Module 5 Flashcards
How long and how wide is the trachea
10-11 cm; 2 cm in diamter
Trachea divides into right and left main stem at the level of _____________
T4 and T5
Other name for the manubriosternal joint
Sternal angle or angle of louis
Arteries that branch from the anterior thoracic aorta and the intercostal arteries
bronchial arteries
The bronchial vein is formed at the __________ of the lung, but most of the blood supplied by the bronchial arteries is returned by the ____________ veins
hilum; pulmonary
A visible and palpable angulation of the sternum and the point at which the second rib articulates with the sternum
The manubriosternal junction (angle of Louis)
A depression, easily palpable and most often visible at the base of the ventral aspect of the neck, just superior to the manubriosternal junction
The Suprasternal notch
The angle formed by the costal margins at the sternum. It is usually no more than 90 degrees, with the ribs inserted at approximately 45-degree angles
Costal angle
Name for the spinous process of C7. It can be more readily seen and felt with the patient’s head bent forward.
Vertebra prominens
When inspecting the chest of an infant: note that the anteroposterior diameter is approximately __________ as the lateral diameter.
The same
The number of alveoli increases at a rapid rate in the first ____ years of life. This slows down by age ____ years.
2: 8
When does an infants lungs fill with air for the first time
During the infants initial gasp and cry
Most often leads to closure of the heart’s foramen ovale within minutes after birth, and the increased oxygen tension in the arterial blood usually stimulates contraction and closure of the ductus arteriosus
Cutting the umbilical cord
The chest of the newborn is generally what shape
Round
The failure for the foremen ovales and ductus arteriosus to close is more common in
Premature infants born before 30 weeks
can lead to left ventricular overload and heart failure in a newborn
Patent ductus arteriosus
The costal angle progressively increases from about 68.5 degrees to approximately _______ degrees in later months of pregnancy
103.5
In pregnancy, the diaphragm at rest rises as much as _____ cm above its usual resting position
4
What usually increases in pregnancy: minute volume or respiratory rate
Minute ventilation due to increase tidal volume
_________ in an older adult is often caused by loss of muscle strength in the thorax and diaphragm, coupled with loss of lung resiliency
Barrel chest
Moist or productive cough, accompanied by fever, may be caused by
infection
A regular, paroxysmal cough that produces an inspiration whoop, is heard in
Pertussis
Commonly observed with pulmonary or cardiac compromise
Dyspnea
shortness of breath that begins or increases when the patient lies down; ask whether the patient needs to sleep on more than one pillow and whether that helps
Orthopnea
a sudden onset of shortness of breath after a period of sleep; sitting upright is helpful
Paroxysmal nocturnal dyspnea
dyspnea increases in the upright posture
Platypnea
can cause tachycardia, hypertension, coronary arterial spasm (with infarction), and pneumothorax (lung collapse), with severe acute chest pain being the common result
Cocaine use
T or F: the AP diameter of the chest is generally > the lateral diameter
F: it is less than
results from compromised respiration as in, for example, chronic asthma, emphysema, or cystic fibrosis.
Barrel chest
Location: vertically down the midline of the sternum
Midsternal line
Location: parallel to the midsternal line, beginning at midclavicle; the
inferior borders of the lungs generally cross the sixth rib at the midclavicular line
Right and left midclavicular lines
Location: parallel to the midsternal line, beginning at the anterior axillary fold
Right and left anterior axillary lines
Location: parallel to the midsternal line, beginning at the midaxilla
Right and left midaxillary lines
Location: parallel to the midsternal line, beginning at the posterior axillary folds
Right and left posterior axillarty lines
Location: vertically down the spinal process
Vertebral line
Location: parallel to the vertebral line, through the inferior angle of the scapula when the patient is erect
Right and left scapular lines
The spine may be deviated either posteriorly (_called:________) or laterally (called: _________)
kyphosis; scoliosis
a prominent sternal protrusion
Pigeon Chest or pectus carinatum
an indentation of the lower sternum above the xiphoid process
Funnel chest (pectus excavatum)
The sequence of steps in examination of the chest and lungs is:
- Inspection
- Palpation
- Percussion
- Auscultation
In a pleural effusion and Lobar pneumonia, the percussion sound is
Dullness
In pleural effusions, breath sounds are
Absent
In lobar pneumonia, breath sounds are
Bronchial
On palpation, tactile fremitus is __________ in a pleural effusion while it is ____________with lobar pneumonia
Absent; increased
Normal RR for adults
12-16 breath per minute
Ratio of RR to HR is
1:4
is a persistent respiratory rate above 16 respirations per minute in an adult
Tachypnea
________________, a rate slower than 12 respirations per minute, may indicate neurologic or electrolyte disturbance, infection, or a conscious response to protect against the pain of pleurisy or other irritative phenomena.
Bradypnea
Word for breathing deeply
Hyperpnea
always deep and most often rapid, is the eponym applied to the respiratory effort associated with metabolic acidosis
Kussmaul breathing
refers to abnormally shallow respirations
Hypopnea
A regular periodic pattern of breathing with intervals of apnea followed by a crescendo/decresendo sequence of respiration
Cheyne stokes
is the result of a prolonged but inefficient expiratory effort; can also result from increased resistance (i.e., chronic bronchitis), decreased elastic recoil of the lung (i.e., emphysema) or a drop in the critical closing pressure of the airway (i.e., asthma)
Air trapping
consists of irregular respirations varying in depth and interrupted by intervals of apnea but lacking the repetitive pattern of periodic respiration
Biot or ataxic respiration
usually is associated with severe and persistent increased intracranial pressure, respiratory compromise resulting from drug poisoning, or brain damage at the level of the medulla and generally indicates a poor prognosis
Biot respiration
Common contributors include seizures, central nervous system trauma or hypoperfusion, a variety of infections of the respiratory passageway, drug ingestions, and obstructive sleep disorders
Apnea
A self-limited condition, and not uncommon after a blow to the head. It is especially noted immediately after the birth of a newborn, who will breathe spontaneously when sufficient carbon dioxide accumulates in the circulation
Primary apnea
Breathing stops and will not begin spontaneously unless resuscitative measures are immediately instituted. Any event that severely limits the absorption of oxygen into the bloodstream will lead to secondary apnea.
Secondary apnea
When irritating and nausea-provoking vapors or gases are inhaled, there can be an involuntary, temporary halt to respiration.
Reflex apnea
characterized by periods of an absence of breathing and oxygenation during sleep. Due to blockage of the airway when the soft tissue in the back of the throat collapses during sleep, airflow is not maintained through the nose and mouth.
Sleep apnea
Characterized by a long inspiration and what amounts to expiration apnea. The neural center for control is in the breathing pons and medulla. When it is affected, breathing can become gasping because inspirations are prolonged and expiration constrained
Apneustic breathing
A normal condition characterized by an irregular pattern of rapid breathing interspersed with brief periods of apnea that one usually associated with rapid eye movement sleep
Periodic apnea of the newborn
Inspiratory stridor (with an I/E ratio of more than 2:1); A hoarse cough or cry; Flaring of the alae nasi; Retraction at the suprasternal notch
All may indicate
Upper airway obstruction
Stridor is inspiratory and expiratory; Cough has a barking character; Retractions also involve the subcostal and intercostal spaces; Cyanosis is obvious even with supplemental oxygen
May indicate
Severe upper airway obstruction
Stridor tends to be quieter; The voice is muffled; Swallowing is more difficult; cough is not a factor; The head and neck may be awkwardly positioned to preserve the airway (e.g., extended with retropharyngeal abscess; head to the affected side with peritonsillar abscess
May indicate what type of obstruction
Above the glottis
Stridor tends to be louder, more rasping; The voice is hoarse; Swallowing is not affected; Cough is harsh, barking; Positioning of the head is not a factor
May indicate what type of obstruction
Below the glottis
causes unilateral retractions, but they are not seen in the suprasternal notch
Foreign body in the bronchus
Retraction of the lower chest occurs with
asthma and bronchiolitis
Flaring of the alae nasi during inspiration is a sign of
air hunger
T or F: Crepitus always results from an underlying pathological process
T
A palpable, coarse, grating vibration, usually on inspiration, suggests a
Pleural friction rub
Where is fremitus best felt
Posteriorly and laterally at the level of the bifurcation of the bronchi
T or F: the scapulae may obscure fremitus
T
dullness to percussion and decreased tactile fremitus are the most useful findings for
Pleural effusion
Hyperresonance associated with hyperinflation may indicate
emphysema, pneumothorax, or asthma
Dullness or flatness on percussion suggests
pneumonia, atelectasis, pleural effusion, or asthma
the movement of the thoracic diaphragm that occurs with inhalation and exhalation
Diaphragmatic excursion
Why is the diaphragm usually higher on the right than the left
Sits over the liver
___________ breath sounds are low-pitched, low-intensity sounds heard over healthy lung tissue
Vesicular
_________________ sounds are heard over the major bronchi and are typically moderate in pitch and intensity.
Bronchovesicular
The sounds highest in pitch and intensity are the __________ breath sounds, which are ordinarily heard only over the trachea
Bronchial
T or F: Both bronchovesicular and bronchial breath sounds are normal if they are heard over the peripheral lung tissue.
F: they are abnormal
sounding as if coming from a cavern, is commonly heard over a pulmonary cavity in which the wall is rigid
Cavernous breathing
T or F: Breath sounds are easier to hear when the lungs are consolidated
T
Are crackles continuous or discontinuous
Discontinuous
Are ronchi and wheezes continuous or discontinuous
Continuous
Is an abnormal respiratory sound heard more often during inspiration and characterized by discrete discontinuous sounds, each lasting just a few milliseconds
Crackles
may be fine, high-pitched, and relatively short in duration or coarse, low-pitched, and relatively longer in duration. They are caused by the disruptive passage of air through the small airways in the respiratory tree
Crackles
High-pitched crackles are described as_____________; the more low-pitched crackles are termed _____________
sibilant; sonorous
are deeper, more rumbling, more pronounced during expiration, more likely to be prolonged and continuous, and less discrete than crackles.
Rhonchi
They are caused by the passage of air through an airway obstructed by thick secretions, muscular spasm, tumor, or external pressure
Rhonchi
High-pitched, discrete, discontinuous crackling sounds heard during the end of inspiration; not cleared by a cough
Fine crackles
lower, more moist sound heard during the midstage of inspiration; not cleared by a cough
Medium crackles
loud, bubbly noise heard during inspiration; not cleared by a cough
Coarse crackles
loud, low, coarse sounds like a snore most often heard continuously during inspiration or expiration; coughing may clear sound (usually means mucus accumulation in trachea or large bronchi)
Rhonchi (sonorous wheezes)
musical noise most often heard continuously during inspiration or expiration; usually louder during expiration
Wheeze (Sibilant wheeze)
dry, rubbing, or grating sound, usually caused by inflammation of pleural surfaces; heard during inspiration or expiration; loudest over lower lateral anterior surface
Pleural friction rub
Do rhonchi or crackles tend to disappear with coughing
Rhonchi
If a wheeze is heard bilaterally, it may be caused by
bronchospasm of asthma (reactive airway disease) or acute or chronic bronchitis.
Adventitious breath sound that occurs outside the respiratory tree
Friction rub
How to tell if a rub is respiratory or cardiac related
Ask pt to hold breath; if sound stops while breath is health it is not respiratory related
is found with mediastinal emphysema
Mediastinal crunch (Hamman sign)
Greater clarity and increased loudness of spoken sounds are defined as
bronchophony
When the intensity of the spoken voice is increased and there is a nasal quality (e.g., “e” becomes a stuffy, broad “a”), the auditory quality is called
Egophany
Normal RR of infant
40-60 up to 80
Do C section or vaginally delivered babies tend to have higher RR at birth
C section
Highest score on a APGAR scoring system
10
In which age group is paradoxical breathing normal
Newborn/infant
Why are crackle and rhonchi normal after birth in newborn
Fetal fluid has not yet been completely cleared
What should you expect if gastrointestinal gurgling sound is persistently heard in the chest of a newborn in respiratory distress
Diaphragmatic hernia
T or F: hyperresonance is common in the young child.
T
How does a parturiant typically change respiration to achieve optimum o2 intake
Breath deeper (higher TV)
Small airway obstruction due to inflammation within the airways; Acute episodes triggered by allergens, anxiety, cold air, exercise, upper respiratory infections, cigarette smoke, or other allergens
Asthma
Incomplete expansion of the lung at birth or the collapse of the lung at any age
Atelectasis
Inflammation of the bronchial tubes leads to increased mucus secretions; Acutely due to a viral infection, whereas chronic is usually due to irritant exposure, most commonly smoking.
Bronchitis
Respiratory failure with low blood oxygen levels resulting from the inhalation of aerosols (vapors) produced from heating solutions containing nicotine or other substances
E-Cigarette or Vaping-Associated Acute Lung Injury
Inflammatory process involving the visceral and parietal pleura; often the result of PE, infection, or connective tissue disease; sometimes associated with asbestos or neoplasms
Pleurisy
Excessive nonpurulent fluid in the pleural space; Sources of fluid vary and include infection, heart failure, renal insufficiency, connective tissue disease, neoplasm, and trauma.
Pleural Effusion
Purulent exudative fluid collected in the pleural space; Non–free-flowing purulent fluid collection develops most commonly from adjacent infected tissues; May be complicated by pneumonia, simultaneous pneumothorax, or a bronchopleural fistula
Empyema
Well-defined, circumscribed, inflammatory, and purulent mass that can develop central necrosis; Aspiration of food or infected material from upper respiratory or dental sources of infection are most common causes; It may elude diagnosis for some time.
Lung abcess
Inflammatory response of the bronchioles and alveoli to an infective agent (bacterial, fungal, or viral); Acute infection of the pulmonary parenchyma may be due to different organisms that may be acquired in the community or hospital setting; contaminant inflammatory exudates leads to lung consolidation
Pneumonia
Viral infection of the lung. Although this originates as a viral respiratory infection, due to alterations in the epithelial barrier, the infected host is more susceptible to secondary bacterial infection; Entire respiratory tract may be overwhelmed by interstitial inflammation and necrosis extending throughout the bronchiolar and alveolar tissue.
Influenza
COVID-19 is a viral infection caused by the severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2).
Covid 19
Chronic infectious disease that most often begins in the lung but may then have widespread manifestation
Tuberculosis
Presence of air or gas in the pleural cavity; May result from trauma or may occur spontaneously, perhaps because of rupture of a congenital or acquired bleb
Pneumothorax
Presence of blood in the pleural cavity; • May be the result of trauma or invasive medical procedures (e.g., thoracentesis, central line placement or attempt, pleural biopsy)
Hemothorax
Generally refers to bronchogenic carcinoma, a malignant tumor that evolves from bronchial epithelial structures; Etiologic agents include tobacco smoke, asbestos, ionizing radiation, and other inhaled carcinogenic agents.
Lung cancer
The embolic occlusion of pulmonary arteries typically resulting from dislodged thrombosis within the deep veins of the legs; Risk factors include, among others, age older than 40 years, a history of venous thromboembolism, surgery with anesthesia longer than 30 min, heart disease, cancer, fracture of the pelvis and leg bones, obesity, and acquired or genetic thrombophilia.
PE
Acute, life-threatening infection involving the epiglottis and surrounding tissues; • Acute inflammation of the epiglottis due to bacterial invasion Haemophilus influenza type B, group A beta hemolytic streptococcus, staphylococcus, leading to life threatening airway obstruction, may cause death
Epiglottitis
Result of an imperfectly structured diaphragm, occurs once in slightly more than 2000 live births; on left side 90% of time; In a Bochdalek hernia, the diaphragm may not develop properly, and the intestine may become trapped in the chest cavity as a result; In a Morgagni hernia, the tendon that should develop in the middle of the diaphragm does not develop properly.
Diaphragmatic Hernia
Autosomal recessive disorder of exocrine glands involving the lungs, pancreas, and sweat glands; Thick mucus causes progressive clogging of the bronchi and bronchioles; Bronchiectasis results with cyst formation and subsequent pulmonary infection.
Cycstic fibrosis
Syndrome that generally results from infection with a variety of viral agents, particularly the parainfluenza viruses, occurring most often in children from about 1.5 to 3 years of age; The inflammation is subglottic and may involve areas beyond the larynx
Croup (Laryngotracheal bronchitis)
Lack of rigidity or a floppiness of the trachea or airway; Trachea narrows in response to the varying pressures of inspiration and expiration.
Tracheomalacia
Bronchiolar (small airway) inflammation leading to hyperinflation of the lungs, occurring most often in infants younger than 6 months; Usual cause is respiratory syncytial virus; other viral organisms include adenovirus, parainfluenza virus, and human metapneumovirus; The virus acts as a parasite invading small bronchioles. The virus bursts and invades other cells that die and obstruct and irritate the airway.
Bronchiolitis
a nonspecific designation that includes a group of respiratory problems in which coughs, chronic and often excessive sputum production, and dyspnea are prominent features. Ultimately, an irreversible expiratory airflow obstruction occurs
COPD
Condition in which the lungs lose elasticity and alveoli enlarge in a way that disrupts function; gas exchange compromised
Emphysema
Chronic dilation of the bronchi or bronchioles caused by repeated pulmonary infections and bronchial obstruction; often seen in Cystic fibrosis
Bronchiectasis
Large airway chronic inflammation leading to mucus production, usually a result of chronic irritant exposure, most often smoking; more commonly a problem for patients older than 40
Chronic bronchitis
The area of the chest overlying the heart is the
Precordium
Broad upper part of the heart is called ___________; while the narrow lower tip is called _____________
Base; apex
When the heart is a mirror image of the normal positioning
Dextrocardia
is when the heart and stomach are placed to the right and the liver to the left
Situs inversus
the thin outermost muscle layer of the heart
Epicardium
What are the typical dimensions of the adult heart
12 cm long X 8 cm wide X 6 cm at AP diameter
What makes up the most posterior aspect of the heart
Left atrium and ventricle
Where is the apical pulse best felt
Fifth left intercostal space at the midclavicular line
The AV valves
Tricuspid and mitral valves
separates the right atrium from the right ventricle
Tricuspid valve
AV valve that has two cusps, and separates the left atrium from the left ventricle
Mitral valve
When are the AV valves open, during systole or diastole?
Diastole
When do the AV valves close, during systole or diastole?
Systole
Do the semilunar valves have two or three cusps
3
Are the semilunar valves open during systole or diastole?
Systole
When are the semilunar valves closed, during systole or diastole?
Diastole
Which valves closing are responsible for the S1 heart sound
AV- mitral and tricuspid
Closure of which valves causes the S2 sound
Semilunar- aortic and pulmonic
Why are valve sounds heard best away from the anatomic site?
Sound is transmitted in the direction of blood flow
Where does the hearts electrical impulse typically come from
They SA node in the wall of the right atrium
On an ECG: the spread of a stimulus through the atria (atrial depolarization)
P wave
On an ECG: the time from initial stimulation of the atria to initial stimulation of the ventricles,
usually 0.12 to 0.20 second
PR interval
On an ECG: the spread of a stimulus through the ventricles (ventricular depolarization), less than 0.12 second
QRS complex
On an ECG: the return of stimulated ventricular muscle to a resting state (ventricular repolarization)
ST segment and T wave
On an ECG: a small deflection rarely seen just after the T wave, thought to be related to repolarization of the Purkinje fibers. They are commonly seen with bradycardia. This is also seen sometimes with electrolyte abnormalities, hypothermia, and hypothyroidism.
U wave
On an ECG: the time elapsed from the onset of ventricular depolarization until the completion of ventricular repolarization. The interval varies with the cardiac rate
QT interval
In the fetus, blood flows from the right atrium into the left atrium via the
foramen ovale
In the newborn, the changes in the heart at birth include:
Closure of ductus artiosus (in 24-48 hours) and closure of inter arterial foramen ovale
What causes foramen ovale to close shortly after birth
Rise in pressure in the left atrium
In a fetus, the right and left ventricles are _________ in weight and muscle mass because they both pump blood into the systemic circulation, unlike the adult heart
Equal
By what age are the relative size of the left and right ventricle approximately the adult ratio, 2:1
1 year old
The adult heart positioning is reached by what age
7
Parturients blood volume increases by what percent
40-50% prepregnancy levels
How much does plasma volume increase in pregnant patient
50%, could be 70% in twin pregnancy
At what point after delivery does blood volume return to prepregnany levels
3-4 weeks
How much does cardiac output increase in pregnant patient
30-40%
When is cardiac output highest in pregnant patient
25-32 weeks gestation
How long after delivery does it take parturients cardiac output to return to pre pregnancy levels
2 weeks
What may elevate the apex of the heart
Pregnancy and ascites
Traditional auscultatory location of aortic valve
second right intercostal space at the right sternal border
Traditional auscultatory location of pulmonic valve
second left intercostal space at the left sternal border
Traditional auscultatory location of second pulmonic area
third left intercostal space at the left sternal border
Traditional auscultatory location of tricuspid
fourth left intercostal space along the lower left sternal border
Traditional auscultatory location of mitral (apical) area
at the apex of the heart in the fifth left intercostal space at the midclavicular line
If cardiac rhythm is irregular, compare the beats per minute by
Over the heart (apical HR) with the radial pulse rate
S1 coincides with the rise (upswing) of the
carotid pulse
marks the initiation of diastole and closure of the aortic and pulmonic valves
S2
marks the beginning of systole
S1
When are systole and diastole equal
When HR is rapid
Where is a split S2 heard
Pulmonic auscultation area
T or F: there may be some asynchrony heard between closure of the mitral and tricuspid valves
T
What is an example of when S1 intensity is increased
Complete heart block
What is an example of when S1 intensity is decreased
Systemic or pulmonary hypertension
occurs when the mitral and tricuspid valves or the pulmonic and aortic valves do not close simultaneously
Splitting
Splitting is more often heard and easier to detect in what population
The young
Why is splitting often best heard in young?
The tendency of of the anterior posterior diameter of the chest to increase with age
What causes the S4 sound in heart
Vibration of valves, papillae, and ventricular wall
What age population is S4 most commonly heard
Older population
T or F: a loud S4 sound is never a cause for concern
F: suggests pathology and should be further evaluated
When does wide splitting occur
RBBB, stenosis delayed Pulmonic valve closure
When does fixed splitting occur
Atrial septal defects, ventricular septal defect with L to R shunting, RV failure
Splitting is said to be fixed when
It is unaffected by respiration
occurs when closure of the aortic valve is delayed (e.g., as in left bundle branch block) so that P2 occurs first, followed by A2
Paradoxical (Reversed) Splitting
In PAradoxical Splitting, the interval between P2 and A1 is heard during __________ and disappears during ___________.
Expiration, inspiration
may produce an opening snap (mitral valve), ejection clicks (semilunar valves), or mid to late non ejection systolic clicks (mitral prolapse)
Valvular stenosis
The pulmonary ejection click is best heard on ___________ in the second left intercostal space and is seldom heard on ________________
Expiration, inspiration
Where would an aortic ejection click be heard
Second right intercostal space
Where is pericardial friction rub best heard
Toward the apex
A prosthetic aortic valve causes a sound in early
Systole
What type of aortic valve material is usually quietest?
Animal tissue
relatively prolonged extra sounds heard during systole or diastole
Heart murmur
T or F: all murmurs are the result of valvular defects
F
A murmur, particularly in young with no apparent cause
Still murmur
Narrowed valve restricts forward flow; forceful ejection into ventricle Often occurs with mitral regurgitation Caused by rheumatic fever or cardiac infection
Mitral stenosis
Calcification of valve cusps restricts forward flow; forceful ejection from ventricle into systemic circulation Caused by congenital bicuspid (rather than the usual tricuspid) valve, rheumatic heart disease, atherosclerosis ; May be the cause of sudden death, particularly in children and adolescents, either at rest or during exercise; risk apparently related to degree of stenosis
Aortic stenosis
Fibrous ring, usually 1–4 mm below aortic valve; most pronounced on ventricular septal side; may become progressively severe with time; difficult to distinguish from aortic stenosis on clinical grounds alone
Subaortic stenosis
Valve restricts forward flow; forceful ejection from ventricle into pulmonary circulation Cause is almost always congenital
Pulmonic stenosis
Calcification of valve cusps restricts forward flow; forceful ejection into ventricles Usually seen with mitral stenosis, rarely occurs alone. Caused by rheumatic heart disease, congenital defect, endocardial fibroelastosis, right atrial myxoma
Tricuspid stenosis
Valve incompetence allows backflow from left ventricle to left atrium Caused by rheumatic fever, myocardial infarction, myxoma, rupture of chordae
Mitral regurgitation
Valve is competent early in systole but prolapses into atrium later in systole; may become progressively severe, resulting in a holosystolic murmur; often concurrent with pectus excavatum
Mitral valve prolapse
Valve incompetence allows backflow from aorta to ventricle Caused by rheumatic heart disease, endocarditis, aortic diseases (Marfan syndrome, medial necrosis), syphilis, ankylosing spondylitis, dissection, cardiac trauma
Aortic regurgitation
Valve incompetence allows backflow from pulmonary artery to ventricle Secondary to pulmonary hypertension or bacterial endocarditis
Pulmonic regurgitation
Valve incompetence allows backflow from ventricle to atrium Caused by congenital defects, bacterial endocarditis (especially in intravenous drug abusers), pulmonary hypertension, cardiac trauma
Tricuspid regurgitation
Valve defect heard at left lower sternum, occasionally radiating a few centimeters to left
Tricuspid regurgitation
Valvular defect Heard with diaphragm,
patient sitting and leaning forward; Austin flint murmur heard with bell; ejection click heard in second intercostal space
Aortic regurgitation
Valvular defect heard at apex and left lower sternal border; easily missed in supine position; also listen with patient upright
Mitral valve prolapse
Valvular defect heard best at apex; loudest there, transmitted into left axilla
Mitral regurgitation
Valvular defect heard with bell over tricuspid area
Tricuspid stenosis
Valvular defect heard over pulmonic area radiating to left and into neck; thrill in second and third left intercostal spaces
Pulmonic stenosis
Valvular defect heard at apex and along left sternal border
Subaortic stenosis
Valvular defect heard over aortic area; ejection sound at second right intercostal border
Aortic stenosis
Valvular defect heard with bell at apex, patient in left lateral decubitus position
Mitral stenosis
A heart rate that is irregular but occurs in a repeated pattern may indicate
Sinus arrhythmia
a cyclic variation of the heart rate characterized by an increasing rate on inspiration and decreasing rate on expiration
Sinus arrhythmia
Infants with ________-sided congestive heart failure have large, firm livers with the inferior edge as much as 5 to 6 cm below the right costal margin
Right
In infants, a purplish plethora/skin tone is associated with
Polycythemia
an ashen white color in a newborns skin indicates
shock
Central cyanosis in a newborn suggests
Congenital heart disease
cyanosis of the hands and feet without central cyanosis
Acrocyanosis
is a characteristic of congenital heart defects that allow mixture of arterial and venous blood or prevent blood flow to the lungs
Cyanosis
evident at birth or shortly thereafter suggests transposition of the great vessels, tetralogy of Fallot, tricuspid atresia, a severe septal defect, or severe pulmonic stenosis
Severe cyanosis
Cyanosis that does not appear until after the neonatal period suggests
- pulmonic stenosis
- eisenmenger complex
- tetralogy of fallout
- large septal defects
heart defect that can lead to a right-to-left shunt
Eisenmenger complex
Where can you palpate the apical pulse in a newborn
Fourth to fifth left intercostal space medial to the midclavicular line
Pneumothorax shifts the apical impulse __________ from the area of injury
Away
more commonly found on the left, shifts the heart of a neonate to the right
Diaphragmatic hernia
Dextrocardia results in an apical impulse on the
Right
In a neonate/infant, where can you feel the closure of the pulmonary valve in the
Second left intercostal space
T or F: splitting of heart sounds is common in neonate/infants
T
If you push up on the liver, thereby increasing right atrial pressure, the murmur of a left-to-right shunt through a septal opening or patent ductus will ____________ briefly, whereas the murmur of a right-to-left shunt will __________.
Disappear; intensify
Murmurs are relatively common in newborns until
48 hours of age
If you cannot tell a murmur from respiration in a neonate, you should
Listen while the baby is feeding
Murmurs that extend beyond S2 and occupy diastole are said to have a _______________ quality
machine-like
accounts for most acquired murmurs in children
Kawasaki disease
More audible splitting of S1 and S2, and S3 may be readily heard after _____ weeks of gestation
20
systolic ejection murmurs may be heard over the pulmonic area in ____% of pregnant patients
90
Pain caused by myocardial ischemia; occurs when myocardial oxygen demand exceeds supply
Angina
Bacterial infection of the endothelial layer of the heart and valves; Individuals with congenital or acquired valve defects and those with history of previous illness or who use intravenous drugs are particularly susceptible
Bacterial endocarditis
small erythematous or hemorrhagic macules appearing on the palms and soles; common to patients with bacterial endocarditis
Janeway lesions
painful, red, raised lesions that appear on the tips of fingers or toes and are caused by septic emboli; common to patients with bacterial endocarditis
Osler nodes
Systolic CHF has a _______ pulse pressure while diastolic CHF has a ___________ pulse pressure
Narrow, wide
Heart fails to propel blood forward with its usual force, resulting in congestion in the pulmonary circulation
Congestive heart failure- left sided
_________ CHF is due to impaired contraction of the left ventricle; ______________ CHF is a result of advanced glycation cross-linking collagen and creating a
stiff ventricle unable to dilate actively (impaired relaxation) and occurs in older adults with diabetes mellitus whose tissue is exposed to glucose for a longer period of time.
Systolic; diastolic
Heart fails to propel blood forward with its usual force, resulting in congestion in the systemic circulation; decreased cardiac output causes decreased blood flow to the tissue
Congestive heart failure- right sided
In what type of CHF is pitting edema in lower extremities, JVD, ascites, and hepatomegaly common
Right sided
The most helpful physical examination findings in the diagnosis of left-sided heart failure is
Cardiomegaly (displaced PMI/abnormal apical impulse
The most helpful physical examination findings in the diagnosis of right-sided congestive heart failure is
JVD
Inflammation of the pericardium often the result of a viral infection such as echovirus or Coxsackie
Pericarditis
Excessive accumulation of effused fluids or blood between the pericardium and the heart; Seriously constrains cardiac relaxation, impairing blood return to the right heart. Common causes: pericarditis, malignancy, aortic dissection, and trauma
Cardiac tamponade
Enlargement of the right ventricle secondary to chronic lung disease; usually chronic condition; Results from chronic obstructive pulmonary disease (COPD) and
pulmonary arterial hypertension
COR pulmonale
In what cardiac condition do you see prominent A or V waves and distended neck veins
COR pulmonale
Ischemic myocardial necrosis caused by abrupt decrease in coronary blood flow to a segment of the myocardium; most commonly affects left ventricle; results from atherosclerosis of coronary blood vessels
Myocardial infarction
Which cardiac abnormality would have new ST elevation in two contiguous leads
Myocardial infarction
Focal or diffuse inflammation of the myocardium. Inflammation can occur from direct cytotoxic effect of secondary immune response. Causes can be viral, bacterial, spirochetal, fungal, protozoal, helminthic, from venomous bites, chemo, drugs, systemic inflammatory diseases, peripartum
Myocarditis
Conduction disturbances either proximal to the bundle of His or diffusely throughout the conduction system; may result from ischemic, infiltrative, or neoplastic causes. Antidepressant medications, digitalis, quinidine, and many other medications can be precipitating factor.
Conduction disturbances
Arrhythmias caused by a malfunction of the sinus node; Occurs secondary to hypertension, arteriosclerotic heart disease, or rheumatic heart, or without known cause (idiopathic)
Sick sinus syndrome
Atrial rate far in excess of ventricular rate; heart sounds not necessarily weak; Regular uniform contractions occur in excess of 200 beats/min, but the ventricular response is limited as a result of physiologic heart block. The conduction system cannot respond to the rapidity of the atrial rate, causing variance from the ventricular rate. The ECG may look like a sawtooth cog.
Atrial flutter (Auricular)
Slow rate below 50 or 60/min; No disruption in conduction is not necessarily suggestive of a problem.
Sinus bradycardia
Dysrhythmic contraction of the atria gives way to rapid series of irregular spasms of the muscle wall; no discernible regularity in rhythm or pattern; The conduction system is malfunctioning and is in an anarchic state. Any contraction of the atria that is best described as “irregularly” irregular.
Atrial fibrillation
Heart rate slower than expected; incomplete heart block rate is often 25–45/min at rest; Conduction from atria to ventricles partially or completely disrupted.
Heart block
Type of heart block: Conduction occurs all the time (but taking a little longer than usual)
First degree heart block
Type of heart block: conduction occurs some of the time
Second degree: type 1 wenkebach or type 2 mobitz
Type of heart block: conduction occurs none of the time
Third degree; complete heart block
Rapid, regular heart rate and narrow QRS complex; originating at or above the AV node; may decrease with Vagal stimulation, deep breath, or general carotid massage
SVT
Rapid, relatively regular heartbeat (often nearly 200/min) without loss in apparent strength; The electrical source of the beat is in an unusual focus somewhere in the ventricles. This usually arises in serious heart disease and is a grave prognostic sign.
V-tach
Complete loss of regular heart rhythm with expected conduction pattern absent if weakened and rapid, ventricular contraction is irregular; The ventricle has lost the rhythm of its expected response, and all evidence of vigorous contraction is gone. It calls for immediate action and may immediately precede sudden death.
V-fib
In an infant/neonate: opening between the left and right ventricles
Ventricular septal defect (VSD)
Recurrent respiratory infections in a neonate/ infant may be indicative of
Ventricular septal defect
In a neonate/infant: Holosystolic murmur, often loud, coarse, high- pitched, and best heard along the left sternal
border in the third to fifth intercostal spaces
Ventricular septal defect
Congenital heart defect composed of four cardiac defects: ventricular septal defect, pulmonic stenosis, dextroposition of the aorta, and right ventricular hypertrophy
Tetralogy of Fallot
Failure of the ductus arteriosus to close after birth; Blood flows from the aorta through the ductus to the pulmonary artery during systole and diastole, increasing pressure in the pulmonary circulation and consequently the workload of the right ventricle.
Patent ductus arteriosus
T or F: in an infant with a patent ductus arteriosus, a murmur is usually unaltered by postural change
T
Congenital defect in the septum dividing the left and right atria; untreated can result in enlargement of the right side of the heart and shunt reversal (right- to-left shunt) and heart failure.
Atrial septal defect (ASD)
In what infant cardiac abnormality is a diamond shaped systolic ejection murmur heard over the pulmonic area
Atrial septal defect
Systemic connective tissue disease occurring after streptococcal pharyngitis or skin infection; May result in serious cardiac valvular involvement of mitral or aortic valve; tricuspid and pulmonic are not often affected; Affected valve becomes stenotic and regurgitant; Children between 5 and 15 years of age are most commonly
affected
Acute Rheumatic Fever
What cardiac abnormality in kids may cause inflamed swollen joints
Acute rheumatic fever
Flat or slightly raised, painless rash with pink margins with
pale centers and a ragged edge (erythema marginatum) and aimless jerky movements (Sydenham chorea or St. Vitus dance) are subjective findings in
Acute rheumatic fever
Narrowing of the small blood vessels that supply blood and oxygen to the heart; Caused by deposition of cholesterol, other lipids, by a complex inflammatory process; Leads to vascular wall thickening and narrowing of the lumen
Atherosclerotic Heart Disease (Atherosclerosis, Coronary Heart Disease)
Amyloid, a fibrillary protein produced by chronic inflammation or neoplastic disease, deposition in the heart; heart contractility may be reduced; causes HF
Senile Cardiac Amyloidosis
