Test 2 Flashcards
Term for heart and stomach on the right and liver on the left
Situs inversus
Term for heart as a mirror image
Dextrocardia
Valve to pulmonary artery
Pulmonic valve
Valve to right ventricle
Tricuspid valve
Valve to aorta
Aortic valve
Valve to left ventricle
Mitral valve
Another name for the mitral valve, it separates what
Bicuspid valve left atria and ventricle
What is s1
First heart sound, ventricles closing the mitral and tricuspid valves
What is s2
Closing of the aortic and pulmonic valve after ventricular emptying
What is a2
Part of s2, it’s aortic valve closer
What is p2
Part of s2, pulmonic valve closer sound
What is s3
After s2 during ventricular filling
What is s4
Atria contracting
What is split s2
When you here a2 and p2 seperatly
A fetus right ventricle pumps where
Patent ductus arteriosus into circulation
What is the hole on a neonate heart
Foramen ovale between the atrium
We’re and what is a PDA
Patent ductus arteriosus from pulmonary vein to aorta
When does the ductus arteriosus close
24 to 48 hours
When does the Foramen ovale close
As soon as pressure in the left heart is higher than the right heart
Substernal; provoked by effort, emotion, eating; relieved by rest and/or nitroglycerin; often accompanied by diaphoresis, occasionally by nausea
anginal
Precipitated by breathing or coughing; usually described as sharp; present during respiration; absent when breath held
pleural
Burning, substernal, occasional radiation to the shoulder; nocturnal occurrence, usually when lying flat; relief with food, antacids, sometimes nitroglycerin
esophageal
Almost always infradiaphragmatic and epigastric; nocturnal occurrence and daytime attacks relieved by food; unrelated to activity
from a peptic ulcer
Usually under right scapula, prolonged in duration; often occurring after eating; will trigger angina more often than mimic it
biliary
Usually lasts for hours; local tenderness and/or pain with movement
arthritis, bursitis
Intensified or provoked by movement, particularly twisting or costochondral bending; long lasting; often associated with focal tenderness
musculoskeletal
Associated with/after anxiety; poorly described; located in intramammary region
psych
what is the proper sequence of cardiac assesment
beginning with inspection and proceeding to palpation, percussion, and then auscultation
apical impulse is visable were
about the midclavicular line in the fifth left intercostal space
a vigorous apical impulse is called what
heave or lift
what is PMI
point of maximal impulse, were you feel the apical pulse greatest
what if you feel a lift along the left sternal boarder
possible right ventricular hypertrophy
what pressure is used with a bell and a diaphragm
firm with the diaphragm and light for the bell
aortic valve
second right intercostal space at the right sternal border
pulmonic valve
second left intercostal space at the left sternal border
2nd pulmonic area
third left intercostal space at the left sternal border
tricuspid area
fourth left intercostal space along the lower left sternal border
mitral
at the apex of the heart in the fifth left intercostal space at the midclavicular line
Split S2 is best heard
in the pulmonic auscultatory area
Early systolic
Begins with S1, decrescendos, ends well before S2
Midsystolic (ejection)
Begins after S1, ends before S2; crescendo-decrescendo quality sometimes difficult to discern
Late systolic
Begins mid to late systole, crescendos, ends at S2; often introduced by mid to late systolic clicks
Early diastolic
Begins with S2
Mid-diastolic
Begins at clear interval after S2
Late diastolic (presystolic)
Begins immediately before S1
Holosystolic (pansystolic)
Begins with S1, occupies all of systole, ends at S2
Holodiastolic (pandiastolic)
Begins with S2, occupies all of diastole, ends at S1
Continuous
Starts in systole, continues without interruption through S2, into all or part of diastole; does not necessarily persist throughout entire cardiac cycle
High, medium, low
Depends on pressure and rate of blood flow; low pitch is heard best with the bell
Grade I
Barely audible in quiet room
Grade II
Quiet but clearly audible
Grade III
Moderately loud
Grade IV
Loud, associated with thrill
Grade V
Very loud, thrill easily palpable
Grade VI
Very loud, audible with stethoscope not in contact with chest, thrill palpable and visible
Crescendo
Increasing intensity caused by increased blood velocity
Decrescendo
Decreasing intensity caused by decreased blood velocity
Square or plateau
Constant intensity
Heard with bell at apex, patient in left lateral decubitus position
Low-frequency diastolic rumble, more intense in early and late diastole, does not radiate; systole usually quiet; palpable thrill at apex in late diastole common; S1 increased and often palpable at left sternal border; S2 split often with accented P2; opening snap follows P2 closely
Visible lift in right parasternal area if right ventricle hypertrophied
Arterial pulse amplitude decreased
Narrowed valve restricts forward flow; forceful ejection into ventricle
Often occurs with mitral regurgitation
Caused by rheumatic fever or cardiac infection
mitral stenosis
; ejection sound at second right intercostal border
Midsystolic (ejection) murmur, medium pitch, coarse, diamond shaped,* crescendo-decrescendo; radiates along left sternal border (sometimes to apex) and to carotid with palpable thrill; S1 often heard best at apex, disappearing when stenosis is severe, often followed by ejection click; S2 soft or absent and may not be split; S4 palpable; ejection sound muted in calcified valves; the more severe the stenosis, the later the peak of the murmur in systole
Apical thrust shifts down and left and is prolonged if left ventricular hypertrophy is also present
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
Heard at apex and along left sternal border
Murmur fills systole, diamond shaped, medium pitch, coarse; thrill often palpable during systole at apex and right sternal border; multiple waves in apical impulses; S2 usually split; S3 and S4 often present
Arterial pulse brisk, double wave in carotid common; jugular venous pulse prominent
Fibrous ring, usually 1 to 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
Heard over pulmonic area radiating to left and into neck; thrill in second and third left intercostals space
Systolic (ejection) murmur, diamond shaped, medium pitch, coarse; usually with thrill; S1 often followed quickly by ejection click; S2 often diminished, usually wide split; P2 soft or absent; S4 common in right ventricular hypertrophy; murmur may be prolonged and confused with that of a ventricular septal defect
Valve restricts forward flow; forceful ejection from ventricle into pulmonary circulation
Cause is almost always congenital/98/8
pulmonic stenosis
Heard with bell over tricuspid area
Diastolic rumble accentuated early and late in diastole, resembling mitral stenosis but louder on inspiration; diastolic thrill palpable over right ventricle; S2 may be split during inspiration
Arterial pulse amplitude decreased; jugular venous pulse prominent, especially a wave; slow fall of v wave (see Chapter 15)
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
Heard best at apex; loudest there, transmitted into left axilla
Holosystolic, plateau-shaped intensity, high pitch, harsh blowing quality, often quite loud and may obliterate S2; radiates from apex to base or to left axilla; thrill may be palpable at apex during systole; S1 intensity diminished; S2 more intense with P2 often accented; S3 often present; S3-S4 gallop common in late disease
If mild, late systolic murmur crescendos; if severe, early systolic intensity decrescendos; apical thrust more to left and down in ventricular hypertrophy
Valve incompetence allows backflow from ventricle to atrium
Caused by rheumatic fever, myocardial infarction, myxoma, rupture of chordae
mitral regurgitation
Heard at apex and left lower sternal border; easily missed in supine position; also listen with patient upright
Typically late systolic murmur preceded by midsystolic clicks, but both murmur and clicks highly variable in intensity and timing
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
Heard with diaphragm, patient sitting and leaning forward; Austin-Flint murmur heard with bell; ejection click heard in second intercostal space
Early diastolic, high pitch, blowing, often with diamond-shaped midsystolic murmur, sounds often not prominent; duration varies with blood pressure; low-pitched, rumbling murmur at apex common (Austin-Flint); early ejection click sometimes present; S1 soft; S2 split may have tambour-like quality; M1 and A2 often intensified, S3-S4 gallop common
In left ventricular hypertrophy, prominent prolonged apical impulse down and to left
Pulse pressure wide; water-hammer or bisferiens or Corrigan pulse common in carotid, brachial, and femoral arteries (see Chapter 15)
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
Difficult to distinguish from aortic regurgitation on physical examination
Valve incompetence allows backflow from pulmonary artery to ventricle
Secondary to pulmonary hypertension or bacterial endocarditisDifficult to distinguish from aortic regurgitation on physical examination
Valve incompetence allows backflow from pulmonary artery to ventricle
Secondary to pulmonary hypertension or bacterial endocarditis
pulmonic regurgitation
Heard at left lower sternum, occasionally radiating a few centimeters to left
Holosystolic murmur over right ventricle, blowing, increased on inspiration; S3 and thrill over tricuspid area common
In pulmonary hypertension, pulmonary artery impulse palpable over second left intercostal space and P2 accented; in right ventricular hypertrophy, visible lift to right of sternum
Jugular venous pulse has large v waves (see Chapter 15)
Valve incompetence allows backflow from ventricle to atrium
Caused by congenital defects, bacterial endocarditis (especially in IV drug abusers), pulmonary hypertension, cardiac trauma
tricuspid regurgitation
what is the first sign for newborn right sided heart failure
enlarged liver
pushing on the liver of a newborn you are looking for what
it increases right atrial pressure and will close a left to right shunt through the septal opening
Individuals with valvular defects, congenital or acquired, and those who use intravenous drugs are particularly susceptible
♦ Fever, fatigue ♦ Murmur ♦ Sudden onset of congestive heart failure ♦ Signs of neurologic dysfunctions ♦ Janeway lesion (small erythematous or hemorrhagic macules appearing on the palms and soles) ♦ Osler nodes (appear on the tips of fingers or toes and are caused by septic emboli)
bacterial endocaritis
♦ Decreased cardiac output causes decreased blood flow to the tissues
♦ May be left or right sided
♦ Left sided is characterized as systolic or diastolic
♦ Diastolic CHF is result of advanced glycation cross-linking collagen and creating a stiff ventricle unable to dilate actively
♦ Diastolic CHF occurs in older adults whose tissue is exposed to glucose for a longer period of time and in individuals with diabetes mellitus
♦ Fatigue ♦ Orthopnea ♦ Breath difficulty, shortness of breath ♦ Edema ♦ Symptoms can develop gradually or suddenly with acute pulmonary edema ♦ Systolic CHF has a narrow pulse pressure ♦ Diastolic CHF has a wide pulse pressure
congestive heart failure
If persists the pericardial effusion may increase and result in cardiac tamponade (Fig. 14-22)
♦ Initially, chest pain is sharp or stabbing ♦ Movement or inspiration may aggravate the pain ♦ Pain may be most severe when supine, relieved when leaning forward ♦ Scratchy, grating, triphasic friction rub on ascultation, comprises ventricular systole, early diastolic ventricular filling, and late diastolic atrial systole ♦ Easily heard just left of the sternum in third and fourth intercostal spaces
pericarditis
Seriously constrains cardiac relaxation, impairing access of blood to the right heart
♦ Common causes: pericarditis, malignancy, aortic dissection, and trauma
♦ Anxiety, restlessness
♦ Chest pain
♦ Difficulty breathing
♦ Discomfort, sometimes relieved by sitting upright or leaning forward
♦ Syncope, light-headedness
♦ Pale, gray, or blue skin
♦ Palpitations
♦ Rapid breathing
♦ Swelling of the abdomen or arms or neck veins
♦ Beck's triad (jugular venous distention, hypotension, and muffled heart sounds) ♦ Chronically and severely involved pericardium may also scar and constrict, limiting cardiac filling; heart sounds are muffled, blood pressure drops, the pulse becomes weakened and rapid, and paradoxic pulse (see Chapter 15) becomes exaggerated
cardiac tamponade
Enlargement of the right ventricle secondary to pulmonary malfunction
♦ Usually chronic, occasionally acute
♦ Chronic common cause: chronic obstructive pulmonary disease (COPD)
♦ Acute causes: massive pulmonary embolism and acute respiratory distress syndrome (ARDS)
♦ Results from chronic pulmonary disease; alterations in pulmonary circulation leads to pulmonary arterial hypertension, which imposes a mechanical load on right ventricular emptying
♦ Fatigue ♦ Tachypnea ♦ Exertional dyspnea ♦ Cough, hemoptysis ♦ Evidence of pulmonary disease ♦ Wheezes and crackles on auscultation ♦ Increase in chest diameter ♦ Labored respiratory efforts with chest wall retractions ♦ Distended neck veins with prominent A or V waves ♦ Cyanosis ♦ Left parasternal systolic heave ♦ Loud S2 exaggerated in the pulmonic region
cor pulmonale
Ischemic myocardial necrosis caused by abrupt decrease in coronary blood flow to a segment of the myocardium
♦ Most commonly affects left ventricle
♦ Atherosclerosis and thrombosis are the common underlying causes
♦ Deep substernal or visceral pain that often radiates to the jaw, neck, and left arm ♦ Discomfort may be mild, especially in older adults or patients with diabetes mellitus ♦ Dysrhythmias are common ♦ S4 is usually present ♦ Distant heart sounds ♦ Soft, systolic, blowing apical murmur ♦ Thready pulse ♦ Blood pressure varies, although hypertension is usual in the early phases
myocardial infarction
Focal or diffuse inflammation of the myocardium
♦ Results from infectious agents, toxins, or autoimmune diseases such as amyloidosis
♦ Initial symptoms vague
♦ Fatigue
♦ Dyspnea
♦ Fever
♦ Palpitations
♦ Cardiac enlargement
♦ Murmurs
♦ Gallop rhythms
♦ Tachycardia
♦ Dysrhythmias
♦ Pulsus alternans
myocarditis
what is CANADA
use when your looking for reasons of syncope
C Cardiac: valve stenosis, Stokes-Adams attacks, other conduction disturbances A Arteriovenous: “steal” syndromes N Nervous: psychologic, autonomic, vagal, coughing A Anemia, altered blood (CO) D Drugs, diabetes, alcohol, poisons A Altitude, acute fevers
Arrhythmias caused by a malfunction of the sinus node
♦ Occurs secondary to hypertension, arteriosclerotic heart disease, or rheumatic heart, or idiopathically ♦ Fainting, transient dizzy spells, light-headedness, seizures, palpitations, and angina ♦ Dysrhythmias ♦ Congestive heart failure
sick sinus syndrome
Four cardiac defects: ventricular septal defect, pulmonic stenosis, dextroposition of the aorta, and right ventricular hypertrophy
♦ Surgical correction is recommended, currently initiated after the first “spell” ♦ Dyspnea with feeding, poor growth, exercise intolerance ♦ Paroxysmal dyspnea with loss of consciousness and central cyanosis (tetralogy spell) ♦ Parasternal heave and precordial prominence, systolic ejection murmur over the third intercostal space, sometimes radiating to the left side of the neck; a single S2 is heard (Fig. 14-24) ♦ Older children develop clubbing of fingers and toes
TETRALOGY OF FALLOT
♦ Significant number (30% to 50%) of small defects close spontaneously, during the first 2 years of life
♦ Recurrent respiratory infections ♦ If large VSD, rapid breathing, poor growth, symptoms of congestive heart failure ♦ Arterial pulse is small, and jugular venous pulse is unaffected ♦ Holosystolic murmur, often loud, coarse, high-pitched, and best heard along the left sternal border in the third to fifth intercostal spaces ♦ Distinct lift is often discernible along left sternal border and the apical area ♦ A smaller defect causes a louder murmur and a more easily felt thrill than a large one
ventricular septal defect VSD
♦ Blood flows through the ductus during systole and diastole, increasing pressure in the pulmonary circulation and consequently workload of the right ventricle
♦ Small shunt can be asymptomatic; a larger one causes dyspnea on exertion ♦ Dilated and pulsatile neck vessels ♦ Wide pulse pressure ♦ Harsh, loud, continuous murmur heard at the first to third intercostal spaces and the lower sternal border, with a machine-like quality ♦ Murmur is usually unaltered by postural change, unlike murmur of a venous hum
patent ductus arteriosus
♦ Often asymptomatic
♦ Heart failure rarely occurs in children but can often occur in adults
♦ Diamond-shaped systolic ejection murmur often loud, high pitched, and harsh, heard over the pulmonic area ♦ May be accompanied by a brief, rumbling, early diastolic murmur ♦ Does not usually radiate beyond the precordium ♦ Systolic thrill may be felt over the area of the murmur, along with a palpable parasternal thrust ♦ S2 may be widely split ♦ Sometimes murmur may not sound particularly impressive, especially in overweight children; if there is a palpable thrust and radiation to the back, it is more apt to be significant
atrial septal defect
Systemic connective tissue disease occurring after streptococcal pharyngitis or skin infection
♦ Characterized by a variety of major and minor manifestations (Box 14-10) ♦ 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 ♦ Prevention—adequate treatment for streptococcal pharyngitis or skin infections—is the best therapy ♦ Fever ♦ Inflamed swollen joints ♦ Flat or slightly raised, painless rash with pink margins with pale centers and a ragged edge (erythema marginatum) ♦ Aimless jerky movements (Sydenham chorea or St. Vitus dance) ♦ Small, painless nodules beneath the skin ♦ Chest pain ♦ Palpitations ♦ Fatigue ♦ Shortness of breath ♦ Murmurs of mitral regurgitation and aortic insufficiency ♦ Cardiomegaly ♦ Friction rub of pericarditis ♦ Congestive heart failure
acute rheumatic fever
what are jones criteria
guide for diagnosing rheumatic fever, must have 2 major or 1 major and two minor symtpms following a strep infection
Condition causing inflammation in walls of small and medium-sized arteries throughout the body, including coronary arteries
♦ Also called mucocutaneous lymph node syndrome because it also affects lymph nodes, skin, and mucous membranes
♦ Frequently (80% of the time) affects infants and children under 5 years of age (Council on Cardiovascular Disease in the Young; Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, American Heart Association, 2001)
♦ High fever, lasting longer than 5 days ♦ Conjunctivitis ♦ Cracked, red, and inflamed lips ♦ Strawberry tongue, white coating on tongue or prominent papillae on the back of the tongue ♦ Cervical lymphadenopathy ♦ Erythema of the palms of the hands and soles of the feet ♦ Joint pain (arthralgia) and swelling, frequently symmetric ♦ Irritability ♦ Tachycardia ♦ Diagnosis is usually made based on the patient having most of the classic symptoms
Kawasaki disease
Caused by deposition of cholesterol, other lipids, and by a complex inflammatory process
♦ Leads to vascular wall thickening and narrowing of the lumen
♦ May be asymptomatic ♦ Angina pectoris, shortness of breath, palpitations ♦ Family history of close relatives with atherosclerotic disease, early death, or dyslipidemia ♦ Dysrhythmias and congestive heart failure
atherosclerotic heart disease
Amyloid, fibrillary protein produced by chronic inflammation or neoplastic disease, deposition in the heart
♦ Heart contractility may be reduced ♦ Causes heart failure ♦ Palpitations, lower extremity edema, fatigue, reduced activity tolerance
♦ Pleural effusion
♦ Arrhythmia
♦ Lower extremity edema
♦ Dilated neck veins
♦ Hepatomegally or ascites
♦ Electrocardiography or echocardiography shows small, thickened left ventricle; right ventricle may also be thickened
senile cardiac amyloidosis
Thickening and calcification of aortic valves
♦ Does not usually cause symptoms
♦ Midsystolic (ejection) murmur
aortic sclerosis
what are the two types of immunity
humoral and cellular, humoral involves the antibodies produced by b cells and cellular involves attacking invaders by cells themselves
what lymphocyte has a short life span and how prevelent are they
b cells, 3 to 4 days, not as prevelent as t cells
what does the thymus do and were is it
lower neck, develops t lymphocytes and the agents controlling the response of b cells.. dosnt do much in the adult
what are the two systems of the spleen
the white pulp, made of lymph nodes and lymph tissue, and the red pulp made of venous sinusoids
what are peyer patches
small raised areas of lymph tissue on the mucosa small intestine
how long does the umbilical cord stay attached
1 to 2 weeks
describe lymphadenopathy
enlarged lymph nodes
describe lymphadenitis
inflamed and enlarged nodes
describe lymphpharangitis
—inflammation of the lymphatics that drain an area of infection; tender erythematous streaks extend proximally from the infected area; regional nodes may also be tender
describe lymphedema
edematous swelling due to excess accumulation of lymph fluid in tissues caused by inadequate lymph drainage
describe lymphangioma
congenital malformation of dilated lymphatics
small nodes that feel like BBs or buckshot under the skin, nodes description
shotty
wavelike motion that is felt when the node is palpated, nodes descritpion
fluctuant
group of nodes that feel connected and seem to move as a unit, nodes description
matted
what node warns of malignancy
anterior to the sternocleidomastoid muscle the supraclavicular node
Inflammation of one or more lymphatic vessels
ACUTE LYMPHANGITIS
Infection and inflammation of a lymph node; may affect a single or localized group of nodes
ACUTE SUPPURATIVE LYMPHADENITIS
stage lymphedema
Latent or subclinical
Swelling is not evident despite impaired lymph transport.
0
stage lymphedema
Pitting may occur.
There is early accumulation of fluid relatively high in protein content (e.g., in comparison with “venous” edema), and it subsides with limb elevation.
1
stage lymphedema
Tissue fibrosis is present.
Limb elevation alone rarely reduces tissue swelling.
Pitting may be present. Late in stage II, the limb may or may not pit as tissue fibrosis
supervenes.
2
stage lymphedema
Pitting is absent.
Trophic skin changes are present (acanthosis, fat deposits, and warty
overgrowths).
3
Congenital malformation of dilated lymphatics
LYMPHANGIOMA/CYSTIC HYGROMA
Massive accumulation of lymphedema throughout the body; the most common cause of secondary lymphedema worldwide
LYMPHATIC FILARIASIS (ELEPHANTIASIS)
