heart and neck vessels

Question 1

when and where can you feel the apical pulse

Answer 1

during contraction, palpable in the 5th ICS

ICS - intercostal space

Question 2

explain how heart is pushed through the <3, starting at the superior/inferior vena cava

Answer 2

the S/I VC return unoxygenated venous blood to the right side of <3. PA leaves RV, bifurcates, & carries venous blood to lungs. PVs return the oxygenated blood to left side of <3 & aorta carries it out to the body

S/I VC - superior/inferior vena cava

Question 3

are the heart valves passive or active in response to pressure gradients?

Answer 3

passive

they do not allow the backflow of blood; they are unidirectional

Question 4

1. what/where are the 2 AV valves?
2. when do they open and close?

Answer 4

1. tricuspid and mitral, b/t atria and ventricles
2. open during diastole (letting blood fall), close during systole (to prevent backflow)

Question 5

1. what/where are the 2 SL valves?
2. when do they open and close?

Answer 5

1. pulmonic and aortic, b/t ventricles & arteries
2. open during systole (to push blood out), close during diastole

pulmonic - right side, aortic - left side

Question 6

since there are no valves b/t the VC & RA or b/t PVs & LA, what can happen

Answer 6

abnormally high BP in the left side gives pt symptoms of pulm. congestion & abnormally high BP in right side shows distended neck veins & abdomen

Question 7

direction of BF

Answer 7

1. from liver to RA thru IVC
2. from RV, venous blood flows thry pulmonic valve to PA
3. lungs oxygenate blood
4. from LA, arterial blood travels thru mitral valve to LV
5. aorta delivers oxygenated blood to body

see pg 454-455 for more detail

Question 8

what is the cardiac cycle

Answer 8

the rhythmic movement of blood through the <3, the 2 phases are systole (1/3rd of CC) & diastole (2/3rds of CC)

Question 9

definition

protodiastolic (early) filling

Answer 9

passive filling phase; blood pours rapidly into the ventricles

Question 10

definition

presystole (atrial systole)

also called: atrial kick

Answer 10

active filling phase; toward the end of diastole, atria contract & push the last amt of blood into ventricles. causes a small rise in left ventricular phase

atrial systole occurs during ventricular diastole. confusing. i know

Question 11

the closure of which valves causes the first heart sounds: S1and signals what?

group name and individual names

Answer 11

AV: mitral and tricuspid
signals beginning of systole

MTS1

Question 12

definition

isometric contraction

this is in systole

Answer 12

when all 4 valves are closed, causing a large buildup of pressure in the ventricles that exceed pressure in the aorta to push blood thru the aortic valves

Question 13

what causes the second heart sound: S2?

Answer 13

after ventricle’s contents are ejected, pressure falls below pressure in aorta & some blood flows backwards causing the aortic valve to swing shut. closure of the SL valves causes S2

this signals the end of systole

Question 14

definition

isometric (isovolumic) relaxation

Answer 14

all 4 valves are closed and ventricles relax

Question 15

explain

S3

Answer 15

when ventricles are resistant to filling during protodiastole. occurs immediately after S2. ventricular filling creates vibrations

protodiastole - early rapid filling phase

Question 16

explain

S4

Answer 16

occurs at end of diastole, presystole, when ventricle is resistant to filling. atria contract & push blood into a noncompliant ventricle. S4 occurs just before S1

Question 17

nursing review question

when listening to a pt’s heart, you hear a gentle blowing, whoosing sound, as the nurse you know this to be

Answer 17

heart murmurs

Question 18

what conditions can result in a murmur

Answer 18

1. blood velocity ↑ (flow murmur, exercise)
2. blood viscosity ↓ (anemia)
3. structural defects in valves (stenotic/narrowed valve, incompetent/reguritant valve) or unusual openings in chambers

Question 19

when listening for heart sounds, you must look for these characteristics

Answer 19

1. frequency (pitch) - high/low pitched
2. intensity (loudness) - loud/soft
3. duration - short - heart sounds, longer periods - silence
4. timing - systole or diastole

Question 20

1. is preload volume or pressure
2. is afterload volume or pressure

Answer 20

1. volume
2. pressure