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PD Block 2 > Cardiac exam > Flashcards

Cardiac exam Flashcards

1
Q

pericardium

A

tough, double-walled, fibrous sac that encases the heart

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2
Q

aortic valve

A

semi lunar valve, between LV and aorta

  • closes off LV until pressure overcomes the pressure in the aorta
  • prevents blood flowing back into LV during diastole
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3
Q

pulmonic valve

A
  • separates the right ventricle from the pulmonary artery
  • closes off RV, opens to allow blood to be pumped into the lungs to be oxygenated
  • prevents blood flowing back into the RV
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4
Q

great vessels

A 
superior vena cava
inferior vena cava
pulmonary artery
pulmonary vein
aorta
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5
Q

apex

A

summit of the heart, points downward at the base

  • muscles in the apex are primarily responsible for regulating ventricle contraction
  • play a role in transmitting signals from the atrial nodes
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6
Q

base

A

the broader portion of the heart

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7
Q

precordium

A

area on anterior chest overlying the heart

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8
Q

tricuspid valve

A

separate the RA from the RV,

tricuspid allows blood to flow from RA to RV during diastole

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9
Q

mitral valve

A

separates LA from LV

allows blood to flow from LA to LV during diastole

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10
Q

order of cardiac valves

A

try pulling my arm

Tricuspid, Pulmonic, mitral, aortic

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11
Q

systole blood flow

A

increasing ventricular pressure causes tricuspid and mitral valves to close (S1)
-pulmonary artery and aorta open and blood flows from ventricles into the arteries

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12
Q

diastolic blood flow

A
  • ventricular pressure falls below arterial pressure, pulmonary and aortic valves close (S2)
  • ventricular pressure falls below atrial pressure, tricuspid and mitral valves open allowing blood to fill the ventricles (S3)
  • atrial contaction to ensure complete ejection of blood into the ventricles (S4).
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13
Q

What are A2 and P2

A

A2 is the closing of the aortic valve

P2 is the closing of the pulmonic valve

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14
Q

What makes S3?

A

relative passive filling of the ventricles

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15
Q

What makes S4?

A

The atria contraction to ensure the the ejection of any remaining blood.

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16
Q

What is split S2 caused by?

A

the aortic valve usually closes slightly ahead of the pulmonic valve, if that is heart it is called a split S2 sound

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17
Q

where do the electrical impulses in the heart begin?

A

The SA sino atrial node, located in the wall of the right atrium

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18
Q

where do the impulses from the SA node travel?

A

to through both atria to the atrioventricular node (AV node), which is located in the atrial septum

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19
Q

What happens when the impulse arrives at the AV node?

A

the impulse is delayed and then passes down he bundle of His to the Purkinje fibers
- the ventricular contraction is initiated at the apex of the heart and moves toward the base

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20
Q

what is depolarization?

A

spread of stimulus through the heart muscle

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21
Q

what is repolarization?

A

the return of the stimulated heart to a resting state

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22
Q

P wave

A

spread of a stimulus through the atria (atrial depolarization)

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23
Q

PR interval

A

time of the intitial stimulation of the atria to the initial stimulation of the ventricle
-usually .12 to .20 of a second

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24
Q

QRS complex

A

spread of the stimulus through the ventricels,

usually less that 0.1 of a second

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25
Q

ST segment of the T wave

A

the return of stimulated ventricular muscle to a resting state
- ventricular repolarization

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26
Q

U wave

A

a small deflection rarely seen after the T wave

- thought to be the repolarization of the Purkinje fibers

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27
Q

QT interval

A

time elapsed from onset of ventricular depolarization until the completion of the ventricular repolarization

28
Q

when are systole and diastole approximately the same length of time

A

at about 120 bpm

29
Q

which is usually shorter at resting heart rate?

A

systole is normally shorter than diastole at a resting heart rate

30
Q

Where is best to listen for aortic focus?

A

right, 2nd ICS right sternal border

hear S2

31
Q

Where is best for pulmonic focus?

A

left 2nd and 3rd ICS left sternal border

hear S2

32
Q

Where is best to hear the tricuspid?

A

left 4th ICS left sternal border

33
Q

Where is best to hear the mitral valve?

A

left 4-5th ICS in midclavicular line

S1 heard here at apex

34
Q

Where is Erb’s point and what is heard here?

A

left 3rd ICS left sternal border

35
Q

Where is best to hear split S2 sounds?

A

during deep inspiration

at the pulmonic area: left 2nd and 3rd ICS

36
Q

Where is S1 usually heard louder than S2?

A

left 4-5th ICS in MCL, apex of heart

37
Q

Where is the best location to hear S2?

A

Either in the aortic or pulmonic areas:

aortic: right 2nd ICS
pulmonic: left 2nd ICS

38
Q

Where is S2 louder than S1?

A

S2 is louder than S1 at the base of the heart

39
Q

When is S2 splitting heard?

A

During inhalation
Causes increased venous return right atrium
and slightly reduced pulmonary return to the left A

40
Q

What makes the S1 sound?

A

Closing of the Mitral and Tricuspid valves

this is the beginning of systole

41
Q

What make the S2 sound?

A

Closing of the aortic and pulmonic valves

This is the end of systole

42
Q

Hypotension

A

low blood pressure

systolic lower than 90mmHg

43
Q

orthostatic hypotension

A

abnormal decrease in BP when going from sitting to standing
systolic change > 20mmHg,
diastolic change > 10mmHg

44
Q

hypertension

A

Stage 1: 140-159 / 90-99

Stage 2: > 160 / 100

45
Q

normotension

A
46
Q

pericardial friction rub

A

widely heard, sound clearest toward the apex
intense, grating, machine-like
may have three components

47
Q

pulmonary valve ejection click

A

In early systole
intensifies on expiration
decrease on inspiration
best heard: 2nd Left ICS, pt. sitting or supine

48
Q

aortic valve click

A

In early systole, opening of the AV
no affected by respiration
best heard apex or right 2nd ICS
pt. sitting or supine

49
Q

Mitral valve opening snap

A 
early in diastole
before S3
sharp snap
easily confused with S2
Best heard medial to apex
50
Q

Gallops

A

pre systole
intense, easily heard
bell at apex, pt. supine or in left lateral recumbent position

51
Q

Thrill

A

fine, palpable rushing vibration
usually felt over the base
indicates turbulent blood flow

52
Q

PMI

A

point of maximal impulse

generated by the apex

53
Q

heave

A

a more pronounced lift of the RV,

RV hypertrophy

54
Q

Aortic stenosis, murmur

A 
systolic ejection murmur
crescendo/decrescendo (diamond shaped)
can radiate to the carotids
can be accompanied by and ejection click
heard in the aortic area
55
Q

Pulmonic stenosis, murmur

A 
systolic ejection murmur
crescendo/decrescendo (diamond shaped)
doesn't not radiate to the carotid
can be accompanied by and ejection click
heard in the pulmonic area
56
Q

Mitral regurgitation

A

holo/pan systolic murmur
flat murmur, no change
radiates to the axila
heard best at the apex, mitral location

57
Q

Tricuspid regurgitation

A

holo/pan systolic murmur
flat murmur, no change
heard best at tricuspid location

58
Q

Aortic regurgitation

A 
along the left sternal border (blood is flowing the other way), not listening at aortic area
diastolic murmur (between S2-S1)
early diastolic murmur: decrescendo
59
Q

Pulmonic regurgitation

A 
heard along the upper left sternal border
diastolic murmur (between S2-S1)
early diastolic murmur: decrescendo
60
Q

Mitral stenosis

A

diastolic murmur (between S2-S1)
with an opening snap followed by
mid diastolic rumble
heard in the mitral area, apex

61
Q

tricuspid stenosis

A

diastolic murmur (between S2-S1)
with an opening snap followed by
mid diastolic rumble
heard in the tricuspid area

62
Q

what position are S3 and S4 best heard

A

left lateral decubitus position

63
Q

In which age can S3 normal

A

In the young

64
Q

preload

A

end of diastolic pressure, ventricles stretched to greatest dimensions

65
Q

afterload

A

there stress/tension developed in wall of left ventricle during ejection

PD Block 2 (6 decks)

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