CV Flashcards
What are the heart landmarks?
- Pulmonic = left 2nd intercostal space
- Aortic=Right 2nd intercostal space
- Tricuspid=R sternal border, 4-5th ICS
- Mitral= 4-5th ICS, MCL
What are the layers of the heart?
Which layer is the muscle that does the pumping?
The pericardium→ the outermost layer, is composed of two tough fibrous membranes that enclose and protect the heart. A few milliliters of serous fluid between the membranes provide lubrication for smooth movement of the heart.
The myocardium→ is the heart muscle that does the pumping.
The endocardium→ is a thin, smooth layer of endothelial tissue that lines the inner surface of the chambers and valves of the heart.
Which valves are the AV valves? When do they open and close? Which one is the loudest? Is it S1 or S2?
- Tricuspid: right AV valve
- Mitral valve (Bicuspid): left AV valve
- AV valves open during diastole, close during systole
- S1 (Mitral valve closure)→ Loudest at PMI
- “Lub”
Which valves are the semi-lunar valves? When do they open and close? Is it S1 or S2?
- Pulmonic = left 2nd intercostal space
- Aortic=Right 2nd intercostal space
- Close during diastole, and open during systole to allow blood to be ejected
- S2 (aortic valve closure), and another diastole begins
- “Dub”
Systole is to ventricular ________ as diastole is to ventricular ________.
Systole→ ventricle contraction
Diastole→Ventricle relaxation
how do you spell the real name of the blood pressure cuff? LOL
Sphygmomanometer
What is pulse pressure? How does one calculate it?
Systole - diastole
What does JVP reflect?
How can you observe JVD?
- Reflects right arterial pressure = central venous pressure (CVP)
- Lower the head of the bed to 30-45 degrees (When documenting, record the height of the bed)
What do you call when a person is experiencing air hunger, and is uncomfortably aware of their SOB?
Dyspnea
What do you call when a person is dyspneic when lying down, and it improves when they sit up?
Orthopnea
What do you call the condition where fluid from dependent edema rushes into your kidneys when you lay down at night, resulting in multiple trips to the bathroom at night?
Nocturia
What are some past family history things you should ask a ptn about?
First degree relative sudden death before 50-60 Stroke DM Obesity cardiovascular disease hypertension
What are the major risk factors for heart disease?
Obesity (BMI > 30 kg / m2) Smoking history Diabetes Mellitus Hypertension High cholesterol levels
You feel a _____ and you hear a _____ (with your ____).
Thrill
Bruit
Bell
What sounds do you hear with the bell?
- Low pitch
- S3, S4
- Murmur of Mitral stenosis
- Apply the bell lightly→press to hard turns into a diaphragm
What sounds do you hear with the diaphragm?
- High pitch
- Aortic and mitral regurgitation
- Pericardial friction rub
- S1 S2
How are murmurs distinguishable from regular heart sounds? Think: Leah
Murmurs are distinguishable from heart sounds by their longer duration. They are attributed to turbulent blood flow.
What is the difference between stenosis & regurgitation?
- Stenotic valve - can’t open all the way
* Aortic regurgitation - Can’t close all the way - back flow
What is a split S2? (which valves?)
When (insp/exp) would you hear it?
When is it NORMAL?
When is it ABNORMAL?
aortic valve closes earlier than pulmonic valve during Inspiration.
Normal:
• <40
• Athlete
• Louder when reclined, disappears when sits up or hold breath
Abnormal:
• Expiration
• Stays when sitting up
What is an S3? When do you hear it?
Ventricular or atrial?
When is it NORMAL?
When is it ABNORMAL?
ventricular gallop→ pathological change in ventricular compliance. Right after S2
Normal:
• Children and young adults
• pregnant women
• increased heart rate (tachycardia)
Abnormal: • Older adults • HTN • CHF (volume overload) • Mitral regurg • High output states (thyroid, anemia) • New S3 • Slosh-ing-in→too much fluid→ Lub-Dub-Da
What is an S4? Ventricular or atrial?
When is it NORMAL?
When is it ABNORMAL?
What does a NEW S4 mean?
Atrial gallop→ Pushing blood into noncompliant ventricle o NEVER NORMAL! o New S4=MI o Ta-Lub-Dub o a-Stiff-Wall o Right before S1
When is the FIRST time you can FEEL A THRILL? (Murmur grading)
At what grade can you have your stethoscope partly off the chest?
Grade 1 Very faint, heard only after listener has “tuned in”; may not be heard in all positions
Grade 2 Quiet, but heard immediately after placing the stethoscope on the chest
Grade 3 Moderately loud, without thrill
Grade 4 Loud, with palpable thrill
Grade 5 Very loud, with thrill. May be heard when the stethoscope is partly off the chest
Grade 6 Very loud, with thrill. May be heard with stethoscope entirely off the chest
What is preload?
What does it mean when there is pathological preload?
the load that stretches the cardiac muscle before contraction. The volume of blood in the right ventricle at the end of diastole, then constitutes the preload for the next beat.
Pathological=volume overload
What is myocardial contractility?
the ability of the cardiac muscle, when given a load, to contract or Shorten
What is afterload?
What is pathological afterload?
degree of vascular resistance to ventricular contraction. Increased arterial blood pressure causes increased afterload. Pathological=pressure overload
What are the values for normal BP?
Prehypertension?
Stage 1 HTN?
Stage 2 HTN?
Normal BP <80
Prehypertension 120-139/80-89
Stage 1 hypertension 140-159/90-99
Stage 2 hypertension greater than or equal to 160/ greater than or equal to 100
What does it mean when a person have central cyanosis? What lab value would be low, and what would be high?
Where would you see central cyanosis in a person?
central cyanosis: gums, conjunctiva; suggests poor arterial circulation
Low 02, high Co2
What do you call it when the apical pulse & the radial pulse are not identical? What is this indicative of?
Pulse deficit
HF or AFIB
