Chapter 9: The Cardiovascular System Flashcards
Which chamber of the heart occupies most of the anterior cardiac surface?
The right ventricle
p. 333
Where is the base of the heart located and to what does this term refer?
It is located at the right and left 2nd interspaces next to the sternum. It refers to the superior aspect of the heart.
(p. 334)
Where is the point of maximal impulse usually found?
In the 5th interspace 7 cm to 9 cm lateral to the midsternal line, typically at or just medial to the left midclavicular line.
(p. 334)
A PMI greater that ___ __ is evidence of left ventricular hypertrophy (LVH), seen in ____________ and ______ ________.
Similarly, displacement of the PMI lateral to the midclavicular line or greater than 10 cm lateral to the midsternal line also suggests ___.
2.5 cm hypertension aortic stenosis LVH (p. 334)
What is the normal diameter of the PMI in supine patients?
1 to 2.5 cm; may be as large as a quarter (which is 2.426 cm in diameter)
(p. 334)
In patients with COPD, the most prominent palpable impulse may be in the _______ or __________ area as a result of _____ ___________ ___________.
xiphoid or epigastric
right ventricular hypertrophy
(p. 334)
The aortic and pulmonic valves are called…
….semilunar valves because each of their leaflets is shaped like a half moon.
(p. 335)
In most adults age 40 or over, the diastolic sounds of S3 and S4 are __________, and are highly correlated with _____ _______ and _____ __________ ________.
pathologic
heart failure
acute myocardial ischemia
(p. 335)
At the beginning of diastole, pressure in the left ventricle falls to below _ __ __, and rises to a normal peak of ___ __ __ during systole.
5 mm Hg
120 mm Hg
(p. 336)
Which valves are open during systole?
The aortic and pulmonic
Which valves are open during diastole?
The mitral and tricuspid
What defines the duration of systole and diastole?
The first and second heart sounds
Closure of what valve produces S1?
Mitral valve
p. 337
The opening of the mitral valve is usually silent, but may be audible as a pathologic _______ ____ if valve leaflets motion is restricted, as in ______ ________.
opening snap
mitral stenosis
(p. 338)
An S3 that is heard in children or young adults may arise from…
…rapid deceleration of the column of blood against the ventricular wall.
(p. 338)
An S3 (or S3 gallop) that is heard in older adults usually indicates…
…a pathologic change in ventricular compliance.
(p. 338)
It can also indicate volume overload or high cardiac output states (i.e. hyperthyroidism, anemia, pregnancy)
If an S4 is heard, it marks…
It is heard in ____ ________, and is best heard at the ____ in the left lateral position.
…atrial contraction.
(p. 338)
late diastole, apex.
[USA powerpoint]
An S4 can reflect…
…a pathologic change in ventricular compliance.
p. 338
Right heart pressures are significantly lower than corresponding pressures on the left side of the heart. As a result, right-sided events usually occur…
…slightly later than those on the left.
p. 338
Instead of a single S2 sound, you may hear two discernible components, the first from _____-_____ closure of the _______ valve, called __, and the second from _____-_____ closure of the _______ valve, known as __.
left-sided
aortic
A2
right-sided
pulmonic
P2
(p. 338)
During inspiration, the right heart filling time is _________, which increases right ventricular ______ ______ and the duration of right ventricular ________. This phenomenon delays the closure of the ________ valve, splitting S2 into two audible components. During expiration, these two components fuse into a ______ sound.
increased, stroke volume, ejection
pulmonic
single
(p. 339)
Because walls of veins contain less smooth muscle, the venous system has more ___________ than the arterial system and _____ systemic pressure. _____________ and _________ in the pulmonary vascular bed contribute to the “_______ ____” that delays P2.
capacitance, lower
distensibility, impedance, hangout time
(p. 339)
Which is louder, A2 or P2? Why?
A2, there is higher pressure in the aorta than in the pulmonary artery
(p. 339)
Where is P2 best heard?
Where is S2 splitting best heard?
The 2nd (and 3rd) left interspaces close to the sternum. Here is where you should listen for the splitting of S2. (p. 339)
