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PCA > Cardio: Anatomy and Physiology > Flashcards

Cardio: Anatomy and Physiology Flashcards

1
Q

What structures are contained within the mediastinum?

A

Heart and great vessels
Esophagus, trachea, thoracic duct and thoracic lymph nodes

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2
Q

Where is the point of maximal impulse (PMI) located and what is the diameter in healthy patients?

A

5th intercostal space, 1-2.5 in healthy patients

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3
Q

What does a PMI of > 2.5 cm indicate?

A

Cardiomegaly
LVH (left ventricular hypertrophy)
Dilated cardiomyopathy

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4
Q

What are the atrioventricular valves?

A
  1. Tricuspid
  2. Mitral
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5
Q

What are the semilunar valves?

A
  1. Pulmonic
  2. Aortic
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6
Q

How many leaflets does a bicuspid aortic valve have?

A

two, most common congenital heart defect.

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7
Q

What are the auscultation landmarks (refer to slide 10)

A

” All physicians earn too much”
A- aortic
P-pulmonic
E- erbs point (left sternal border)
T- tricuspid area
M- mitral area

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8
Q

During systole, the ______ and _____ valves are open, allowing for blood to flow from the

A

aortic, pulmonic
LV to the aorta and RV to pulmonary artery

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9
Q

During systole, the ________ and _________ valves are closed, allows for

A

mitral, tricuspid
allows for the atrium to fill with blood

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10
Q

S1

A

beginning of systole the mitral valve and tricuspid valve close

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11
Q

S2

A

end of systole the aortic valve and pulmonic closes

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12
Q

Diastole is ventricular _______

A

relaxation

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13
Q

During diastole, the ________ and ________ valves are closed allowing for what

A

aortic and pulmonic
allowing for the ventricles to relax and fill with blood

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14
Q

During diastole, the _______ and ________ valves are open and the atria________

A

mitral and tricuspid, atria contracts to fill the ventricles with blood

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15
Q

What occurs during the beginning of diastole

A

The aortic valve closes (S2) and the mitral valve opens, LV fills

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16
Q

What occurs during the end of diastole

A

Mitral valve closes (S1)

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17
Q

What are the classifications of heart sounds?

A

First heart sound (S1)
Second heart sound (S2)
Opening Snap
Third heart sound (S3)
Fourth heart sound (S4)
Physiologic and pathologic split S2

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18
Q

What is S1?

A

“LUB”

Closing of the atrioventricular valves (mitral and tricuspid)

Marks the onset of systole

Occurs just before the upstroke of the carotid pulse

Typically louder than S2, heart best over the apex (mitral area) and the lower left sternal border

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19
Q

What is S2?

A

“DUB”

Closing of the semilunar valves (aortic and pulmonary)

Marks the onset of diastole

Occurs after peak carotid pulse

Typically quieter than S1, best heard over the left 2nd interspace (aortic area), close to sternal border

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20
Q

What is the opening snap?

A

-pathologic sound
Generated from a calcified mitral valve (mitral stenosis)

The rapid opening of the calcified mitral valve leaflets to its maximal open position causes the opening snap
Mitral stenosis

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21
Q

Where is the opening snap best heard at?

A

Heard at best the apex with the diaphragm of the stethoscope, left 2nd intercostal space

High frequency

22
Q

S3 is rapid deceleration of blood as it hits the ______ wall

A

LV
-ventricular gallop

23
Q

S4 is an audible ____________ just before _______

A

atrial contraction, systole
atrial gallop

24
Q

Which heart sound can be physiologic or pathologic?

A

S3
physiologic in young adults
Often pathologic if age > 40 years
Rapid deceleration of blood as it hits the LV wall = Ventricular gallop

25
Q

What is the clinical significance of S3?

A

Dilated, volume overloaded LV
Heart failure
Aortic valve disease
Severe mitral regurgitation

26
Q

Which heart sound is ALWAYS considered pathologic however not uncommon after age >40 due to lower ventricular compliance

A

S4

27
Q

In S4, the LV is ____ and ____

A

stiff, less compliant

28
Q

What is the clinical significance of S4?

A

Hypertension
HCOM
Aortic stenosis
Acute MI

29
Q

In Ten-Ne-See, the _____ is S4

A

TEN

30
Q

In Ken-Tuck-Y the ______ is S3

A

Y

31
Q

Split S2=

A

A2(aortic valve closing) + P2(pulmonic valve closing)

32
Q

What does a split S2 mean?

A

that you can hear both components (A2 and P2) rather that one combined sound

33
Q

What is A2?

A

the aortic valve closing
Louder, reflecting higher aortic pressure c/w pulmonary artery pressure
Heard throughout the precordium, heard best at right 2nd intercostal space (aortic area)
Because of higher pressure system, typically closes first

34
Q

What is P2?

A

pulmonic valve closing
In normal anatomy, relatively soft sound
Heard best at 2nd and 3rd intercostal space near the sternal border (pulmonic area)

35
Q

A2 with increased intensity

A

Systemic HTN: louder due to increased pressure load
Aortic root dilated due to increased proximity of aortic root to the chest wall

36
Q

A2 decreased or absent

A

Severe aortic stenosis due to valve immobility, no closure sound is heard

37
Q

P2 with increased intensity

A

When P2 is louder than A2, suspect pulmonary hypertension, dilated pulmonary artery or atrial septal defect

38
Q

P2 with decreased intensity or absent

A

Occurs with increased AP diameter of the chest (aging)
Also in pulmonary stenosis due to valve immobility, no closure sound is heart

39
Q

Physiologic split S2

A

A2 precedes P2 during inspiration only

40
Q

Wide splitting

A

Split S2 has further delay with inspiration
Pulmonary stenosis or RBBB

41
Q

Fixed splitting

A

No change in wide split S2 with inspiration OR expiration
Atrial septal defect, fixed split because of prolonged right ventricular systole

42
Q

Paradoxical splitting

A

P2 precedes A2 in expiration when closure of aortic valve is abnormally delayed
The split disappears during inspiration (P2 is normally delayed during inspiration) causing the split to disappear
Aortic stenosis, LBBB

43
Q

Systolic (ejection) click

A

Typically mid or late systole
Apex or left sternal border

Common finding in mitral valve prolapse
The mitral valve has redundant or elongated chordae tendineae causing an abnormal ballooning of the mitral valve leaflets during systole

44
Q

Which of the following is NOT occurring during diastole?

A) Pulmonic valve is closed
B) Aortic valve is open
C) Right ventricle is relaxed
D) Left atrium is contracting

A

Aortic valve is open

45
Q

The ___________ artery is the only artery in the body that carries deoxygenated blood

A

pulmonary

46
Q

S1 marks the onset of ________________.

A

systole

47
Q

In a paradoxical split S2:

A) The pulmonic valve closes before aortic valve during expiration
B) The aortic valve is stenosed
C) The pulmonic valve closes after aortic valve during expiration
D) A and B

A

D

48
Q

What is the most lateral aspect of the cardiac silouhette on a CXR?

A) Pulmonary artery
B) Right ventricle
C) Left atrium
D) Left ventricle

A

D

49
Q

Which of the following is NOT true of S3:

A) Can be physiologic (normal) in children/young adults
B) Is considered an atrial gallop
C) Indicative of reduced ventricular compliance, or left ventricular hypertrophy
D) Heard just after S2, early in diastole

A

B

50
Q

Name the two atrioventricular valves:

A) Tricuspid
B) Pulmonic
C) Mitral
D) Aortic

A

A, C

51
Q

What does an opening snap suggest?

A) Mitral stenosis
B)Heart failure
C) Pulmonic stenosis
D) Atrial septal defect

A

Mitral stenosis

PCA (17 decks)

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