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Bates' Guide to Physical Examination and History Taking > Chapter 9: The Cardiovascular System > Flashcards

Chapter 9: The Cardiovascular System Flashcards

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1
Q

Which chamber of the heart occupies most of the anterior cardiac surface?

A

The right ventricle

p. 333

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2
Q

Where is the base of the heart located and to what does this term refer?

A

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)

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3
Q

Where is the point of maximal impulse usually found?

A

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)

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4
Q

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 ___.

A 
2.5 cm
hypertension
aortic stenosis
LVH
(p. 334)
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5
Q

What is the normal diameter of the PMI in supine patients?

A

1 to 2.5 cm; may be as large as a quarter (which is 2.426 cm in diameter)
(p. 334)

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6
Q

In patients with COPD, the most prominent palpable impulse may be in the _______ or __________ area as a result of _____ ___________ ___________.

A

xiphoid or epigastric
right ventricular hypertrophy
(p. 334)

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7
Q

The aortic and pulmonic valves are called…

A

….semilunar valves because each of their leaflets is shaped like a half moon.
(p. 335)

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8
Q

In most adults age 40 or over, the diastolic sounds of S3 and S4 are __________, and are highly correlated with _____ _______ and _____ __________ ________.

A

pathologic
heart failure
acute myocardial ischemia
(p. 335)

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9
Q

At the beginning of diastole, pressure in the left ventricle falls to below _ __ __, and rises to a normal peak of ___ __ __ during systole.

A

5 mm Hg
120 mm Hg
(p. 336)

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10
Q

Which valves are open during systole?

A

The aortic and pulmonic

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11
Q

Which valves are open during diastole?

A

The mitral and tricuspid

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12
Q

What defines the duration of systole and diastole?

A

The first and second heart sounds

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13
Q

Closure of what valve produces S1?

A

Mitral valve

p. 337

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14
Q

The opening of the mitral valve is usually silent, but may be audible as a pathologic _______ ____ if valve leaflets motion is restricted, as in ______ ________.

A

opening snap
mitral stenosis
(p. 338)

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15
Q

An S3 that is heard in children or young adults may arise from…

A

…rapid deceleration of the column of blood against the ventricular wall.
(p. 338)

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16
Q

An S3 (or S3 gallop) that is heard in older adults usually indicates…

A

…a pathologic change in ventricular compliance.
(p. 338)

It can also indicate volume overload or high cardiac output states (i.e. hyperthyroidism, anemia, pregnancy)

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17
Q

If an S4 is heard, it marks…

It is heard in ____ ________, and is best heard at the ____ in the left lateral position.

A

…atrial contraction.
(p. 338)

late diastole, apex.
[USA powerpoint]

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18
Q

An S4 can reflect…

A

…a pathologic change in ventricular compliance.

p. 338

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19
Q

Right heart pressures are significantly lower than corresponding pressures on the left side of the heart. As a result, right-sided events usually occur…

A

…slightly later than those on the left.

p. 338

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20
Q

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 __.

A

left-sided
aortic
A2

right-sided
pulmonic
P2

(p. 338)

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21
Q

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.

A

increased, stroke volume, ejection
pulmonic
single
(p. 339)

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22
Q

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.

A

capacitance, lower
distensibility, impedance, hangout time
(p. 339)

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23
Q

Which is louder, A2 or P2? Why?

A

A2, there is higher pressure in the aorta than in the pulmonary artery
(p. 339)

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24
Q

Where is P2 best heard?

Where is S2 splitting best heard?

A 
The 2nd (and 3rd) left interspaces close to the sternum.  Here is where you should listen for the splitting of S2.  
(p. 339)
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25
Q

S1 also has…

A

…two components.

p. 339

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26
Q

The closure of the mitral valve can be heard best at…

A

…the cardiac apex.

p. 339

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27
Q

The closure of the tricuspid valve and S1 splitting (if discernible) can be heard best at…

A

…the lower left sternal border (the 4th and 5th interspaces).
(p. 339)

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28
Q

Splitting of S1 does not…

A

…vary with respiration.

p. 339

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29
Q

Where is the sinoatrial node located?

A

In the right atrium near the junction of the vena cava.

p. 341

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30
Q

Where is the atrioventricular node located?

What occurs at this node?

A

In the atrial septum
The impulse is delayed
(p. 341)

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31
Q

The ECG consists of 6…

A

…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)

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32
Q

Electrical vectors approaching a lead cause…

A

…a positive, or upward, deflection.

p. 341

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33
Q

Electrical vectors moving away from a lead cause…

A

…a negative, or downward deflection.

p. 341

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34
Q

When positive and negative vectors balance, they…

A

…are isoelectric, appearing as a straight line.

p. 341

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35
Q

The P wave represents…

A

…atrial depolarization.

p. 341

36
Q

The QRS as a whole represents…

A

…ventricular depolarization.

p. 341

37
Q

The Q wave is…

A

…a downward deflection from septal depolarization.

p. 341

38
Q

The R wave is…

A

…an upward deflection from ventricular depolarization.

p. 341

39
Q

The S wave is…

A

…a downward deflection following an R wave.

p. 341

40
Q

The T wave represents…

A

…ventricular repolarization (or recovery)

p. 341

41
Q

In terms of connecting systole with the ECG waveforms, when does systole begin and end?

A

Begins in the middle of the QRS (since electrical activity slightly precedes mechanical activity), and ends after the T wave.
(p. 342)

42
Q

In terms of connecting diastole with the ECG waveforms, when does diastole begin and end?

A

Begins after the T wave, and ends in the middle of the QRS.
(p. 342)

43
Q

Stroke volume depends on…

A

…preload, myocardial contractility, and afterload

p. 342

44
Q

The volume of blood in the _____ _________ at the end of ________ constitutes its preload for the next beat.

A

right ventricle
diastole
(p. 342)

45
Q

Myocardial contractility refers to the ability of the muscle to _______ when given a ____.

A

shorten
load
(p. 342)

46
Q

Contractility decreases when _____ ____ or ______ ________ to the myocardium is impaired.

A

blood flow
oxygen delivery
(p. 342)

47
Q

Sources of resistance to left ventricular contraction include…

A

…the tone in the walls of the aorta, arteries, and arterioles, as well as the volume of blood already in the aorta.
(p. 342)

48
Q

A pathologic increase in preload is known as…

A

…volume overload.

p. 343

49
Q

A pathologic increase in afterload is known as…

A

…pressure overload.

p. 343

50
Q

The difference between systolic and diastolic pressures is known as…

A

…pulse pressure.

p. 343

51
Q

Name 4 factors influencing arterial pressure.

A

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)

52
Q

The jugular venous pressure is best estimated from the…

A

…right internal jugular vein, which has the most direct channel into the right atrium.
(p. 344)

53
Q

Changing pressures in the right atrium during the cardiac cycle produce ____________ of filling and emptying in the jugular veins known as _______ ______ __________.

A

oscillations
jugular venous pulsations
(p. 344)

54
Q

Jugular venous pulsation waveforms -

Atrial contraction produces an _ wave just before __ and _______, followed by the _ _______ of atrial relaxation.

A 
a
S1
systole
x 
(p. 344)
55
Q

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.

A 
inflow 
vena cava
systole
v
y descent
(p. 344)
56
Q

True or false? Aging affects the location of the apical impulse. Why?

A

True; as the chest deepens in its AP diameter, the impulse gets harder to find.
(p. 344)

57
Q

At some time in the life span, almost everyone has a _____ ______.

A

heart murmur

p. 344

58
Q

A cervical systolic murmur or bruit may be innocent in ________, but suspicious for _______________ ________ in adults.

A

children
atherosclerotic disease
(p. 344)

59
Q

When assessing cardiac symptoms, it is important to quantify…

A

…the patient’s baseline level of activity.

p. 345

60
Q

What is the leading cause of death for both men and women?

A

coronary heart disease

p. 345

61
Q

Classic exertional pain, pressure, or discomfort in the chest, shoulder, back, neck, or arm is seen in only __% of patients with an MI.

A

50%

p. 345

62
Q

In the absence of CAD on angiogram, what two disease states could cause chest pain?

A

Microvascular coronary dysfunction
Abnormal cardiac nocioception
(p. 346)

63
Q

Roughly ____ of women with chest pain and normal angiograms have…

A

half
…microvascular coronary dysfunction
(p. 346)

64
Q

What type of pain is often felt in patients with acute aortic dissection?

A

Anterior chest pain, often of a tearing or ripping nature that radiates into the back or neck.
(p. 346)

65
Q

What is dyspnea?

A

An uncomfortable awareness of breathing that is inappropriate to a given level of exertion
(p. 346)

66
Q

What is orthopnea?

A

Dyspnea that occurs when the patient is lying down and improves when the patient sits up
(p. 346)

67
Q

What is paroxysmal nocturnal dyspnea?

A

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)

68
Q

What is the brown discoloration called that is associated with venous stasis?

A

hemosiderin deposits

[USA powerpoint]

69
Q

Where do venous ulcers occur d/t bacterial invasion of poorly drained tissue?

A

usually at the medial malleoli

[USA powerpoint]

70
Q

Where do arterial ulcers usually occur?

A

The tip of the toes, metatarsal heads, and lateral malleoli

[USA powerpoint]

71
Q

Homan’s sign is + in what percent of patients with DVTs?

A

35%

[USA powerpoint]

72
Q

What are some tips for palpating the PMI?

A

Use 1 finger pad
Ask patient to exhale and hold.
Have patient tilt to the left
[USA powerpoint]

73
Q

S1 is loudest at the…

A

…apex.

[USA powerpoint]

74
Q

S2 is loudest at the…

A

…base.

[USA powerpoint]

75
Q

An S3 occurs in _____ ________ and is best heard at the ____.

A

early diastole, apex

76
Q

A pericardial friction rub is caused by…

…and its quality is….

A

…inflammation of the pericardium
…high pitched and stratchy.
[USA powerpoint]

77
Q

Describe the characteristics of aortic stenosis.

A

It is a midsystolic ejection murmur, loud, harsh, crescendo-decrescendo, and often radiates to the carotids.
[USA powerpoint]

78
Q

Describe the characteristics of pulmonic stenosis.

A

It is a midsystolic, medium pitch, coarse, crescendo-decrescendo, and radiates to the neck or back.
[USA powerpoint]

79
Q

Describe the characteristics of mitral regurgitation.

A

It is a pansystolic, loud, blowing murmur, best heard at the apex, and radiates to the left axilla.
[USA powerpoint]

80
Q

Describe the characteristics of tricuspid regurgitation.

A

It is a soft, blowing murmur, heard best at left lower sternal border, and increases with inspiration.
[USA powerpoint]

81
Q

Describe the characteristics of mitral stenosis.

A

It is a diastolic rumble, low-pitched, and best heard at the apex in the left lateral position. It does not radiate.
[USA powerpoint]

82
Q

Describe the characteristics of tricuspid stenosis.

A

It is a diastolic rumble that gets louder in inspiration.

[USA powerpoint]

83
Q

Which two murmurs are due to incompetent semilunar valves? When are they heard?

A

Aortic and pulmonic regurgitation.
Heard in early diastole.
[USA powerpoint]

84
Q

Describe the various grades of murmurs.

A

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]

85
Q

An S3 is also called a….

It sounds like…

A

…ventricular gallop (p. 398)

…“Ken-tuck-y”

86
Q

An S4 is also called…

It sounds like…

A

…an atrial sound or atrial gallop (p. 398)

…“Ten-nes-see”

87
Q

An S4 is never heard…

A

…in the absence of atrial contraction, such as with atrial fibrillation.
(p. 398)

Bates' Guide to Physical Examination and History Taking (18 decks)

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