Chapter 9, Module 5; Cardiovascular System Flashcards
In supine patients the diameter of the PMI may be as large as a quarter, approximately _____ cm.
1 to 2.5
For example, in patients with chronic obstructive pulmonary disease (COPD), the most prominent palpable impulse or PMI may be in the xiphoid or ______ area due to right ventricular hypertrophy.
epigastric
Rarely, in situs inversus and dextrocardia, the PMI is located on the _____ side of the chest.
right
A PMI >2.5 cm is evidence of _______ _____ ______ from hypertension or aortic stenosis.
left ventricular hypertrophy (LVH)
Displacement of the PMI lateral to the midclavicular line or>____ cm lateral to the midsternal line occurs in LVH and also in ventricular dilatation from myocardial infarction (Ml) or heart failure.
10
mitral and tricuspid valves are often called _______ valves.
atrioventricular (AV)
The aortic and pulmonic valves are called semilunar valves because the valve leaflets are shaped like _____ moons.
half
In most adults over age 40 years, the diastolic sounds of S3 and S4 ________, are and are correlated with heart failure and acute myocardial ischemia.
pathologic
In recent studies, anS3 corresponds to an abrupt deceleration of _____across the mitral valve, and an S4 to increased left ventricular end diastolic stiffness which decreases compliance.
inflow
Systole is the period of ventricular contraction. As shown in Figure 9-4, pressure in the left ventricle rises, from less than ____ mm Hg in its resting state, to a normal peak of ____ mm Hg. After the ventricle ejects much of its blood into the aorta, the pressure levels off and starts to fall.
5 mmHg
120 mmHg
____ is the period of ventricular relaxation. Ventricular pressure falls further to below 5 mmHg, and blood flows from atrium to ventricle.
Diastole
Pressure in the blood- filled left atrium slightly exceeds that in the relaxed left ventricle, and blood flows from left atrium to left ventricle across the open mitral valve (Fig. 9-5). Just before the onset of ventricular systole, atrial contraction produces a slight pressure rise in both chambers.
During diastole
The left ventricle starts to contract and ventricular pressure rapidly exceeds left atrial pressure, closing the mitral valve (Fig. 9-6). Closure of the mitral valve produces the first heart sound, S1.As left ventricular pressure continues to rise, it quickly exceeds the pressure in the aorta and forces the aortic valve open.
During systole
In some pathologic conditions, an earlysystolic ___ _______ accompaniesthe opening of the aortic valve.As the left ventricle ejects most of its blood, ventricular pressure begins to fall. When left ventricular pressure drops below aortic pressure, the aortic valve closesAortic valve closure produces the second heart sound, S2, and another diastole begins.
ejection sound (Ej)
In diastole,left ventricular pressure continues to drop and falls below left atrial pressure. The mitral valve opensthis event is usually silent, but may be audible as a pathologic opening snap (OS) if valve leaflet motion is restricted, as in ____ _____after the mitral valve opens, there is a period of rapid ventricular filling as blood flows early in diastole from left atrium to left ventriclein children and young adults, athird heart sound, S3, may arise from rapid deceleration of the column of blood against the ventricular wall. In older adults, andsometimes termedusually indicates a pathologic change in ventricular compliance.Finally, although not often heard in normal adults,
mitral stenosis
Afourth heart sound, ____,Marks atrial contraction it immediately precedes S3 of the next beat and can also reflect a pathologic change in ventricular compliance.Note that right-sided cardiac events usually occur slightlylaterthan those on the left. Instead of a hearing a single heart sound for S2, you may hear two discernible components, the first from left-sided aortic valve closure, or A2, and the second from right-sided closure of the pulmonic valve, or P2.
S4
The second heart sound, S2, and its two components, A2 and P2, are caused primarily by closure of the
aortic and pulmonic valves
Of the two components of the S2, A2 is normally____, reflecting the high pressure in the aorta. It s heard throughout the precordium. In contrast, P2 is relativelysoft,reflecting the lower pressure in the pulmonary artery.
louder
Si also has two components, an earlier mitral and a later tricuspid sound. The mitral sound—the principal component of Si—is much______,again reflecting the higher pressures on the left side of the heart. It can be heard throughout the precordium and is loudest at the cardiac apex. Thesoftertricuspid component is heard best at the lower left sternal border; it is here that you may hear a split Si.
louder
_____ are distinct heart sounds distinguished by their pitch and their longer duration. They are attributed to turbulent blood flow and are usually diagnostic of valvular heart disease.
Heart murmurs
_____ valvehas an abnormally narrowed valvular orifice that obstructs blood.Such a valve allows blood to leak backward in a retrograde direction and produces aregurgitant murmur.
Stenotic
Electrical vectors approaching a lead cause a positive, or upward, ____?
deflection.
Electrical vectors moving away from the lead cause a negative?
downward, deflection.
When positive and negative vectors balance, they are isoelectric and appear as a ______ ______.
straight line.
