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Exam 2 > Cardiovascular Module > Flashcards

Cardiovascular Module Flashcards

1
Q

Mid-sternal line

A

An imaginary line drawn down the center of the anterior chest from the center of the manubrial notch superiorly to the center of the xyphoid process inferiorly.

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2
Q

The Right and Left Parasternal Lines

A

Vertical imaginary lines on the anterior surface which parallel the mid-sternal line; they are drawn along side the sternum through the junctions of the costal cartilages with the sternum.

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3
Q

The Right and Left Mid-clavicular Lines

A

Imaginary vertical lines which parallel the midsternal line and which are drawn on the anterior chest wall from the mid-point of each clavical to the mid-point of each anterior costal margin. They pass through the nipples and are sometimes referred to as the nipple lines

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4
Q

The Left Anterior Axillary Line

A

An imaginary vertical line which parallels the mid- sternal line and is drawn through the left anterior axillary fold

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5
Q

The Left Mid-axillary Line

A

an imaginary vertical lines which parallels the mid- sternal line and is drawn from the apex of the left axilla to the lateral costal margin

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6
Q

The Angle of Louis

A

A bony prominence located on the anterior surface of the sternum which marks the junction of the manubrium and the body of the sternum. It is located approximately 5 cm below the manubrial notch. It also marks the site where the second rib (actually the second costal cartilage) meets the sternum

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7
Q

The Right and Left Second Intercostal Spaces

A

The interspaces which lie immediately below the right and left second ribs respectively.

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8
Q

The Left Third, Fourth, and Fifth Intercostal Spaces

A

the interspaces immediately below the left third, fourth, and fifth ribs respectively.

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9
Q

When auscultating the heart, it is necessary to identify each of the

A

heart sounds separately. This is accomplished by noting the location (on the anterior wall) where the sound is heard and by recognizing the cadence of the sounds by their timing

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10
Q

To understand this timing sequence of cardiac sounds, it is helpful to “visualize” the cardiac cycle as

A

a clock face with the cardiac sounds being audible at specific “times” on the clock

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11
Q

Choosing the S1 as a starting point, the S1 is heard at the

A

12 o’clock position

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12
Q

The S1 is a combination sound composed of the closing sounds of the

A

right and left atrio-ventricular valves (mitral and tricuspid) at the onset of ventricular systole. Normally the 2 components are heard simultaneously and are heard as one sound

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13
Q

The S2 sound is normally heard at the

A

4 or 5 o’clock position on the clock face

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14
Q

The S2 sound is composed of 2 separate sounds consisting of the

A

closing of the semilunar valves (aortic and pulmonic) at the beginning of ventricular diastole.

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15
Q

The S2 sound is normally heard either as one sound or 2 separate sounds depending on

A

the time in the respiratory cycle (inspiration or expiration) they are being auscultated

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16
Q

S2 sound: The filling of the right ventricle during its diastole takes a little longer when the patient is

A

inspiring. Therefore, it contains a little more blood at the beginning of its next systole. This will cause the right ventricle to take a bit longer to empty during the next systole and the pulmonic valve will close a fraction of a second later than the aortic

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17
Q

This slightly delayed closure of the pulmonic valve will create a slight separation in the 2 components of the S2 sound and this is referred to as

A

splitting of the second heart sound. Since this is a normal phenomenon, it is referred to “physiologic splitting” of S2 and the 2 components of S2 are referred to as A2 and P2

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18
Q

During the expiratory phase of respiration, the right and left ventricle take

A

about the same amount of time to fill and the same amount of time to empty

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19
Q

The 2 components (A2 and P2) of the S2 will occur simultaneously and will be heard as

A

one sound

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20
Q

The S3 sound is normally heard (if at all) at the

A

7 o’clock position on the clock face

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21
Q

S3 consists of the sound created by the

A

vibration of the ventricular wall during the passive phase of ventricular diastole (when blood is simply flowing from the atria)

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22
Q

S3 occurs early in ventricular diastole before the

A

atria contract

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23
Q

The S3 sound can be a normal finding or it may represent

A

a pathological condition

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24
Q

The S4 sound is normally heard (if at all) at the

A

11 o’clock position on the clock face

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25
Q

S4 occurs very late in the ventricular diastolic phase and is produced by the

A

vibration of the semilunar (aortic and pulmonic) valves generated by the contraction of the atria known as the “atrial kick”

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26
Q

S4 is heard a fraction of a second before the normal

A

S1 and is frequently confused for a splitting of the S1 heart sound

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27
Q

The S4 can be a normal finding but most often it represents a

A

pathological condition

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28
Q

The time intervals between the main cardiac sounds (S1 and S2) are also named

A

intervals

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29
Q

The period of time b/t the S1 and S2 is referred to as the

A

systolic interval

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30
Q

The period of time b/t the S2 and the next S1 is referred to as the

A

diastolic interval

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31
Q

Any event (such as a murmur) occurring during these intervals is referred to as

A

either a systolic event or a diastolic event

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32
Q

There are traditionally five areas on the anterior chest wall that are designated for special attention during cardiac evaluation:
1. The Aortic Area

A

located in the second right intercostal space at the sternal border

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33
Q

There are traditionally five areas on the anterior chest wall that are designated for special attention during cardiac evaluation:
2. The Pulmonic Area

A

located in the second left intercostal space at the sternal border

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34
Q

There are traditionally five areas on the anterior chest wall that are designated for special attention during cardiac evaluation:
3. ERB’s Point

A

located in the third intercostal space at the sternal border

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35
Q

There are traditionally five areas on the anterior chest wall that are designated for special attention during cardiac evaluation:
4. The Tricuspid Area

A

located in the fourth left intercostal space at the sternal border

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36
Q

There are traditionally five areas on the anterior chest wall that are designated for special attention during cardiac evaluation:
5. The Mitral (or Apical) Area

A

located in the fifth left intercostal space at the left mid-clavicular line

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37
Q

Inspection of the heart usually begins with the patient lying

A

supine with the entire anterior chest revealed. Inspecting the anterior chest while the patient is sitting upright is also acceptable.

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38
Q

Identify the surface topographical features that will be required to locate

A

the anatomical structures of importance

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39
Q

Notice the location of the cardiac apex usually marked by the point of

A

maximal impulse or apical impulse

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40
Q

Use of a penlight to direct a beam of light across the anterior chest will help in locating this point

A

it is typically located in the 5th left intercostal space at the mid-clavicular line

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41
Q

More precisely, in an adult, the PMI is located

A

10 cm lateral to the mid-sternal line

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42
Q

Note the diameter (in cm) of the impulse and note the

A

intensity (forcefulness) of the deflection it creates on the anterior chest wall

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43
Q

A PMI may not be visible in patients with

A

large amount of chest muscularity, obese patients, and women with large breasts

44
Q

Excessive intensity of the PMI or a PMI diameter greater than 3cm suggests

A

either volume overload or pressure overload conditions of the left ventricle

45
Q

The location of a normal PMI may be shifted upward and to the left in

A

pregnancy and downward and medially in patients with emphysema

46
Q

Palpation is best performed with the proximal parts of the

A

fingers or the entire hand

47
Q

The patient should be supine and the room should be

A

warm and comfortable to prevent any shivering by the patient

48
Q

Palpation is performed for pulsations, for

A

generalized motions (Heaves or lifts), the point of maximal impulse (PMI), and thrills

49
Q

Pulsations- palpate for pulsations in the

A

sternoclavicular, aortic, pulmonic, left sternal border, and epigastric area

50
Q

When palpating pulsations, note the location,

A

rhythm, amplitude, duration and any associated findings. Pulsations may be normal or abnormal.

51
Q

Generalized motion- palpate for an area of forward motion of a relatively large

A

segment of the anterior chest wall (usually extending over two or three interspaces). These are called heaves or lifts and (if present) will be located along the right or left sternal borders and are associated with right ventricular function

52
Q

Also note the presence of a retraction (a backward motion) of the

A

anterior chest wall. This is also noted along the left sternal border and usually involves an area covering several ribs and interspaces and extends for several cm to the left of the left parasternal line

53
Q

A retraction may be a normal finding in patients with a

A

thin and supple chest wall (children) but in adults it is usually a sign of ventricular enlargement

54
Q

Point of Maximal Impulse (PMI) - palpate the area near the

A

5th left interspace at the mid-clavicular line for the “apical impulse” more correctly referred to as the “point of maximal impulse”

55
Q

PMI - note the location, amplitude (force),

A

duration, rhythm, and diameter of the impulse

56
Q

PMI

Note: this pulsation may be easier to detect with the patient

A

sitting up. Also, in females, the breast may cover this area preventing identification of the PMI

57
Q

Thrills - palpate the same areas noted above for pulsations to note the presence of

A

thrills. In addition, palpate the left axillary area.

58
Q

Thrills are actually palpable murmurs and are

A

vibrations on the surface of the chest wall caused by turbulent blood flow within the heart

59
Q

Thrills

Touch the skin lightly with the bases of the fingers for the best

A

sensitivity to detect these vibrations

60
Q

Note the location, amplitude, radiation, and timing to the cardiac cycle

A

(this is done by correlating the thrill with the carotid pulse)

61
Q

Note: any turbulence that can produce a palpable thrill will be

A

easily heard on auscultation as a murmur or bruit

62
Q

The key points to be made about cardiac auscultation are to be

A

systematic in the approach and to be un-hurried

63
Q

The heart is capable of producing a variety of

A

normal and abnormal sounds that vary in pitch from high to low

64
Q

Both the bell and diaphragm are necessary for

A

adequately hearing of all of these possible sounds

65
Q

Cardiac sounds are heard both at the locations of the structures (valves)

A

which create them and also in the direction of the blood flowing through those structures

66
Q

As a result, auscultation should be performed at the

A

5 cardiac areas and also in several “in b/t” areas corresponding to the direction of blood flow from these 5 main areas

67
Q

When listening to the cardiac sounds, select and concentrate on each of the

A

segments of the cardiac cycle while “blocking out” all of the other sounds

68
Q

For example, at each location on the chest wall, listen only to the

A

S1 sound for several heart beats, then listen to the S2 sound for several beats, then listen to the systolic interval for several beats, and finally the diastolic interval for several beats

69
Q

During the intervals, listen for

A

S3s and S4s or any other sounds (clicks, opening snaps, murmurs)

70
Q

Auscultate all areas with both the

A

bell and diaphragm of the stethoscope and do this with the patient in the supine, sitting up, and leaning forward and the left lateral decubitus positions

71
Q

During cardiac auscultation, instruct the patient to breath

A

normally

72
Q

Auscultation can begin at the base of the heart and move

A

toward the apex or at the apex of the heart and move toward the base

73
Q

Movements of the stethoscope should “inch” along this route,

A

moving to new positions only a few centimeters at a time

74
Q

The valves snapping shut make the 2 basic heart sounds often called

A

“lub-dub”

75
Q

As you listen to a patient’s chest, you want to hear a crisp

A

“lub” followed by an equally crisp “dub” with a brief moment of silence in between each lub-dub

76
Q

The 1st heart sound, or lub, is

A

S1

77
Q

S1 is produced when the

A

tricuspid and mitral valves simultaneously close

78
Q

S1 marks the onset of

A

systole, or ventricular contraction

79
Q

The simultaneous closing of the pulmonic and aortic valves produces

A

S2 or dub

80
Q

S2 marks the end of

A

systole

81
Q

The brief silent period between S2 and S1 represents

A

diastole, or ventricular relaxation

82
Q

During diastole the ventricles

A

fill with blood coming from the atria

83
Q

As you assess a patient’s heart sounds, any new whoosh, plop, or an extra lub or dub may indicate

A

a change in the patient’s condition and should prompt you to contact the physician

84
Q

S1 is normally softer than

A

S2, except over the apex, where S1 is louder

85
Q

Since S1 is in sync with the carotid pulse,

A

palpating the pulse helps to distinguish lub from dub

86
Q

If you hear a quick “lu-lub”, S1 may be split, meaning that

A

the mitral valve closed just before the tricuspid. A split may be normal, but it can also occur in the presence of a bundle-branch block

87
Q

If you hear a “du-dub” it means S2 is split, which occurs when the

A

aortic valve closes before the pulmonic valve. A split S2 is often normal and heard on inspiration

88
Q

A ventricular gallop is produced when a

A

third heart sound, called S3, occurs early in diastole

89
Q

S3 is heard as a low-pitched “Plop” right after

A

dub, when there should be silence

90
Q

The cadence created by S3 resembles the word

A

Ken-tuc-ky, where S1 represents “Ken”. S2 carries the accent on “tuc” and S3 is the “ky”

91
Q

While a ventricular gallop may be normal in children and young adults, it is abnormal in

A

patients over the age of 30

92
Q

In adults, the sudden appearance of an S3 may indicate

A

ischemia or heart failure

93
Q

The S3 is caused by the vibration of non-compliant

A

ventricles as they resist the rapid filling of the early phase of diastole

94
Q

S3 is heard best over the apex, using the

A

bell of the stethoscope. it helps to have the patient hold his breath for a moment as you listen. It also helps to have him supine or in the left-side lying position

95
Q

An atrial gallop is produced by a

A

fourth heart sounds, called S4

96
Q

S4 is another low-pitched sound heard best over the

A

apex

97
Q

S4 is heard late in diastole

A

just prior to S1

98
Q

The presence of S4 creates a rhythm that sounds like the word

A

Ten-nes-see

99
Q

S4 represents the “Ten”, S1 represents

A

“nes: and S2 carries the accent on the syllable “see”

100
Q

S4 is normal in

A

infants and children and common in the elderly

101
Q

In adults, however, S4 often occurs after an

A

MI

102
Q

S4 is also linked to

A

aortic stenosis, myocardial ischemia, heart failure, and hypertension. Its caused when stiff and over distended ventricles are forced to accept blood from the atria during late diastole, when the atria exert their final squeeze, called the atrial kick

103
Q

Like the third heart sound, S4 is heard best when you use the

A

bell of the stethoscope and the patient is in a supine position while holding his breath

104
Q

Murmurs are either high or low pitched sounds that usually last

A

longer than normal heart sounds

105
Q

Murmurs are most often caused by a

A

stiffened valve that leaves only a narrow passage for blood to get through or by a weak, floppy valve that allows blood to backflow

106
Q

A murmur can also be caused by blood flowing turbulently through a hole in the

A

septal wall.

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