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Clinical Skills > Cardiovascular System > Flashcards

Cardiovascular System Flashcards

1
Q

Where is the R ventricle positioned on the body?

A

Anteriorly

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2
Q

Where is the L ventricle positioned on the body?

A

Lateral and posterior

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3
Q

Where is the pulmonary artery found?

A

Sternal angle

L of the aorta, L side of body at the base of the heart

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4
Q

Where is the cardiac apex?

A

Bottom tip of the LV

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5
Q

Where is the PMI found?

A

LV tip, 5th intercostal space, midaxillary line

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6
Q

Where is the aorta found?

A

To the R of the pulmonary artery; medial of the body

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7
Q

What should the diameter of the PMI be?

A

1-2.5 cm

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8
Q

If the PMI is > 2.5, what does that suggest?

A

LVH from either HTN or aortic stenosis

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9
Q

What could a lateral displacement of the PMI mean?

A

LVH

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10
Q

If there is RVH, where could you find the greater impulse?

A

Xiphoid or epigastric area

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11
Q

About how much ventricle blood is pushed in there by gravity?

A

~ 2/3

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12
Q

What does heart sound S1 indicate?

A

Closure of the AV valves

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13
Q

What does heart sound S2 indicate?

A

Closure of the semilunar valves

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14
Q

What valves are open in systole?

A

Semilunar valves

Ventricular contraction

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15
Q

What valves are open in diastole?

A

AV valves

Ventricular relaxation

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16
Q

What layers create the pericardial cavity?

A

Visceral and parietal layers

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17
Q

How can you best see and diagnose pericarditis?

A

US

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18
Q

How would pericarditis sound?

A

“Old-timey washing machine”

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19
Q

What happens in diastole?

A

Atrial pressure exceeds that of the ventricle and the AV valves open to allow blood flow through them; at the end of diastole, the atrium contracts and increases the pressure in both chambers

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20
Q

What happens in systole?

A

The ventricle contracts, pressure increases and closes the AV valves, opening the semilunar. As the ventricle ejects most of its blood, the ventricular pressure decreases; the pressure in the aorta/pulmonary artery exceeds that of the ventricle and the semilunar valves close. The pressure in the atrium now increases to start diastole

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21
Q

Why are L sided heart sounds louder?

A

Higher pressure

22
Q

How are heart sounds made?

A

Due to vibrations in the leaflets and the adjacent cardiac structures and blood flow

23
Q

What is a splitting S1 and S2 heart sound?

A

When the valves do not close at the same time

24
Q

What would a split in S1 indicate?

A

Indicates heart abnormality, such as a conduction defect; during AV valve closure

25
Q

What does a split in S2 indicate?

A

Can be normal - this can happen simply with expiration due to the drop in intrathoracic pressure and an increased RV filling time and delay in pulmonic valve closure

26
Q

What is an opening snap?

A

Mitral valve is stenotic and opens; happens early in diastole

27
Q

What is a systolic click?

A

This is heard with a prolapsing mitral valve in systole as the ventricular pressure pushes the valve through to the atrium

28
Q

What is a pericardial friction rub?

A

Grating sound made as the heart beats when the pericardial sac is inflamed

29
Q

What is S3

A

Sound heard early in diastole when the blood passively enters the ventricles and contacts the walls, making them vibrate

This can occur in healthy people when their CO is elevated, but most often happens when ventricular wall is abnormal

30
Q

What is S4?

A

Sound heard at the end of diastole when the atria contracts and a bolus of blood is sent into the ventricle

This immediately precedes S1

A loud S4 often indicates pathology of a noncompliant ventricular wall

31
Q

Which heart sounds make up a “gallop,” and when is this common?

A

Either S3 or S4; common in a patient with heart disease due to volume overload or a noncompliant ventricle

32
Q

Where is the mitral valve best heard?

A

Around or at the cardiac apex

33
Q

Where is the tricuspid valves best heard?

A

At or around the LL sternal border

34
Q

Where is the pulmonic valve best heard?

A

around the 2nd and 3rd L interspaces close to the sternum

35
Q

Where is the aortic valve best heard?

A

R 2nd interspace

36
Q

What causes heart murmurs?

A

Rapid blood flow over a normal valve; blood flow over a narrowed valve; backflow of blood through an incompetent valve; blood flow through an abnormal opening

37
Q

What do you evaluate in a murmur?

A

Timing, shape, location, radiation, intensity, pitch, quality

38
Q

What is a thrill?

A

humming vibration over a narrowed artery

39
Q

What is a bruit?

A

murmur-like sound of a narrowed artery

40
Q

What do you do if you feel a thrill or hear a bruit int he carotid artery?

A

Assess the amplitude and contour of the pulse in the brachial artery

41
Q

Where do you palpate the aortic area?

A

R 2nd interspace

42
Q

Where do you feel the pulmonic area?

A

L 2nd interspace

43
Q

Where do you feel the RV area?

A

L lower sternal border

44
Q

Where do you feel the apex?

A

LV area

45
Q

How would you describe a heave?

A

Sustained impulse that rhythmically lifts your fingers; produced by an enlarged ventricle

46
Q

How can you best appreciate thrills?

A

Ball of hand firmly on the chest to feel a vibration or buzzing sensation; these sounds may accompany loud murmurs

47
Q

How would you best describe a normal amplitude?

A

small, brisk, tapping, diffuse, sustained

48
Q

What sounds does the diaphragm best pick up?

A

High pitched sounds, S1 and S2, murmurs from the aortic or mitral regurgitation and friction rubs

49
Q

How do you best hold the diaphragm to listen?

A

Press firmly against patient

50
Q

What sounds does the bell pick up best?

A

Low pitched sounds such as S3, S4, murmur due to mitral stenosis

51
Q

How do you best hold the bell to hear?

A

light pressure, just enough to make an air seal

Clinical Skills (5 decks)

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