Exam 3 Flashcards
What happens during contraction?
The Apex beats against the chest wall producing an apical impulse
Where is the apical impulse located?
Normally at the fifth intercostal space 7 to 9 cm from midsternal line
The heart is rotated so what side is anterior and what side is posterior
The right side is anterior in the left side is posterior
Atrium
Reservoir for holding blood
Ventricle
Muscular pumping chamber
Pericardium
Tough fibrous double walled sac that surrounds and protects the heart. It has two layers that contain a few milliliters of a serous pericardial fluid does ensure a smooth friction free movement of the heart muscle
Pericardium
Adherent to great vessels esophagus sternum and pleural and anchored to the diaphragm
Myocardium
Muscular wall of the heart it does pumping
Endocardium
Thin layer of endothelial tissue that lines inner surface of heart chambers and valves
And normally high pressures in the left side of the heart gives person symptoms of
Pulmonary congestion
Abnormally high pressures in right side of heart shows in
In neck veins and abdomen
During the pumping phase or systole what happens?
The AV valves close to prevent regurgitation of blood back up into atria
What happens when the AV valves open during hearts filling phase also known as diastoly
It allows the ventricles to fill with blood
How is diastole defined?
Ventricles relax and fill with blood this takes up to 2/3 of cardiac cycle
Systole
Hearts contraction, blood pumped from ventricles Phils pulmonary and systemic arteries, this is 1/3 of cardiac cycle
What are you hearing with the first heart sound S1
Closure of AV valves
What are you hearing when you hear the second heart sound S2
Closure of semi lunar valves and signals end of systole
Name five characteristics of the first heart sound
Onset of systole
Closure of mitral and tricuspid valves
High pitched
Heard loudest at the mitral an apical area
What are four characteristics of the second heart sound
Onset of diastole to end of diastole
Closure of aortic and pulmonic valves
High pitched
Heard loudest at base of heart
Murmur
Gentle blowing, swooshing sound that can be heart on the chest wall
Conditions resulting in murmur
Thyrotoxicosis- in exercise- velocity of blood increases
Anemia- velocity of blood decreases
Structural defects in valves, narrowed valve, incompetent valves
Unusual openings occur in chambers, dilated chamber, wall defect
Conduction
Automaticity- Unique ability of the heart to contract by itself in response to an electrical current conveyed by the conduction system
Sa node
Pacemaker; Discharges impulse between 60 to 100 bpm
P wave
Depolarization of atria
P-R interval
From beginning of P wave to beginning of QRS complex (Time necessary for atria depolarization plus time for impulse to travel through AV node to ventricles)
QRS complex
Depolarization of ventricles
T wave
Repolarization of ventricles
How do you calculate cardiac output?
Cardiac output equals volume of blood in each systole or stroke volume times the number of beats per minute
What are some hemodynamic changes with aging?

Overall size of heart does not increase with age but left ventricular wall in thickness increases
No change in Diastolic pressure occurs with age
A rising systolic pressure with a relatively constant diastolic pressure increases pulse pressure
No change in resting heart rate occurs with aging
Cardiac output at rest is not changed with aging
Decreased ability of hard to augment cardiac output with exercise
Does the incident of coronary artery disease increase or decrease sharply with advanced age
Increases and accounts for about half of all deaths in older people
An increase in physical activity of older adults is associated with reduced risks of death from what?
Cardiovascular disease and respiratory illness
What are five major risk factors for heart disease and stroke
Hypertension, smoking, serum cholesterol, type two diabetes, obesity
For a person middle age or older who is showing signs of cardiovascular disease auscultate each carotid artery for the presence of bruit. How do you perform this?
Lately apply Bell of stethoscope over carotid arteries at three levels
The angle of the jaw, mid cervical area, base of neck,
How to estimate jugular venous pressure
Precordium
Auscultation
Sound radiates with blood flow direction valves areas are:
Second right into space is the aortic valve area
Second left interspace: Pomonic valve area
Third left interspace: Erb’s point
Left lower sternal border: tricuspid valve area
Fifth interspace at around left midclsvicular line: mitral valve area
Grade 1 murmur
Very faint, heard only after listener has tune in
Grade 2 murmur
Quiet but hurt immediately after placing the stethoscope on the chest
Grade 3 murmur
Moderately loud
Grade 4 murmur
Loud, with palpable thrill
Grade 5 murmur
Very loud, with thrill. May be heard when the stethoscope is partially off the chest
Grade 6 murmur
Very loud with thrill. May be heard with stethoscope entirely off the chest
Abnormal pulsation
S3 and S4 heart sounds
Portrait of heart failure
Dilated pupils Skin is pale, cyanotic, gray Dyspnea Decreased BP nausea and vomiting Ascites Pitting edema Anxiety Jvd Fatigue S3 DecreSed urine output Weak pulse
+1 pitting edema
Mild petting, slight indentation, no perceptible swelling
+2 pitting edema
Moderate pitting, indentation, no perceptible swelling
+3 pitting edema
Deep pitting, indentation remains, legs look swollen.
+4 pitting edema
Very deep pitting, indentation lasts a long time, leg very swollen.
Manual compression test of varicose veins
While person is standing, test length of varicose being to determine whether its valves are competent then place one hand on lower part of varicose vein and compressed being with your other hand about 20 cm higher competent means present a wave transmission and your distal lower fingers will feel no change
S1 you r first heart sounds is heard loudest at the??
Apical and mitral area
Second heart sound is heard loudest at the ??
Base of the heart
S3 can indicate
CHF
S4 can indicate
Hypertrophy
All people eat taco meat
Aortic pulmonic erbs tricuspid mitral
During contraction, apex beats against chest wall, producing an apical impulse and is palpable
In most people normally at the fifth intercostal space 7-9cm from midsternal line
Flow of blood?
Toilet paper my ass
Tricuspid pulmonic mitral aortic
What organs are located in the right upper quadrant? 7
Liver, gallbladder, Duodenum, Head of pancreas, right kidney and adrenal gland, hepatic flexure of colon, and part of ascending and transverse colon
What organs are located in the left upper quadrant? 7
Stomach, spleen, left lobe of liver, body of pancreas, left kidney and adrenal gland, splenic fixture of colon, and part of transverse and descending colon
Which organs are located in the right lower quadrant? 5 
Second, appendix, right ovary and tube, right ureter, right spermatic cord
What organs are located in the left lower quadrant? 5 
Part of the descending colon, Sigmoid colon, Leftover into, left your order, left spermatic cord
Blumberg sign
Rebound tenderness, sign of peritoneal inflammation, present if the patient experiences sharp discomfort over the inflamed site when pressure is released
Murphy’s sign
Inspiratory arrest, pain is present on deep inspiration when an inflamed gallbladder is palpated by pressing the fingers under the rib cage. Positive for cholecystitis
Iliopsoas muscle test
Lift the supply in patient’s right leg straight up flexing at the hip then push down over the lower part of the right thigh as the person tries to hold the leg up. Positive for pain with appendicitis
Obturator test
Lift a supply in patient’s right leg, flexing at the hip and 90° at the knee. Hold the ankle and rotate the leg internally and externally pain is a listed with appendicitis
Rovsing’s sign
Press deeply and evenly in the left lower quadrant then quickly withdrawal fingers. Referred rebound pain in the right lower quadrant present with appendicitis
Cutaneous hyperesthesia
Add a series of points down in the abdominal wall, gently pick up a fold of skin between your thumb and index finger, without pinching it. May accompany appendicitis
