Lab Final Flashcards
Where is the auscultatory position for the aortic valve?
2nd intercostal space to the immediate right of the sternum
Where is the auscultatory position for the pulmonary valve?
2nd intercostal space to the immediate left of the sternum
Where is the auscultatory position for the tricuspid valve?
5th intercostal space to the immediate left of the sternum
Where is the auscultatory position for the mitral valve?
5th intercostal space on the mid clavicuar line (over apex of heart)
S1 and the mitral valve may sound louder if the patient:
leans forward and left while twisting a bit to their right.
What is the S1 heart sound and what produces it?
“lub” is produced by the closing of atrioventricular valves at the beginning of ventricular systole (contraction/emptying)
What is the S2 heart sound and what produces it?
“dub” is produced by the closing of semilunar valves at the beginning of ventricular diastole (relaxation/filling)
IF you hear odd “swishing,” “clicking,” or “blowing sounds” between S1 and S2 you may be hearing :
Murmur
What is the suggested sweep pattern for auscultation of the heart?
A P T M
I.e. aortic valve -> pulmonary valve -> tricuspid valve -> mitral valve
arterial blood pressure is a consequence of two parameters:
1) cardiac output, and 2) peripheral resistance.
What is the typical systolic blood pressure (SBP)?
120 mmHg
What is the typical diastole blood pressure (DBP)?
80 mmHg
The cyclical nature of the cardiac pumping action produces a pulse pressure, with is high systolic and low diastolic. What is the typical pulse pressure?
SBP-DBP which is 120-80= 40 mmHg
Why is simple screening for high BP so important?
It is a way to catch many dangerous cardiovascular diseases before they actually develop
In addition to assessing BP as part of routine 1st time patient screenings, when might chiropractors also record BP?
- if a patient has chest pain
- for a pre-sports or pre-employment physical
- for a geriatric patient (where hypertension is common)
- in patients where symptoms may indicate a heart problem (such as edema in the legs)
What is the indirect way of measuring arterial blood pressure?
Sphygmomanometry which increases pressure on a tourniquet over the brachial artery while placing a stethoscope immediately downstream of the site of occlusion.
What are Korotkov sounds?
“Thumping” sounds heard during sphygmomanometry due to turbulence in the vessel
there are many potentially confounding factors that can seriously alter an accurate reading of arterial blood pressure. What are some of the most common ones?
- missed auscultatory gap
- cuff too narrow
- cuff over clothing
- patient arm unsupported
- “white coat” reaction
The white coat reaction can alter systolic blood pressure by how much?
11-28 mmHg
The white coat reaction can alter diastolic blood pressure by how much?
3-15 mmHg
excessively high pressure is termed:
hypertension (HTN)
What is the SBP range for pre hypertension?
120-139 mmHg
What is the DBP range for prehypertension?
80-89 mmHg
What is the SBP range for stage 1 hypertension?
140-159 mmHg
What is the DBP range for stage 1 hypertension?
90-99
What is the SBP for stage 2 hypertension?
160 mmHg or more
What is the DBP for stage 2 hypertension?
100 mmHg or more
What is an auscultatory gap?
When lowering the pressure in the cuff, there is a period when the sounds may lessen a bit and in some people the sound may temporarily disappear, termed a auscultatory gap. This would cause the examiner to mistakenly record SBP lower than it actually is
What procedure can be done to avoid inadvertently missing an auscultatory gap?
Palpatory systolic BP
How would you take a palpatory systolic BP?
palpate the radial pulse and rapidly inflate the cuff to the point at which the pulse disappears. This represents the approximate SBP.
When pumping up the blood pressure cuff, it should be inflated to a pressure that is ________ above the palpatory systolic pressure
20-30 mmHg
While checking blood pressure, the sphygmomanometer exhaust valve should be opened so that the pressure falls at what rate?
about 3-5 mmHg per sec
How are blood pressure values recorded?
As a fraction (DBP/ SBP i.e 120/80) and with even numbers
How do you calculate mean arterial pressure?
MAP = (SBP-DBP)/3 + DBP
NOTE: it is usually around 93
Where should the stethoscope head be placed what checking blood pressure with a sphygmomanometer?
Slightly medial, just above the ante-cubital fossa
What should be the placement of the blood pressure cuff?
The bottom of the blood pressure cuff should be about 1” above the ante-cubital fossa and the “artery arrow” should be aligned with brachial artery
also make sure you have a properly fitting cuff for patient size
The effect of ______ and ______ can play a profound role in measured BP
gravity and vascular resistance
What is VO2
Oxygen consumption measured in liters per minute
What is aerobic capacity?
The typically linear relationship between work load (of skeletal muscle) and oxygen consumption - as work load increases, so does oxygen consumption
There is a limit to aerobic capacity and it is represented by:
Max VO2
max VO2 is affected by a variety of conditions. What are they?
- body size
- gender
- age
- heredity
- training
How does body size affect maxVO2?
larger people have a higher maxVO2
How does gender affect max VO2?
males typically have a higher maxVO2 than females (may simply be due to body size)
How does age affect max VO2?
maxVO2 declines with years
How does training affect max VO2?
aerobic fitness increases ones maxVO2
Oxygen utilization (VO2) is a function of three cardiovascular parameters :
VO2 = Heart Rate X Stroke Volume X A-V O2 Difference
Remember that heart rate x stroke volume is simply cardiac output, therefore by knowing A-V O2 and cardiac output, you can calculate VO2
What is A-V O2 Difference?
arterio-venous oxygen difference. It identifies the difference between oxygen content of the systemic arterial system and the systemic venous system - essentially a measure of oxygen extraction or consumption from metabolizing tissues
Who would have a higher stroke volume? A trained or untrained person?
Trained
Therefore VO2 is also higher in trained people
In graphs of exercise physiology, the linear relationship between cardiac output and VO2 is due to the ______, and the difference in end-point is due to ________.
- heart rate
- stroke volume
This leads to two lines with different slopes
What is the rate-limiting agent when it comes to aerobic work?
The heart
Because work load is linearly related to VO2, and VO2 is linearly related to heart rate, then:
work load should be linearly related to heart rate
Submaximal tests measure VO2 and heart rate to at submaximal levels and then graphically estimate max VO2. Why are submaximal tests used to determine fitness?
Because of the linear relationship between oxygen consumption and heart rate, the slope of the heart rate/work load line should make it possible to determine how well-conditioned a person is at any point during some exercising activity. This eliminates the need to special equipment and potentially hazardous conditions required to measure max VO2 directly
What is the training effect (or training sensitive zone) for cardiovascular conditioning?
EXERCISE 3-5 times/week @ 50-85% of maxVO2 for 15-60 minutes
What is the pulse rate differential?
Exercise HR (aka pulse rate differential) = Resting HR + %maxVO2(Maximum HR – Resting HR)
A ratio of ones exercising heart rate to their normal range used to approximately estimate whether or not an individual is performing at their training threshold.
What is ones maximum theoretical heart rate?
220 minus ones age in years although some believe that 206 minus ½ your age is a better method.
%maxVO2 represents:
the percent of ones maxVO2 (with 0.6 as the training threshold to obtain fitness)
With this example, calculate the target HR for the “training effect”:
A 25 year old with a resting heart rate of 70 bpm
Using:
Exercise HR = Resting HR + %maxVO2(Maximum HR – Resting HR)
Resting HR = 70
Max HR = (220-30) = 195
%maxVO2 for training effect = 0.6
70 + 0.60(195 – 70) = 145 bpm TARGET PULSE
With this example, calculate the percentage of the persons max VO2 being utilized during aerobic exercise:
A 38 year old with a resting heart rate of 55 bpm and a peak heart rate during the exercise of 128 bpm.
Using:
Exercise HR = Resting HR + %maxVO2(Maximum HR – Resting HR)
Resting HR = 55
Max HR = 220-38 = 182
Exercise HR = 128
128 = 55 + X(182 – 55) → X or %maxVO2 = 0.57 (just under training sensitive zone)
The science of measuring ventilation is termed:
spirometry
A spirometer records:
both the amount of air as well as the amount over time.
The routine amount of air moved by the lungs during breathing?
Tidal volume (TV) which is normally 500ml at rest but can rise to more than 3 liters during exercise!
The “spare” air than can be inhaled?
Inspiration reserve volume (IRV) and is normally around 3 liters
The “spare” air than can be exhaled?
Exploratory reserve volume (ERV) which is normal about 1 L
The total amount of air that can be moved by the lungs in a given ventilation cycle
Vital capacity (VC) which is the sum of tidal volume, IRV and ERV and normally about 4.5 liters
The total amount of air that can be forced out of the lungs (from a fully inhaled state) in a specified amount of time
Forced expiratory volume (FEV), usually measured over 1 second (sometimes 3 seconds), thus FEV1.0 (or FEV3.0).
What is the percentage of forced expiratory volume per forced vital capacity over 1 second (FEV1.0/FVC) for a normal adult?
65-85%
What is the percentage of forced expiratory volume per forced vital capacity over 3 second (FEV3.0/FVC) for a normal adult?
80-100%
The total amount of air that can be forced in and out over a specified amount of time
Maximum voluntary ventilation
It is usually measure for about 10 seconds and then extrapolated to the total amount of air that could be moved in 1 minute
In a breath holding experiment, rank from shortest to longest duration: the expected breath holding times at rest, after hyperventilation and after hypoventilation
- after hypoventilation breath holding time would be shortest
- at rest breath holding time would be intermediate
- after hyperventilation breath holding time would be longest
the feeling of wanting to breathe, “breathing hunger”
Dyspnea
Target HR (straight up equation)
RHR + %maxVO@ (MHR - RHR)
%MaxVO2 (straight up equation)
(EHR - RHR) / (MHR - RHR)
