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
What is myocardial ischemia
lack of o2 to the heart, causing angina
What is stroke volume
The amount of blood ejected at each heart beat
Preload
Myocardial contractility
Afterload
- load that stretches muscle before contraction
- ability of heart muscle to shorten
- degree of ventricular resistance to ventricular contraction
