Chapter 9, Module 5; Cardiovascular System

Question 1

In supine patients the diameter of the PMI may be as large as a quarter, approximately _____ cm.

Answer 1

1 to 2.5

Question 2

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.

Answer 2

epigastric

Question 3

Rarely, in situs inversus and dextrocardia, the PMI is located on the _____ side of the chest.

Answer 3

right

Question 4

A PMI >2.5 cm is evidence of _______ _____ ______ from hypertension or aortic stenosis.

Answer 4

left ventricular hypertrophy (LVH)

Question 5

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.

Answer 5

10

Question 6

​​​​​​​ mitral and tricuspid valves are often called _______ valves.

Answer 6

atrioventricular (AV)

Question 7

The aortic and pulmonic valves are called semilunar valves because the valve leaflets are shaped like _____ moons.

Answer 7

half

Question 8

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.

Answer 8

pathologic

Question 9

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.

Answer 9

inflow

Question 10

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.

Answer 10

5 mmHg

120 mmHg

Question 11

____ is the period of ventricular relaxation. Ventricular pressure falls further to below 5 mmHg, and blood flows from atrium to ventricle.

Answer 11

Diastole

Question 12

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.

Answer 12

During diastole

Question 13

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.

Answer 13

During systole

Question 14

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.

Answer 14

ejection sound (Ej)

Question 15

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,

Answer 15

mitral stenosis

Question 16

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.

Answer 16

S4

Question 17

The second heart sound, S2, and its two components, A2 and P2, are caused primarily by closure of the

Answer 17

aortic and pulmonic valves

Question 18

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.

Answer 18

louder

Question 19

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.

Answer 19

louder

Question 20

_____ 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.

Answer 20

Heart murmurs

Question 21

_____ 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.

Answer 21

Stenotic

Question 22

Electrical vectors approaching a lead cause a positive, or upward, ____?

Answer 22

deflection.

Question 23

Electrical vectors moving away from the lead cause a negative?

Answer 23

downward, deflection.

Question 24

When positive and negative vectors balance, they are isoelectric and appear as a ______ ______.

Answer 24

straight line.

Question 25

The small ____ wave of atrial depolarization (duration up to 80 milliseconds; PR interval no to 200 milliseconds)

Answer 25

P

Question 26

A downward deflection from septal depolarization?

Answer 26

Q wave

Question 27

An upward deflection from ventricular depolarization?

Answer 27

R wave

Question 28

A downward deflection following an R wave

Answer 28

S wave

Question 29

Ventricular repolarization, or recovery (duration relates to QRS)?

Answer 29

T wave

Question 30

The volume of blood ejected from each ventricle during 1 minute, is the product of heart rate and stroke volume.

Answer 30

Cardiac output

Question 31

(the volume of blood ejected with each heartbeat) depends in turn on preload, myocardial contractility, and afterload.

Answer 31

Stroke volume

Question 32

____ refers to the load that stretches the cardiac muscle before contraction. The volume of blood in the RV at the end of diastole constitutes its

Answer 32

Preload

Question 33

Right ventricular preload is increased by increasing______return to the right heart.

Answer 33

venous

Question 34

_____ ______refers to the ability of the cardiac muscle, when given a load, to shorten. Contractility increases when stimulated by action of the sympathetic nervous system and decreases when blood flow or oxygen delivery to the myocardium is impaired.

Answer 34

Myocardial contractility

Question 35

______ refers to the degree of vascular resistance to ventricular contrac¬ tion. Sources of resistance to contraction include the tone in the walls of the aorta, the large arteries, and the peripheral vascular tree (primarily the small arteries and arterioles), as well as the volume of blood already in the aorta.These are the levels that are measured with the blood pressure cuff, or sphygmomanometer. The difference between systolic and diastolic pressures is known as the pulse pressure.

Answer 35

Afterload

Question 36

Atrial contraction produces an ______?

Answer 36

a wave

Question 37

the jugular veins just before S1and systole, followed by the _____ _____ ​​​​​​​of atrial relaxation.

Answer 37

x descent

Question 38

As right atrial pressure begins to rise with inflow from the vena cava during right ventricular systole, there is a second elevation, ___ ______ followed by the y descent as blood passively empties into the RV during early and middiastole.

Answer 38

the v wave,

Question 39

This section approaches chest symptoms from a cardiac standpoint, and includes the important symptoms of chest pain, palpitations, shortness of breath from

Answer 39

orthopnea

Question 40

Or paroxysmal nocturnal dyspnea (PND), swelling from edema, and fainting. Study the various causes of chest pain, dyspnea, wheezing, cough, and even because these symptoms can be cardiac as well as pulmonary in origin.

Answer 40

hemoptysis,

Question 41

Classic exertional pain, pressure, or discomfort in the chest, shoulder, back, neck, or arm in ___ _____. is seen in 18% of patients with acute Ml32; atypical descriptors also are common, such as cramping, grinding, pricking or, rarely, tooth or jaw pain.

Answer 41

angina pectoris,

Question 42

Both men and women with acute coronary syndrome usually present with the classic symptoms of exertional angina; however, women, particularly those over age _____?

Answer 42

65

Question 43

_____ involve an unpleasant awareness of the heartbeat. Patients use various terms to describe such as skipping, racing, fluttering, pounding, or stopping of the heart. ____ may be irregular, rapidly slow down or accelerate, or arise from the increased forcefulness of cardiac contraction.

Answer 43

Palpitations

Question 44

PND describes episodes of sudden dyspnea and

_________?

Answer 44

orthopnea

Question 45

_____ ____ that awaken the patient from sleep, usually 1 or 2 hours after going to bed, prompting the patient to sit up, stand up, or go to a window for air. occurs in pulmonary embolus, spontaneous pneumothorax, and anxiety.Causes are frequently cardiac (right or left ventricular dysfunction;

Answer 45

Sudden dyspnea

Question 46

______is severe generalized edema extending to the sacrumabdomen. Look for the periorbital puffiness and tight rings ofnephrotic syndrome and an enlarged waistlinefrom ascites and liver failure.

Answer 46

Anasarca

Question 47

The absence of clinically manifest CVD and the simultaneous presence of optimal levels of seven health metrics, including _______ four health behaviors (lean body mass index not smoking, being physically active, and following a healthy diet), and three health factors

Answer 47

<25 kg/m2,

Question 48

NRML BP according to Adults—JNC 7, American Society of Hypertension is?

Answer 48

SBP <120 and DBP <80

Question 49

Prehypertension BP according to Adults—JNC 7, American Society of Hypertension is?

Answer 49

SBP 120-139 and DBP 80-89

Question 50

Stage 1 hypertension Age >18 to <60 yrs according to Adults—JNC 7, American Society of Hypertension is?

Answer 50

SBP 140-159 and DBP 90-99