EXAM 1: Lecture 6 Flashcards
What influences deviations from normal anatomy in the heart?
The stretchiness, compliance, or rigidity of the ventricular walls.
What happens to the heart wall in severe aortic stenosis?
The heart wall becomes thicker due to muscle hypertrophy.
What type of hypertrophy occurs in the case of aortic stenosis?
Pathologic hypertrophy.
What is a downside of pathologic hypertrophy in the ventricle?
It makes the ventricle much harder to fill with blood.
What does reduced compliance of the ventricular wall indicate?
The wall is thicker and harder to fill with blood.
How does reduced compliance affect filling pressures?
It may change the pressures required to fill the heart with the normal amount of blood.
What does a shallower slope on a pressure-volume curve indicate?
Increased compliance of the ventricle.
What condition can lead to a thin-walled heart?
Dilated cardiomyopathy.
How do pediatric hearts handle increased venous return differently than adults?
They rely on an increase in heart rate.
What is the first heart sound (S1) associated with?
Closure of the AV valves.
Where is S1 heard loudest?
At the apex of the heart.
What does S2 represent?
Closure of the pulmonic and aortic valves.
Where is S2 heard loudest?
At the base of the heart.
What causes splitting of S2?
Differences in pressure differential on both sides of the heart during deep inspiration.
What does S3 indicate?
Rapid blood rush from the atria to the ventricle.
What conditions can S3 be indicative of?
- CHF
- Pulmonary hypertension
- Cor pulmonale
- Valve insufficiencies
What does S4 indicate?
Contraction of the atria pushing blood into a stiff or hypertrophic ventricle.
What conditions is S4 associated with?
- Myocardial ischemia
- Infarction
- Hypertension
- Ventricular hypertrophy
- Aortic stenosis
What is the purpose of a phonocardiogram?
To identify frequencies where heart murmurs occur.
What type of murmur is associated with aortic stenosis?
Systolic murmur.
What type of murmur is associated with aortic regurgitation?
Diastolic murmur.
What type of murmur is associated with mitral stenosis?
Diastolic murmur.
What type of murmur is associated with mitral regurgitation?
Systolic murmur.
What causes stenosis murmurs?
Forward flow of blood through stiff stenotic open valves.
What causes insufficiency murmurs?
Backward flow of blood through incompletely closed valves.
What is the location of the aortic area for auscultation?
To the right of the sternum at the second intercostal space.
What is the location of the mitral area for auscultation?
To the left of the sternum at the midclavicular line at the fifth intercostal space.
What are the divisions of the mediastinum?
- Superior mediastinum
- Inferior mediastinum
What are the parts of the inferior mediastinum?
- Anterior mediastinum
- Middle mediastinum
- Posterior mediastinum
What is located in the inferior middle mediastinum?
- Heart
- Ascending aorta
- Pericardium
- Superior vena cava
- Pulmonary arteries
- Pulmonary veins
- Pericardiophrenic nerves
What do the pericardiophrenic nerves supply?
Sensory perception in the pericardium and innervation to the diaphragm.
What happens when there is endocarditis affecting the heart?
It can cause pericardial pain due to the pericardiophrenic nerves.
What does the presence of a defined dichrotic notch in an arterial line indicate?
A clean art line with no clots.
What effect does an air bubble have on an arterial line waveform?
It causes over dampening of the waveform.
What does an overdampened wave response indicate?
Falsely decreased systolic pressure and poorly defined pressure tracing components.
What does an underdampened wave response indicate?
Falsely high systolic pressure and ringing artifacts on the waveform.
What is the significance of the square wave test in arterial line monitoring?
To assess the accuracy of the hemodynamic monitoring system.
Where does the waveform begin its rise in an arterial line?
Where the aortic valve opens, marking the beginning of systole.
What is underdampening in a waveform?
Less common clinically; may be due to pinpoint air bubbles, excessive tubing, tachycardia, hypothermia, high cardiac output, or a defective transducer
Underdampening causes the waveform to look whipped with many oscillations.
What does an arterial line monitor?
Blood pressure in real time
An invasive way to continuously track blood pressure.
What marks the beginning of systole in a waveform?
Where the aortic valve opens
This is indicated by the rise of the waveform.
Define peak systolic pressure.
The highest pressure at the strongest point of contraction of the left ventricle
This is what registers as the patient’s systolic blood pressure.
What is the dicrotic notch?
The slight upward wave before continuing downward
Marks the end of systole when the aortic and pulmonic valves close.
What does diastolic runoff refer to?
The decline in pressure as arteries equalize after systole
Continues until the lowest point before the aortic valve opens.
What is pulse pressure?
The difference between peak systolic pressure and minimum diastolic pressure
Indicates the force that the heart generates each time it contracts.
How is the slope of the systolic upstroke correlated?
To contractility
A steeper slope indicates better contractility.
What do the epicardial blood vessels include?
- LAD
- PDA
- Left and right coronary arteries
- Circumflex
These vessels are superficial and sit on the outside of the heart.
What is the significance of the endocardial vessels?
They are exposed to the most pressure during the cardiac cycle
These vessels are located deep within the heart muscle.
What is eccentric left ventricular hypertrophy?
Thinner walls of the left ventricle, often dilated
Can be caused by congenital conditions or aortic valve insufficiency.
What is concentric left ventricular hypertrophy?
Thicker walls of the left ventricle
Often caused by aortic valve stenosis and chronic untreated hypertension.
What happens during retrograde coronary perfusion?
Blood moves retrograde from subendocardial branches to epicardial branches
This occurs due to high pressures in the left ventricle.
What is the relationship between ventricular compliance and heart pathologies?
Reduced compliance leads to increased reliance on atrial contraction for filling
This can exacerbate conditions like aortic stenosis.
What role do fibroblasts play after a myocardial infarction?
They lay down scar tissue to repair damaged heart muscle
Excessive scar tissue can lead to dilated cardiomyopathy.
True or False: The heart’s ability to dilate surrounding blood vessels can affect the extent of tissue damage during ischemia.
True
Inability to dilate increases risk of larger infarcts.
Fill in the blank: The slope of the diastolic runoff is correlated with _______.
vascular resistance
Indicates how well blood can flow through the vessels.
What is the consequence of decreased ventricular compliance over time?
Increased pressure buildup in the atria and higher risk for atrial rhythms
Can lead to congestion in pulmonary veins and pulmonary edema.
What is a common outcome of excessive pressure in the left ventricle due to heart failure?
Congestion in the pulmonary veins
This can lead to pulmonary edema over time.
