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.
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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)
S1 also has…
…two components.
p. 339
The closure of the mitral valve can be heard best at…
…the cardiac apex.
p. 339
The closure of the tricuspid valve and S1 splitting (if discernible) can be heard best at…
…the lower left sternal border (the 4th and 5th interspaces).
(p. 339)
Splitting of S1 does not…
…vary with respiration.
p. 339
Where is the sinoatrial node located?
In the right atrium near the junction of the vena cava.
p. 341
Where is the atrioventricular node located?
What occurs at this node?
In the atrial septum
The impulse is delayed
(p. 341)
The ECG consists of 6…
…limb leads in the frontal plane (leads I, II, and III, and aVR, aVL, and aVF), and six chest (or precordial) leads in the transverse plane (V1 - V6).
(p. 341)
Electrical vectors approaching a lead cause…
…a positive, or upward, deflection.
p. 341
Electrical vectors moving away from a lead cause…
…a negative, or downward deflection.
p. 341
When positive and negative vectors balance, they…
…are isoelectric, appearing as a straight line.
p. 341
The P wave represents…
…atrial depolarization.
p. 341
The QRS as a whole represents…
…ventricular depolarization.
p. 341
The Q wave is…
…a downward deflection from septal depolarization.
p. 341
The R wave is…
…an upward deflection from ventricular depolarization.
p. 341
The S wave is…
…a downward deflection following an R wave.
p. 341
The T wave represents…
…ventricular repolarization (or recovery)
p. 341
In terms of connecting systole with the ECG waveforms, when does systole begin and end?
Begins in the middle of the QRS (since electrical activity slightly precedes mechanical activity), and ends after the T wave.
(p. 342)
In terms of connecting diastole with the ECG waveforms, when does diastole begin and end?
Begins after the T wave, and ends in the middle of the QRS.
(p. 342)
Stroke volume depends on…
…preload, myocardial contractility, and afterload
p. 342
The volume of blood in the _____ _________ at the end of ________ constitutes its preload for the next beat.
right ventricle
diastole
(p. 342)
Myocardial contractility refers to the ability of the muscle to _______ when given a ____.
shorten
load
(p. 342)
Contractility decreases when _____ ____ or ______ ________ to the myocardium is impaired.
blood flow
oxygen delivery
(p. 342)
Sources of resistance to left ventricular contraction include…
…the tone in the walls of the aorta, arteries, and arterioles, as well as the volume of blood already in the aorta.
(p. 342)
A pathologic increase in preload is known as…
…volume overload.
p. 343
A pathologic increase in afterload is known as…
…pressure overload.
p. 343
The difference between systolic and diastolic pressures is known as…
…pulse pressure.
p. 343
Name 4 factors influencing arterial pressure.
Left ventricular stroke volume
Distensibility of the aorta and large arteries
Peripheral vascular resistance, especially arteriolar
Volume of blood in the arterial system
(p. 343)
The jugular venous pressure is best estimated from the…
…right internal jugular vein, which has the most direct channel into the right atrium.
(p. 344)
Changing pressures in the right atrium during the cardiac cycle produce ____________ of filling and emptying in the jugular veins known as _______ ______ __________.
oscillations
jugular venous pulsations
(p. 344)
Jugular venous pulsation waveforms -
Atrial contraction produces an _ wave just before __ and _______, followed by the _ _______ of atrial relaxation.
a S1 systole x (p. 344)
Jugular venous pulsation waveforms -
As right atrial pressure begins to rise with ______ from the ____ ____ during right ventricular _______, there is a second elevation, the _ wave, followed by the _ _______ as blood passively empties into the right ventricle during early and mid diastole.
inflow vena cava systole v y descent (p. 344)
True or false? Aging affects the location of the apical impulse. Why?
True; as the chest deepens in its AP diameter, the impulse gets harder to find.
(p. 344)
At some time in the life span, almost everyone has a _____ ______.
heart murmur
p. 344
A cervical systolic murmur or bruit may be innocent in ________, but suspicious for _______________ ________ in adults.
children
atherosclerotic disease
(p. 344)
When assessing cardiac symptoms, it is important to quantify…
…the patient’s baseline level of activity.
p. 345
What is the leading cause of death for both men and women?
coronary heart disease
p. 345
Classic exertional pain, pressure, or discomfort in the chest, shoulder, back, neck, or arm is seen in only __% of patients with an MI.
50%
p. 345
In the absence of CAD on angiogram, what two disease states could cause chest pain?
Microvascular coronary dysfunction
Abnormal cardiac nocioception
(p. 346)
Roughly ____ of women with chest pain and normal angiograms have…
half
…microvascular coronary dysfunction
(p. 346)
What type of pain is often felt in patients with acute aortic dissection?
Anterior chest pain, often of a tearing or ripping nature that radiates into the back or neck.
(p. 346)
What is dyspnea?
An uncomfortable awareness of breathing that is inappropriate to a given level of exertion
(p. 346)
What is orthopnea?
Dyspnea that occurs when the patient is lying down and improves when the patient sits up
(p. 346)
What is paroxysmal nocturnal dyspnea?
Episodes of sudden dyspnea and orthopnea that awaken the patient from sleep, usually 1 or 2 hours after going to bed, prompting the patient to sit or stand up
(p. 347)
What is the brown discoloration called that is associated with venous stasis?
hemosiderin deposits
[USA powerpoint]
Where do venous ulcers occur d/t bacterial invasion of poorly drained tissue?
usually at the medial malleoli
[USA powerpoint]
Where do arterial ulcers usually occur?
The tip of the toes, metatarsal heads, and lateral malleoli
[USA powerpoint]
Homan’s sign is + in what percent of patients with DVTs?
35%
[USA powerpoint]
What are some tips for palpating the PMI?
Use 1 finger pad
Ask patient to exhale and hold.
Have patient tilt to the left
[USA powerpoint]
S1 is loudest at the…
…apex.
[USA powerpoint]
S2 is loudest at the…
…base.
[USA powerpoint]
An S3 occurs in _____ ________ and is best heard at the ____.
early diastole, apex
A pericardial friction rub is caused by…
…and its quality is….
…inflammation of the pericardium
…high pitched and stratchy.
[USA powerpoint]
Describe the characteristics of aortic stenosis.
It is a midsystolic ejection murmur, loud, harsh, crescendo-decrescendo, and often radiates to the carotids.
[USA powerpoint]
Describe the characteristics of pulmonic stenosis.
It is a midsystolic, medium pitch, coarse, crescendo-decrescendo, and radiates to the neck or back.
[USA powerpoint]
Describe the characteristics of mitral regurgitation.
It is a pansystolic, loud, blowing murmur, best heard at the apex, and radiates to the left axilla.
[USA powerpoint]
Describe the characteristics of tricuspid regurgitation.
It is a soft, blowing murmur, heard best at left lower sternal border, and increases with inspiration.
[USA powerpoint]
Describe the characteristics of mitral stenosis.
It is a diastolic rumble, low-pitched, and best heard at the apex in the left lateral position. It does not radiate.
[USA powerpoint]
Describe the characteristics of tricuspid stenosis.
It is a diastolic rumble that gets louder in inspiration.
[USA powerpoint]
Which two murmurs are due to incompetent semilunar valves? When are they heard?
Aortic and pulmonic regurgitation.
Heard in early diastole.
[USA powerpoint]
Describe the various grades of murmurs.
Grade I: Barely audible.
Grade II: Clearly audible but faint.
Grade III: Moderately loud, easily heard.
Grade IV: Moderately loud, associated with a thrill.
Grade V: Very loud, heard with one corner of stethoscope lifted off chest wall.
Grade VI: Loudest, heard without a
stethoscope.
[USA powerpoint]
An S3 is also called a….
It sounds like…
…ventricular gallop (p. 398)
…“Ken-tuck-y”
An S4 is also called…
It sounds like…
…an atrial sound or atrial gallop (p. 398)
…“Ten-nes-see”
An S4 is never heard…
…in the absence of atrial contraction, such as with atrial fibrillation.
(p. 398)
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