Week 7- Cardiac Flashcards
What occupies most of the anterior cardiac surface?
RV
The inferior border of the RV lies below the junction of the:
Sternum and the xiphoid process
This is behind the RV and to the left, it forms the lateral margin of the heart.
LV
The LVs tapered inferior tip if often termed the:
Cardiac apex and this produces the apical impulse, identified during palpating of the precordium as the PMI
Where is PMI typically found:
5th inter coastal space at or just medial to the left midclavicular line.
A displaced PMI is seen in:
RVH such as in COPD, MI, or heart failure
Mitral and tricuspid valves are called:
Atrioventricular valves
The aortic and pulmonic valves are called:
Semilunar valves
Systole is:
Ventricular contraction- LV pressure 5-120
Diastole is:
A period of ventricular relaxation - ventricular pressure falls further to below 5mmhg
During systole the aortic valve is ___ and the mitral valve is ___.
Open
Closed to prevent backflow
During diastole the aortic valve is ___ and the mitral valve is ____ open.
Closed
Open
S1 is produced by:
Closure of the mitral valve (normal)
S2 is produced by:
Closure of the aortic valve (normal)
S3 and s4 are produced by:
Atrial contraction and are generally pathologic in adults (heart failure, MI)
Right sided cardiac events usually occur slightly ___ than those on the left.
Later
A split s2 is caused by:
Left sided closure of the aortic valve and right sided closure of the pulmonic valve
Where can you hear a split s2?
2nd-3rd intercostal space near sternum.
When will a split s2 happen?
During inspiration (right heart filling time is increased, which increases rv stroke volume and the duration of rv ejection compared with the LV)
Split S1 is the result of:
An earlier mitral and later tricuspid sound
M1 of a split S1 is heard best ___ while the T1 is best heard ____.
Cardiac Apex
LLSB
Splitting of S1 does or does not vary with respiration?
Does not
Distinct heart sounds distinguishable by their pitch and their longer duration and are attributed to turbulent blood flow.
Heart murmurs
Heart murmurs are usually:
Diagnostic or a valvular heart disease
This has an abnormally narrowed valvular orifice that obstructs blood flow:
Stenotic valve
When a valve allows blood to leak backward in a retrograde direction:
Regurgitate murmur
Murmurs in children may be innocent flow murmurs T/F?
True
Aortic valve can beat be heard:
Right 2nd intercostal space
Pulmonic valve can best be heard:
left 2nd-3rd interspaces close to the sternum
Tricuspid valve can beat be heard:
LLSB
Mitral valve can beat be heard:
At/around the apex/PMI (5th intercostal)
What is to be included in description of murmurs?
Location, timing, shape, maximal intensity, grade of intensity, direction of radiation and quality
The p wave is:
Atrial depolarization- atrial systole begins (atria forces blood into ventricles)
The qrs complex is:
Ventricular depolarization- ventricular systole (first phase: ventricular contraction pushes av valves closed)
Q wave is:
Downward septal depolarization
R wave is:
Upward ventricular depolarization
S wave is:
Downward
T wave is:
Ventricular repolarization- ventricular diastole
Where is atrial repolarization?
Buried in the QRS
What does upward mean in terms of the EKG?
Impulse toward the lead
What does downward mean in terms of the EKG?
Moving away from lead
What does the straight (flat) line indicate on EKG?
Positive and negative impulses balanced
Cardiac output=
Stroke volume x HR
Cardiac output is the:
Volume of blood ejected from each ventricle during 1 minute
Stroke volume is
The volume of blood ejected with each heartbeat
Stroke volume is dependent on:
Preload, myocardial contractility, and afterload
Refers to the load that stretches the cardiac muscle before contraction. The volume of blood in the RV At the end of diastole constitutes this:
Preload
Refers to the ability of the cardiac muscle, when given a load, to shorten.
Myocardial contractility
Refers to the degree of vascular resistance to ventricular contraction.
Afterload
Most common symptom of coronary heard disease which is the leading killer or both males and females.
Chest pain
Exertional angina is:
A classic symptom of CHD
As you evaluate your patients history of chest pain, always consider:
Life-threatening diagnoses such as angina pectoris, MI, dissecting aortic aneurysms, and PE.
Involve and unpleasant awareness of the heartbeat with descriptions of skipping, racing, fluttering, pounding, or stopping of the heart.
Palpitations
Awareness of breathing that is inappropriate given level of exertion.
Dyspnea
Dyspnea that occurs when the patient is supine and improves with sitting.
Orthopena
Sudden dyspnea and orthopnea that awaken patients from sleep.
Paroxysmal nocturnal dyspnea - fluid in lungs and classic sign of heart failure
Orthopnea and PND occur in
LV heart failure, mitral stenosis, and obstructive lung disease
Refers to the accumulation of excessive fluid in the extra vascular interstitial space.
Edema
Most common type of syncope?
Neurocardiogenic (vasovagal)
The jugular venous pressure reflects:
Right atrial pressure, which in turn equals the CVP and RV end-diastolic pressure
The JVP is best estimated from the:
Right internal jugular vein, which has the most direct channel into the RA
What is an abnormal JVP?
Greater than 3 cm above sternal angle
An elevated JVP is greater than 95 percent specific for an:
Increase LV end-diastolic pressure and low LV EF
How to assess the carotid pulse?
Supine, HOB at 30 degrees, inspect for pulsations ; index and middle finger on the R carotid
Amplitude of the carotid pulse correlates with:
Pulse pressure
The speed of upstroke, duration of its summit, and the speed of the downstroke of the carotid pulse.
Contour
Rhythm regular, force alternates between strong and weak.
Pulsus alternans
Pulsus alternans is associated with:
LV dysfunction
Vibration of the carotid artery:
Thrill
Murmur like sound
Bruit
Cardiac exam patient positioning:
Stand on patients right side
Patient supine
HOB at 30 degrees
How to assess the PMI and for S3 or S4:
Ask patient to turn to left side (left lateral decubitus position- which brings the ventricular apex closer to the chest wall)
To bring the LV outflow tract closer to the chest wall and improve detection of aortic regurgitation, patient should:
Sit up, lean forward, and exhale
In left lateral position a low pitched extra sound such as an S3, opening snap, and diastolic rumble is indicative of:
Mitral stenosis
When patient is sitting and leaning forward a soft decrescendo higher pitched diastolic murmur is indicative of:
Aortic regurgitation
S1 is usually louder than s2 at the ___; S2 is usually louder than S1 at the ___.
Apex
Base
S1 is finished in ____; S2 is diminished in ___.
1st degree heart block
Aortic stenosis
With your palm or finger pads obliquely against the chest, these are sustained impulses that left fingers:
Heavens and lifts
Heavens and lifts can be indicative of:
Enlarged RV or LV or atrium, ventricular aneurysms
When the ball of your hand is pressed firmly of the chest and there is buzzing or vibratory sensation caused by underlying turbulent flow it is called:
Thrills
Can be found in left lateral decubitus position and listen lightly on the apical pulse with bell of stethoscope:
Mitral stenosis
Can be found with patient sitting, leaning forward, listening with the diaphragm of the stethoscope for a soft, decrescendo murmur:
Aortic regurgitation
Systolic murmurs fall between:
S1 and S2
Diastolic murmurs fall between:
S2 and s1
Murmurs that coincide with carotid upstroke are:
Systolic
Normal dysrhythmias in peds:
HR increases on inspiration
Decreased on expiration
3rd heart sounds (low pitched, early diastolic sounds can be:
Normal in peds
This murmur is G I-II/ VI, musical, vibratory, early and midsystolic, LLSB; diminishes from supine to sitting.
Stills murmur
Heart murmur plus central cyanosis in peds equals:
Congenital heart failure
Thrills are always:
Pathologic
What grade of murmur starts to have a thrill?
Grade IV
Type of systolic murmur that is grade II-IV/VI systolic ejection murmur, with it without a thrill at upper right sternal border, ejection click, s2 may be single:
Aortic valve stenosis
Aortic valve stenosis is best heard in:
The right upper sternal border; transmits to neck
A type of systolic murmur that is grade II-III/VI regurgitation murmur, may be holisystolic, May be loud in mid-precordium:
Mitral regurgitation
Mitral regurgitation is best heard:
At the apex; transmits to left axillae in infants
Type of systolic murmur that is a grade II-III/VI continuous machine like murmur, with or without a thrill, and bounding pulses:
PDA
Where can a PDA best be heard?
Upper left sternal border, left infraclavicular area
A type of systolic murmur that is a grade II-IV/VI, with or without a thrill, and an ejection click at second left intercostal space:
Pulmonary valve stenosis
Peripheral pulmonary stenosis before age 6 months is or is not pathologic?
Is not
Pulmonary valve stenosis is best heard at the:
Upper left sternal border; transmits to back
Presence of a systolic murmur more than grade III/ IV, presence of a thrill, presence of a loud systolic murmur that is loud in duration, presence of a diastolic murmur, and presence of a pansystolic murmur.
Characteristics of pathologic murmurs
Begins after S1 and stops before S2 with brief gaps between the murmur and the heart sounds.
Midsystolic murmur
Starts with S1 and stops at S2, without a gap between murmur and heart sounds.
Pansystolic murmur
Usually starts in mid or late systole and persists up to S2.
Late systolic murmur
Starts immediately after S2 with a discernible gap, the usually fades into silence before the next S1
Early diastolic murmur
Starts a short time after S2. It may fade away, or merge into a late diastolic murmur
Middiastolic murmur
Starts late in diastole and typically continues up to S1
Late diastolic (presystolic) murmur
Diastolic murmurs usually represent:
Valvular heart disease
Systolic murmurs point to:
Valvular disease by can be physiologic flow murmurs arising from normal heart valves
Midsystolic murmurs typically arise from:
Blood flow across semilunar valves
Pansystolic murmurs often occur with:
Regurgitant flow across AV valves
A late systolic murmur is the murmur of:
Mitral valve prolapse and is often, but lot always preceded by a systolic click
Early diastolic murmurs typically reflect:
Regurgitant flow across incompetent semilunar valves
Middiastolic and presystolic murmurs reflect:
Turbulent flow across the AV valves
Common innocent murmurs in kids:
Classic vibratory murmur
Stills murmur
This murmur is caused by a low frequency vibration generated by normal pulmonary valve leaflets during systole or periodic vibrations generated by a left ventricular false tendon.
Stills murmur
This murmur is detected in kids 3-6 but can be detected at any age. It is grade II-III/ VI in intensity and is best heard between the lower left sternal border and the apex.
Stills murmur
