Cardiovascular system Flashcards
where is the base of the heart
right ventricle meets pulmonary artery superiorly
where is the point of maximal impulse (PMI) ?
apex of the heart
trace the flow of blood through the heart
superior VC > right atrium > tricuspid valve > right ventricle > pulmonary valve > pulmonary artery> lungs> pulmonary veins > left atrium > mitral valve > Left ventricle > aortic valve > aorta
what are the positions of the valves during sytole?
aortic valve = open
mitral valve = closed
what are the positions of the valves during diastole?
aortic valve = closed
mitral valve = open
what produces heart sound S1?
closing of mitral valve (listen with diaphragm)
what produces heart sound S2?
closing of aorta valve (listen with diaphragm)
what does heart sound S3 represent?
S3 gallop (listen with bell) rapid deceleration of column of blood against ventricular wall
what does heart sound S4
usually happens just before S1 (listen with bell)
marks atrial contraction
what causes splitting of S2?
occurs with inspiration
aortic valve and pulmonic valve closure
What causes the “harsh” sounding heart murmur?
a stenotic valve
abnormally narrow valvular oriface
(i.e. aortic stenosis)
Where is the mital valve heard best?
cardiac apex (5th intercostal space)
where is the tricuspid valve heard best?
LLSB (lower left substernal border)
where is the pulmonic valve heard best?
Left 2nd & 3 rd intercostal space (close to sternum)
where is the aortic valve heard best?
Right 2nd intercostal space
Which node has a delay in conduction?
AV node
the p wave is associated with what?
atrial depolarization
the QRS complex is associated with what?
ventricular depolarization
heart sound S1 (R wave)
left ventricular end diastolic volume
the T wave is associated with what
ventricular repolarization
end of T wave (S2 sound)
left ventricular end systolic volume
what is the Q wave?
1st downward deflection
septal depolarization
what is the R wave?
ventricular depolarization
define cardiac output
volume of blood ejected each ventricle in 1 min
define stroke volume
volume of blood ejected with each heartbeat
define preload
the load that stretches the cardiac muscle before contraction.
volume of blood in the RV at end of diastole
the following increase preload
- inspiration
- increase volume
- CHF
the following decrease preload
- exhalation
- decreased LV output
- pooling of blood (cap. bed/venous system)
define myocardial contractility
refers to the ability of the cardiac muscle, when given a load, to shorten
what increase myocardial contractility
stimulation from sympathetic nervous system
What decreases myocardial contractility
impaired blood flow (O2 delivery) to myocardium
what is afterload?
degree of vascular resistance (tone in walls of artial system) to ventricular contraction
what is arterial pulse?
pressure wave felt on exam by the contraction of the LV ejecting a volume of blood into the aorta then into arterial system
what is true of jugular venous pressure?
- height in venous column of blood in the internal jugular vein
- reflects R. atrial pressure
- clinical indicator right hear dynamics
- measured on right side, more direct path to right atrium
how is JVP (jugular venous pressure) measured?
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
what is paroxysmal nocturnal dyspnea?
suddent dyspnea or orthopnea that awakens pt. feel like they need to open a window to get air
what are some indicationos of obstructive sleep apnea?
snoring
sleepy during day
complete obstruction of airway more than 10 seconds while sleeping
what are non modifiable risk factors for cardiac disease?
age
gender
heredity
how far do you inflate the cuff for B/P?
30 mmHg
what is a thrill
palpable humming virbration
what is a bruit
murmur like sound in vasculature, use diaphragm of stethoscope
True or false. Brachial arteries reflect aortic pulsations more accurately
False. carotid artery. brachial when carotid occluded
PMI is how big in diameter? and last how long?
a. 2.5 cm
b. first 2/3 of systole
Which part of stethoscope do you use to hear high pitch sound? low pitch?
High - diaphragm
low - bell
what is true of S1
is first heart sound
hear mostly the mitral valve;
Heard best near heart’s apex over the mitral area with diaphragm
What is true of S2
second heart sound
Long diastolic intervals separates one pair from another
Heard best near heart’s base, over pulmonic area
what is true of S3
Heard best with bell over mitral area
May be seen in anemia, fever, pregnancy, thyrotoxicosis
What is true of S4q
Heard best with the bell near heart’s apex, over the mitral area
non-compliant left ventricle
What are the murmur grades?
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
Mid-systolic ejection murmur, heard best over aortic area, crescendo/decrescendo, radiates to neck
aortic stenosis
Mid-systolic click, heard best over mitral area
mitral valve prolapse
valve is unable to contain blood within the ventricle during systole, S1 may be decreased heard best over apex, radiates to left axilla
mitral regurg - pansystolic (holosystolic)
valve fails to close completely during systole, heard best over lower left sternal border
tricuspic regurg - pansystolic
what is true of aortic regurg
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
what is true of mitral stenosis
Leaflets of valve have become thick, stiff, and distorted because of rheumatic fever
Heard best at apex and using bell
Mainly rheumatic in origin
What are the murmur intensisty grades
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
