Cardiovascular Flashcards
Where is the point of maximal impulse (PMI) located?
Left border of the heart, 5th intercostal space, at or just medial to the left midclavicular line.
- In dextrocardia the PMI is located on the right side of the chest
- PMI >2.5 cm is evidence of LVH
- Displacement of the the PMI lateral to the midclavicular line occurs in LVH and ventricular dilatation from MI or heart failure
What are the diastolic sounds of S3 and S4 correlated with?
They are pathologic sounds correlated with systolic and diastolic heart failure, respectively.
S3
Corresponds to an abrupt deceleration of inflow across the mitral valve.
S4
An increased left ventricular and diastolic stiffness which decreases compliance.
Which valves are open in diastole?
Mitral and tricuspid are open. Aortic and pulmonic are closed.
Define systole.
Ventricular contraction & ejection.
- aortic valve open, mitral valve closed
- when the left ventricle ejects blood into the aorta. After the ventricle ejects much of its blood into the aorta, the pressure levels off and starts to fall.
Define diastole.
Ventricular relaxation & filling.
- aortic valve closed, mitral valve open
- once ventricular pressure levels off, Ventricular pressure falls further and blood flows from atrium to ventricle.
Which valves are open during systole?
Aortic & pulmonic
What is S1?
Closure of tricuspid and mitral valves.
What is S2?
Closure of pulmonic and aortic valves?
What does maximal left ventricular pressure correspond to?
Systolic blood pressure
A third heart sound is created by
Diastolic filling
A fourth heart sound is created by
Atrial contraction.
Reflects ventricular stiffness, as seen in hypertension or acute MI.
Describe splitting of S2
During inspiration, right heart filling time is increased, which increases right ventricular stroke volume and the duration of right ventricular ejection compared with the LV. This delays closure of the pulmonic valve, splitting S2.
- can be heard at the second and third intercostal spaces close to the sternum.
Where is S1 best heard?
Cardiac apex.
-mitral component throughout precordium and loudest at apex
- tricuspid component loudest at lower left sternal border
Define heart murmurs.
Heart sounds distinguished by their pitch and longer duration. Attributed to turbulent blood flow and usually indicate valvular disease.
Stenotic valve
A valve with an abnormally narrowed orifice that obstructs blood flow and causes a murmur.
Regurgitating murmur
Valves that close abnormally such that blood is allowed to leak backward in a retrograde direction and produces a murmur.
Where on the chest wall can the aortic valve be best heard?
Right second intercostal spaces close or cardiac apex
Where on the chest wall can the pulmonic valve best be heard?
Left second and third intercostal spaces close to the sternum.
Where on the chest wall can the tricuspid valve best be heard?
At or near the lower left sternal border.
Where on the chest wall can the mitral valve best be heard?
Cardiac apex
Cardiac output
Heart rate x Stroke volume
Stroke volume
Preload, myocardial contractility, & afterload
Causes of decreased right ventricular preload
Exhalation, dehydration, & pooling of blood in the capillary bed or the venous system.
Causes of increased right ventricular preload
Inspiration, increased volume of blood flow from exercising muscles, increased blood volume of a dilated RV in heart failure.
Myocardial contractility
- Increases when stimulated by the sympathetic nervous system.
- Decreases when blood flow or oxygen delivery to the myocardium is impaired, as in MI.
Where does blood pressure in the arterial system peak and trough?
Peak- systole
Trough- diastole
Factors affecting blood pressure
- 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 arteriolar system
What is JVP?
Right atrial pressure, which, in turn, equals central venous pressure and right ventricular end diastolic pressure. Best estimated from the right internal jugular vein.
A wave of jugular venous pulsation
Atrial contraction, tricuspid valve open
“V” wave of jugular venous pulsation
Venous filling, atrium tense, tricuspid closed
“X” wave of jugular venous pulsation
Atrial relaxation then filling, tricuspid closed
“Y” descent wave of jugular venous pulsation
Atrial emptying, tricuspid open
“C” wave of jugular pulsations
Coincides with S1 and systole
Cannon “a” waves of jugular pulsation
Occur in increased resistance to right atrial contraction
- tricuspid stenosis
- severe 1st, 2nd, & 3rd degree AV block
- supraventricular tachycardia
- junctional tachycardia
- pulmonary HTN
- pulmonic stenosis
Absent “a” waves of jugular pulsation
Atrial fibrillation
Increased “v” wave of jugular pulsations
Tricuspid regurgitation, atrial septal defects, constrictive pericarditis
What donpalpitations usually mean?
Disease of the conduction system of the heart
What signs are present if the LV is not pumping adequately?
Pulmonary edema, SOB with/without exertion, orthopnea, lightheadedness or loss of consciousness if blood supply to the brain is inadequate
What signs point to RV pump dysfunction?
Peripheral edema
What condition presents with anterior chest pain, often tearing or ripping and radiating into the back or neck?
Acute aortic dissection
Causes of chest pain in the absence of obstructive coronary artery disease include
Micro vascular coronary dysfunction
Abnormal cardiac noicioception
More common in women
Which non-cardiac conditions may produce palpitations?
Anxiety
Hyperthyroid
