Chapter 20 Heart and Vessels Flashcards
Which normal variations may affect the location of the apical impulse
- lying left
- thick chest walls
- obese
Which abnormal variations may affect the location of apical impulse
LV dilation
left hypertrophy
Mechanism producing first and second heart sounds
S1 - closure of mitral and tricuspid ales (heard at the same time as the carotid pulse)
2 - closure of aortic and pulmonic
Explain the physiologic mechanism for normal splitting of S2. In what location on the heart would you expect to hear a split S2?
- normal, towards the end of inspiration
- when aortic valve closes a lot earlier than pulmonic valve
- instead of hearing DUB, hear T-DUP
- only heard in the pulmonic valve area
Differentiate a physiological S3 from a pathological S3.
Where is it heard?
• Physiological (normal) in children – disappear when pt sits up
• Pathological (abnormal) in adults – persists when pt sits up → indicates heart failure
- heard at apex
Define the fourth heart sound. When in the cardiac cycle does it occur?
Where is S4 heard?
- occurs when atria contracts late
- heard immediately before S1
- heard at apex
Define venous pressure and jugular venous pulse
Venous pressure - the pressure on the walls of the veins
Jugular Venous Pulse - The pulse in the right internal jugular vein at neck; pressure of right atrium
The carotid artery pulsation
- pulse with each systole as blood is pumped into the aorta
Define bruit
turbulence of blood flow ie. atherosclerosis
Heave or lift
ventricular hypertrophy = increased workload
Define pulse deficit, and discuss what it indicates
Signals a weak contraction of the ventricle
What is a murmur
- turbulent blood flow through a cardiac valve
- swishing
Four key heart sounds to look for
Frequency, duration, timing, intensity
What is ischemia
lack of blood to heart
What is myocardial infarction
necrosis of heart muscle
