CCRN Cardiovascular Concepts_Assessment and Valvular Disease Flashcards
S2 sound is caused by the closure of which valves?
Aortic and Pulmonic (semilunar)
Where is the S2 sound loudest?
The Base (right sternal border, 2nd ICS); base of the heart is the aortic area, where S2 (dub) is loudest.
S2 marks the beginning of diaystole or systole?
Diastole
S2 is louder with what type of embolism?
Pulmonary
Anatomically, where is S1 (lub) the loudest?
The apex of the heart is the mitral area, where S1 (lub) is loudest. Anatomically it is at the 5th ICS, midclavicular
S3 is an abnormal heart sound. What is it caused by?
S3 is caused by a rapid rush of blood into a dilated ventricle.
S3 is associated with heart failure. What other conditions may cause it?
Pulmonary Hypertension, Cor Pulmonale, mitral, aortic, or tricuspid insufficiency
Where would you hear S3 the best?
Apex of the heart (5th ICS), using the BELL because it is low frequency.
What causes S4 sound?
Atrial contraction of blood into a non-compliant ventricle
What conditions are S4 associated with?
Myocardial ischemia, infarction, hypertension, ventricular hypertrophy, aortic stenosis
Why is S4 not heard in the presence of afib?
There is no atrial contraction
What is the range for normal pulse pressure?
40 - 60 mmHg
Which blood pressure is an indirect measurement of cardiac output and stroke volume?
Systolic
What is a narrowing pulse pressure?
A decrease in systolic pressure with little change or an increase in diastolic pressure
What type of pulse pressure is typically seen with severe hypovolemia or severe drop in cardiac output?
Narrow Pulse Pressure
What type of blood pressure is an indirect measurement of systemic vascular resistence (SVR)?
Diastolic
What type of pulse pressure is typically associated with vasodilation, a drop in SVR; often seen in sepsis, septic shock?
Wide pulse pressure
The coronary arteries are perfused during systole or diastole?
Diastole
Ejection, high pressure is associated with which phase of the cardiac cycle?
Systole
Filling, low pressure is associated with which phase of the cardiac cycle?
Diastole
Why do cardiac output and blood pressure drop with extreme tachyarrhythmias?
No time for filling, therefore less output
What are some causes of valvular heart disease?
CAD, ischemia, acute MI, dilated cardiomyopathy, degeneration, Bicuspid aortic valve (genetic), Rheumatic fever, infection, connective tissue diseases
A murmur of insufficiency is also called _______
Regurgitation
Regurgitation occurs when the valves are open or closed?
CLOSED. Can be acute or chronic.
Stenosis occurs when the valve is open or closed?
OPEN. It is a chronic problem that develops over time and is NOT ACUTE.
What type of stenosis is associated with Afib d/t atrial enlargement that occurs over time?
Mitral Stenosis
Ventricular Septal Defect (VSD), is most common with an acute MI. What type of murmur may results because of this?
Systolic
Heard at the left sternal border, 5th ICS
What is Hypertensive Emergency or CRISIS?
elevated BP with EVIDENCE of end organ damage (brain, heart, kidneys, retina) that can be related to acute hypertensionW
What is Hypertensive URGENCY?
elevated BP without evidence of end organ damage–usually no need for critical care admission.
What 2 drugs are used in Hypertensive CRISIS or EMERGENCY
Nitroprusside (reduces both preload and afterload)
Labetalol (intermittent IV doses; effective 4-6 hours after dose is dc’d)
What is the greatest risk associated with Hypertensive CRISIS/EMERGENCY?
Stroke
