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Clinical Methods Final > Cardiovascular system > Flashcards

Cardiovascular system Flashcards

1
Q

where is the base of the heart

A

right ventricle meets pulmonary artery superiorly

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2
Q

where is the point of maximal impulse (PMI) ?

A

apex of the heart

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3
Q

trace the flow of blood through the heart

A

superior VC > right atrium > tricuspid valve > right ventricle > pulmonary valve > pulmonary artery> lungs> pulmonary veins > left atrium > mitral valve > Left ventricle > aortic valve > aorta

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4
Q

what are the positions of the valves during sytole?

A

aortic valve = open

mitral valve = closed

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5
Q

what are the positions of the valves during diastole?

A

aortic valve = closed

mitral valve = open

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6
Q

what produces heart sound S1?

A

closing of mitral valve (listen with diaphragm)

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7
Q

what produces heart sound S2?

A

closing of aorta valve (listen with diaphragm)

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8
Q

what does heart sound S3 represent?

A 
S3 gallop  (listen with bell)
rapid deceleration of column of blood against ventricular wall
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9
Q

what does heart sound S4

A

usually happens just before S1 (listen with bell)

marks atrial contraction

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10
Q

what causes splitting of S2?

A

occurs with inspiration

aortic valve and pulmonic valve closure

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11
Q

What causes the “harsh” sounding heart murmur?

A

a stenotic valve
abnormally narrow valvular oriface
(i.e. aortic stenosis)

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12
Q

Where is the mital valve heard best?

A

cardiac apex (5th intercostal space)

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13
Q

where is the tricuspid valve heard best?

A

LLSB (lower left substernal border)

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14
Q

where is the pulmonic valve heard best?

A

Left 2nd & 3 rd intercostal space (close to sternum)

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15
Q

where is the aortic valve heard best?

A

Right 2nd intercostal space

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16
Q

Which node has a delay in conduction?

A

AV node

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17
Q

the p wave is associated with what?

A

atrial depolarization

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18
Q

the QRS complex is associated with what?

A

ventricular depolarization
heart sound S1 (R wave)
left ventricular end diastolic volume

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19
Q

the T wave is associated with what

A

ventricular repolarization
end of T wave (S2 sound)
left ventricular end systolic volume

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20
Q

what is the Q wave?

A

1st downward deflection

septal depolarization

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21
Q

what is the R wave?

A

ventricular depolarization

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22
Q

define cardiac output

A

volume of blood ejected each ventricle in 1 min

23
Q

define stroke volume

A

volume of blood ejected with each heartbeat

24
Q

define preload

A

the load that stretches the cardiac muscle before contraction.
volume of blood in the RV at end of diastole

25
Q

the following increase preload

A
  1. inspiration
  2. increase volume
  3. CHF
26
Q

the following decrease preload

A
  1. exhalation
  2. decreased LV output
  3. pooling of blood (cap. bed/venous system)
27
Q

define myocardial contractility

A

refers to the ability of the cardiac muscle, when given a load, to shorten

28
Q

what increase myocardial contractility

A

stimulation from sympathetic nervous system

29
Q

What decreases myocardial contractility

A

impaired blood flow (O2 delivery) to myocardium

30
Q

what is afterload?

A

degree of vascular resistance (tone in walls of artial system) to ventricular contraction

31
Q

what is arterial pulse?

A

pressure wave felt on exam by the contraction of the LV ejecting a volume of blood into the aorta then into arterial system

32
Q

what is true of jugular venous pressure?

A
  1. height in venous column of blood in the internal jugular vein
  2. reflects R. atrial pressure
  3. clinical indicator right hear dynamics
  4. measured on right side, more direct path to right atrium
33
Q

how is JVP (jugular venous pressure) measured?

A

1) make patient comfortable. Raise head slightly (pillow) to relax the sternomastoid ms.
2) Raise head of bead (HOB) of exam table to 30 degrees and turn patients head away from side inspected.
3) Examine both sides of neck. Identify external jugular vein (EJ) then find the internal jugular pulsations.
4) Raise or lower the HOB until oscillations of IJV are seen in the lower half of the neck.
5) Focus on the right internal jugular vein. Look for pulsations in the suprasternal notch.
6) Identify the highest point of pulsation in the right IJV. Extend card horizontally and ruler vertically from sternal angle and form a right angle. Distance on ruler in cm=JVP

34
Q

what is paroxysmal nocturnal dyspnea?

A

suddent dyspnea or orthopnea that awakens pt. feel like they need to open a window to get air

35
Q

what are some indicationos of obstructive sleep apnea?

A

snoring
sleepy during day
complete obstruction of airway more than 10 seconds while sleeping

36
Q

what are non modifiable risk factors for cardiac disease?

A

age
gender
heredity

37
Q

how far do you inflate the cuff for B/P?

A

30 mmHg

38
Q

what is a thrill

A

palpable humming virbration

39
Q

what is a bruit

A

murmur like sound in vasculature, use diaphragm of stethoscope

40
Q

True or false. Brachial arteries reflect aortic pulsations more accurately

A

False. carotid artery. brachial when carotid occluded

41
Q

PMI is how big in diameter? and last how long?

A

a. 2.5 cm

b. first 2/3 of systole

42
Q

Which part of stethoscope do you use to hear high pitch sound? low pitch?

A

High - diaphragm

low - bell

43
Q

what is true of S1

A

is first heart sound
hear mostly the mitral valve;
Heard best near heart’s apex over the mitral area with diaphragm

44
Q

What is true of S2

A

second heart sound
Long diastolic intervals separates one pair from another
Heard best near heart’s base, over pulmonic area

45
Q

what is true of S3

A

Heard best with bell over mitral area

May be seen in anemia, fever, pregnancy, thyrotoxicosis

46
Q

What is true of S4q

A

Heard best with the bell near heart’s apex, over the mitral area
non-compliant left ventricle

47
Q

What are the murmur grades?

A

I – very faint
II – quiet but heard immediately
III – moderately loud
IV – loud with a palpable thrill
V – very loud, thrill, heard with stethoscope partly off the chest
VI – very loud, thrill, heard with stethoscope entirely off the chest

48
Q

Mid-systolic ejection murmur, heard best over aortic area, crescendo/decrescendo, radiates to neck

A

aortic stenosis

49
Q

Mid-systolic click, heard best over mitral area

A

mitral valve prolapse

50
Q

valve is unable to contain blood within the ventricle during systole, S1 may be decreased heard best over apex, radiates to left axilla

A

mitral regurg - pansystolic (holosystolic)

51
Q

valve fails to close completely during systole, heard best over lower left sternal border

A

tricuspic regurg - pansystolic

52
Q

what is true of aortic regurg

A

Leaflets of aortic valve fail to close – volume overload in LV
Heard best in aortic area with patient sitting and leaning forward
May be caused by rheumatic heart disease, congenital bicuspid valves, Marfan’s syndrome, aortic dissection, syphilis

53
Q

what is true of mitral stenosis

A

Leaflets of valve have become thick, stiff, and distorted because of rheumatic fever
Heard best at apex and using bell
Mainly rheumatic in origin

54
Q

What are the murmur intensisty grades

A

I – very faint
II – quiet but heard immediately
III – moderately loud
IV – loud with a palpable thrill
V – very loud, thrill, heard with stethoscope partly off the chest
VI – very loud, thrill, heard with stethoscope entirely off the chest

Clinical Methods Final (9 decks)

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