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HA Exam 3 - Wk 9-12 > Cardiovascular - Bates > Flashcards

Cardiovascular - Bates Flashcards

1
Q

What part of the heart occupies most of the anterior cardiac surface?

A

Right ventricle

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2
Q

Where is the base of the heart?

A

At the right and left 2nd interspaces next to the sternum

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3
Q

Where is the apex of the heart?

A

Normally, in the 5th interspace, 7-9 cm lateral to the midsternal line

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4
Q

What does the PMI locate?

A

The left border of the heart

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5
Q

What is a normal PMI measurement?

A

1-2.5 cm in a supine patient (about the size of a quarter)

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6
Q

What does a PMI > 2.5 cm suggest?

A

LVH (left ventricular hypertrophy)

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7
Q

What does a mislocated PMI > 10cm lateral to the midsternal line suggest?

A

LVH (left ventricular hypertrophy)

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8
Q

Where might you hear the PMI in a patient with COPD?

A

At the xiphoid or epigastric area

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9
Q

Name the two atrioventricular valves

A

Mitral and tricuspid

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10
Q

Name the two semilunar valves

A

Aortic and pulmonic

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11
Q

An S3 or S4 in adults over 40 indicate what conditions?

A

HF and acute myocardial ischemia

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12
Q

What do you call the period of ventricular contraction?

A

Systole

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13
Q

What do you call the period of ventricular relaxation?

A

Diastole

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14
Q

Pressures in the left ventricle range from ___ to ___ mm Hg

A

< 5 to 120

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15
Q

What valves are open during systole?

A

Aortic and pulmonic

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16
Q

What valves are open during diastole?

A

Mitral and tricuspid

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17
Q

What defines the duration of systole and diastole?

A

S1 and S2

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18
Q

Which side of the heart usually has the lower pressure?

A

Right

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19
Q

What produces the sound of S1?

A

The closing of the mitral and tricuspid valves

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20
Q

What does LV end diastolic pressure correspond to?

A

Systolic blood pressure

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21
Q

What produces the sound of S2?

A

The closing of the aortic and pulmonic valves

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22
Q

The opening of the mitral valve is normally silent but may produce an audible “snap” in what condition?

A

Mitral stenosis

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23
Q

An S3 in children and young adults is most likely:

A

Normal ,due to rapid deceleration of blood into the ventricle

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24
Q

What is an S3 in older adults called?

A

A gallop

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25
Q

What does an S3 gallop or an S4 represent?

A

A change in ventricular compliance

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26
Q

What does S4 mark?

A

Atrial contraction just before the onset of ventricular systole

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27
Q

Right sided events occur slightly ___ than those on the left

A

Later

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28
Q

During which part of respiration would S2 most likely split?

A

During inspiration due to increased right heart fill time

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29
Q

Of the two components of S2, A2 and P2, which is louder?

A

A2 due to the high pressure in the aorta

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30
Q

Where is an S2 split heard best?

A

At the left 2nd or 3rd interspace, close to the sternum

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31
Q

Where is an S1 split heard best?

A

It is loudest at the apex

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32
Q

Does an S1 split vary with respiration?

A

No

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33
Q

Murmurs are different from heart sounds because they are _____?

A

Longer in duration

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34
Q

To what are murmurs attributed?

A

Turbulent blood flow

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35
Q

What has an abnormally narrowed valvular orifice that obstruct flow and causes a distinctive murmur?

A

Aortic stenosis

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36
Q

What allows blood to leak backward and prevents full closure causing a distinctive murmur?

A

Aortic regurgitation or insufficiency

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37
Q

Where are sounds and murmurs associated with the mitral valve usually heard?

A

At the apex of the heart

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38
Q

Where are sounds and murmurs associated with the pulmonic valve usually heard?

A

At the 2nd and 3rd left interspaces close to the sternum

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39
Q

Where are sounds and murmurs associated with the aortic valve usually heard?

A

From the right 2nd interspace to the apex

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40
Q

Where are sounds and murmurs associated with the tricuspid valve usually heard?

A

At or near the lower left sternal border

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41
Q

An ECG has twelve leads. Six of these are in the ___plane and the other six are in the ___ plane.

A

Frontal, transverse

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42
Q

Electrical vectors that approach a lead cause what kind of a deflection?

A

An upward or positive deflection

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43
Q

Electrical vectors that move away from a lead cause what kind of a deflection?

A

A downward or negative deflection

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44
Q

When vectors balance they cause what kind of a line?

A

Isoelectric or flat line

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45
Q

The P wave represents:

A

Atrial contraction or depolarization

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46
Q

The QRS interval represents:

A

Ventricular depolarization

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47
Q

The T wave represents:

A

Ventricular repolarization or recovery

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48
Q

The electrical impulse slightly ___ the myocardial contraction that it stimulates

A

Preceeds

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49
Q

What is the term for the volume of blood ejected from each ventricle during 1 minute?

A

Cardiac output (CO)

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50
Q

The CO is the product of what two measures?

A

Stroke volume and heart rate

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51
Q

Stroke volume depends on what three things?

A

1) preload
2) contractility
3) afterload

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52
Q

What is the name of the load that stretches the cardiac muscle before contraction?

A

Preload

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53
Q

What can increase RV preload?

A

Inspiration, increased volume of blood flow (exercise), dialated RV of HF

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54
Q

What can decrease RV preload?

A

Exhalation, decreased LV output, blood pooling in capillary beds or venous system

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55
Q

What term refers to the intrinsic ability of the heart to beat (or the ability of the muscles to shorten with a load)?

A

Contractility

56
Q

What can increase contractility?

A

The SNS

57
Q

What can decrease contractility?

A

A decrease in blood flow or decreased oxygen delivery to the muscles of the heart

58
Q

What term refers to the degree of vascular resistance to ventricular contraction?

A

Afterload

59
Q

What affects afterload?

A

The tone in the aorta, the large arteries and the peripheral vascular tree. Also the blood volume in the aorta.

60
Q

Blood pressure in the arteries ___ during systole and ___ during diastole.

A

Peaks, falls

61
Q

What is the term for the difference between systole and diastole?

A

The pulse pressure

62
Q

What are the four factors that influence arterial pressure?

A

1) LV stroke volume
2) Distensibility of the aorta and large arteries
3) PVR, particularly in the arterioles
4) Volume of the in the arterial system

63
Q

What provides an important index of right atrial heart pressure or central venous pressure?

A

Jugular venous pressure (JVP)

64
Q

What best estimates the JVP?

A

Right internal jugular vein due to its direct channel into the right atrium

65
Q

The “a” wave in the jugular veins represents what?

A

Atrial contraction

66
Q

The “x” decent in the jugular veins represents what?

A

Atrial relaxation

67
Q

The “v” wave in the jugular veins represents what?

A

Atrial filling - Inflow from the vena cava during RV systole

68
Q

The “y” decent in the jugular veins represents what?

A

Atrial emptying - Passive blood flow into the right ventricle

69
Q

What is a common vessel murmur to children and young adults?

A

Jugular venous hum

70
Q

What vessel murmur is innocent in children but may be a sign of atherosclerosis in adults?

A

Cervical systolic murmur or bruit

71
Q

What is the most common symptom of CHD?

A

Chest pain

72
Q

What ethnic group is affected the most with CHD?

A

African Americans

73
Q

Classic symptoms of exertional pain, pressure or discomfort to the chest, shoulder, back, neck, or arm are seen in what % of patients with AMI?

A

50%

74
Q

What are some less common descriptors of AMI?

A

Cramping, grinding, pricking, or tooth/jaw pain

75
Q

What is the term used to refer to any of the clinical syndromes caused by acute myocardial ischemia (unstable angina, non-STEMI, STEMI)?

A

Acute Coronary Syndrome

76
Q

Who is likely to report atypical symptoms such as upper back, neck, or jaw pain, SOB, paroxysmal nocturnal dyspnea, N, V or fatigue?

A

Women, especially those >65

77
Q

Anterior chest pain that radiates into the back or neck may be an indicator of what serious problem?

A

Acute aortic dissection

78
Q

What is the term for an unpleasant awareness of the heartbeat?

A

Palpitations

79
Q

What two types of patients frequently report palpitations?

A

Hyperthyroid and anxiety

80
Q

What is the term for an uncomfortable awareness of breathing that is inappropriate to a given level of exertion?

A

Dyspnea

81
Q

What is the term for dyspnea that occurs while lying down?

A

Orthopnea

82
Q

Sudden dyspnea can occur in:

A

Anxiety, PE, spontaneous pneumothorax

83
Q

With what conditions does orthopnea occur?

A

LVHF, mitral stenosis, obstructive lung disease

84
Q

What is the term for sudden episodes of dyspnea and orthopnea that awaken the patient from sleep?

A

Paroxysmal nocturnal dyspnea (PND)

85
Q

In what conditions does PND occur?

A

LVHF and mitral stenosis

86
Q

PND may mimic what condition?

A

Nocturnal asthma due to wheezing and coughing

87
Q

What is the term for the accumulation of excessive fluid in the extravascular interstitial space?

A

Edema

88
Q

What are some causes of edema?

A

HF, hypoalbuminemia, position, kidney (nephrotic syndrome) or liver disease (ascites)

89
Q

What remains the leading cause of death for women and men?

A

Cardiovascular disease

90
Q

What group has the highest prevalence for HTN?

A

African American women (44%)

91
Q

What is the most important risk factor for CVD at age 50?

A

Diabetes

92
Q

An average 55 year old has what lifetime risk of developing HTN?

A

90%

93
Q

The diagnosis of diabetes is based on what two values and numbers?

A

Fasting glucose > 126 mg/dL and HgA1C > 6.5%

94
Q

What are the components of the metabolic syndrome? (must meet 3+)

A

1) Waist circumference
2) Fasting plasma glucose
3) HDL cholesterol
4) Triglycerides
5) Blood Pressure

95
Q

JVP is not useful under what age?

A

12 years of age

96
Q

What causes JVP to decrease?

A

Blood loss

97
Q

What causes JVP to increase?

A

RHF, LHF, pulmonary HTN, tricuspid stenosis, pericardial compression or tamponade

98
Q

How is the JVP measured?

A

The distance in centimeters above the sternal angle

99
Q

What is a normal JVP?

A

< 3-4 cm above the sternal angle or < 8-9 cm above the right atrium

100
Q

The “a” wave just precedes what?

A

S1

101
Q

What can cause decreased carotid pulsations?

A

Decreased stroke volume or atherosclerosis

102
Q

The upstroke of the carotid pulse should be ___.

A

Brisk

103
Q

The carotid upstroke follows what?

A

S1 (precedes S2 during systole)

104
Q

What is it called when the rhythm of the carotid pulse is strong but the force alternates?

A

Pulsus alternans

105
Q

Pulsus alternans is best felt where?

A

The radial or femoral artery

106
Q

Pulsus alternans almost always indicates what?

A

Left-sided heart failure

107
Q

What happens in a parodoxical pulse?

A

There is a greater than normal drop in systolic blood pressure during inspiration

108
Q

What does a paradoxical pulse usually indicate?

A

Pericardial tamponade, constrictive pericarditis or most commonly obstructive airway disease

109
Q

What is a murmur like sound that sounds like a cat purring?

A

A bruit

110
Q

What causes a bruit?

A

Turbulent blood flow

111
Q

Sounds and murmurs coinciding with the carotid upstroke are ___.

A

Systolic

112
Q

Sounds and murmurs occurring after the completion of the upstroke are ___.

A

Diastolic

113
Q

What do you call a heart situated in the right chest?

A

Dextrocardia

114
Q

A PMI with increased amplitude may show in what conditions?

A

Hyperthyroidism, severe anemia or pressure overload of the left ventricle

115
Q

What should the amplitude of the PMI feel like?

A

Brisk and tapping

116
Q

S2 is louder than S1 at what location?

A

At the base

117
Q

S1 is louder than S2 at what location?

A

At the apex

118
Q

What kinds of sounds does the diaphragm pick up?

A

high-pitched sounds ( S1 and S2)

119
Q

What kinds of sounds does the bell pick up?

A

low-pitched (S3 and S4)

120
Q

When the patient is in the left lateral decubitis position, listen with the ___.

A

Bell

121
Q

When the patient is sitting up and leaning forward, listen with the ___.

A

Diaphragm

122
Q

A systolic murmur falls between ___ and ___.

A

S1 and S2

123
Q

A diastolic murmur falls between ___ and ___.

A

S2 and S1

124
Q

Midsystolic murmurs arise from blood flow across what?

A

Aortic and pulmonic

125
Q

Pansystolic murmurs occur with what?

A

Regurge or backflow across AV valves

126
Q

A late systolic murmur indicates what?

A

Mitral valve prolapse

127
Q

An early diastolic murmur occurs with?

A

Regurgitant flow across the semilunar valves

128
Q

A middiastolic murmur picks up?

A

Turbulent flow across the AV valves

129
Q

A continuous murmur may be present in what conditions?

A

Patent ductus arteriosus and AV fistulas

130
Q

Crescendo murmurs grow ___.

A

Louder (mitral stenosis)

131
Q

Decrescendo murmurs grow ___.

A

Softer (aortic regurg)

132
Q

Crescendo-decrescendo murmurs ___ and ___.

A

Rise and fall (aortic stenosis)

133
Q

Plateau murmurs retain ___.

A

Intensity (mitral regurg)

134
Q

Murmurs are graded on a scale from ___ to ___.

A

1 to 6

135
Q

Which murmurs tend to vary with respiration?

A

Right heart murmurs

136
Q

Having a patient squat may help to identify what kind of murmur?

A

A prolapsed mitral valve (shortens) or to distinguish hypertrophic cardiomyopathy (decreased intensity) from aortic stenosis (increased intensity)

137
Q

Having a patient valsalva while standing may help to identify what kind of murmur?

A

A prolapsed mitral valve (lengthens) or to distinguish hypertrophic cardiomyopathy (increased intensity) from aortic stenosis (decreased intensity)

HA Exam 3 - Wk 9-12 (10 decks)

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