heard throughout the respiratory cycle. Again, note the pressure level. The difference between these two levels is normally no greater than 3 or 4 mm Hg.

50
Q

How can you easily differentiate between paradoxical pulse and pulsus alternans?

A

Pulsus alternans and a bigeminal pulse vary beat to beat; a paradoxical pulse varies with respiration.

51
Q

How can palpation of the carotid artery help in the assessment of cardiac murmurs?

A

Palpation of the carotid artery during auscultation is an invaluable aid to the timing of sounds and murmurs. Since the carotid upstroke always occurs in systole immediately after S1, sounds or murmurs coinciding with the upstroke are systolic; sounds or murmurs following the carotid upstroke are diastolic.

52
Q

In what patients might palpation of the chest wall be less useful?

A

Palpation is less useful in patients with a thickened chest wall (obesity) or increased AP diameter (obstructive lung disease).

53
Q

When palpating the chest wall- what is a heave? What might it indicate?

A

To palpate heaves, use your palm and/or hold your fingerpads flat or obliquely against the chest. Heaves are sustained impulses that rhythmically lift your fingers, usually produced by an enlarged right or left ventricle (depending on the location of the heave) and occasionally by ventricular aneurysms.

54
Q

True or false: the presence of a thrill changes the grading of a murmur

A

True

55
Q

How might an apical impulse be shifted in a pregnant patient?

A

Upward and left

56
Q

How might a patient with atrial stenosis present?

A

Patients with an atrial septal defect often experience dyspnea as well as atrial arrhythmias. Fixed splitting of the second heart sound occurs in atrial septal defects and right heart failure and does not vary with respiration

57
Q

True or false: Tricuspid stenosis causes a splitting of the S2 heart sound

A

False. Tricuspid stenosis would not usually affect the second heart sound as it is a component of S1.

58
Q

How long is a normal QRS complex? How would a left bundle branch block effect the QRS complex?

A

The QRS complex is the duration of ventricular depolarization and is normally less than 100 milliseconds. A left bundle branch block would extend ventricular depolarization and cause lengthening of the QRS complex and its duration.

59
Q

What does the QRS wave correspond to? The P wave? T wave?

A

The P wave is the result of atrial depolarization and would therefore have changes associated with atrial enlargement. The QRS complex, R wave, and S wave are a result of ventricular depolarization, whereas the T wave is a result of ventricular repolarization.

60
Q

If heart rate reduces by 20%, with no change in stroke volume, how would the cardiac output change?

A

Cardiac output is the product of heart rate and stroke volume. Therefore, if the heart rate decreases by 20%, the cardiac output would decrease by 20% if the stroke volume did not change.

61
Q

How can you assess for splitting of S2?

A

Listen for splitting of this sound in the second and third left intercostal spaces. Ask the patient to breathe quietly and then slightly more deeply than normal.

62
Q

True or False: murmurs are a common, normal finding in pregnant patients.

A

False. Murmurs detected during pregnancy should be promptly evaluated for possible risk to the mother and fetus, especially those of aortic stenosis or pulmonary hypertension.

63
Q

what is the intima and why is it significant in cardiovascular disease?

A

The innermost layer of all blood vessels is the intima, a single continuous lining of endothelial cells with remarkable metabolic properties.1 Atherosclerotic plaque formation begins in the intima

64
Q

What is an anastamoses?

A

If an artery is obstructed, anastomoses between branching networks of smaller arteries can increase in size over time to form collateral circulation that perfuses structures distal to the occlusion.

65
Q

What are the three arteries of the upper limbs?

A

Ulnar, Radial and Brachial

66
Q

What are the three arteries that stem from the femoral artery?

A

the popiteal, posterior tibial and dorsalis pedis

67
Q

How can you differentiate between edema and lymphedema?

A

Edema is typically compressable, while lymphedema (from obstructed lymphatic drainage) is usually not compressable.

68
Q

Why are upper extremity DVTs more common in recent years?

A

increased placement of central venous catheters, cardiac pacemakers, and defibrillators.19 Most patients present with unilateral or asymmetric swelling of the extremities.

69
Q

Differentiate between pulses tardus and pulses parves

A

Pulsus parvus refers to weak pulses, usually seen with atherosclerotic PVD, while pulsus tardus refers to sluggish pulses, usually occurring in the setting of aortic stenosis or low cardiac output.

518 Exam 1 (3 decks)

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