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Nurp 500: Health Assessment > Week 7- Cardiac > Flashcards

Week 7- Cardiac Flashcards

1
Q

What occupies most of the anterior cardiac surface?

A

RV

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2
Q

The inferior border of the RV lies below the junction of the:

A

Sternum and the xiphoid process

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3
Q

This is behind the RV and to the left, it forms the lateral margin of the heart.

A

LV

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4
Q

The LVs tapered inferior tip if often termed the:

A

Cardiac apex and this produces the apical impulse, identified during palpating of the precordium as the PMI

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5
Q

Where is PMI typically found:

A

5th inter coastal space at or just medial to the left midclavicular line.

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6
Q

A displaced PMI is seen in:

A

RVH such as in COPD, MI, or heart failure

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7
Q

Mitral and tricuspid valves are called:

A

Atrioventricular valves

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8
Q

The aortic and pulmonic valves are called:

A

Semilunar valves

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9
Q

Systole is:

A

Ventricular contraction- LV pressure 5-120

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10
Q

Diastole is:

A

A period of ventricular relaxation - ventricular pressure falls further to below 5mmhg

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11
Q

During systole the aortic valve is ___ and the mitral valve is ___.

A

Open

Closed to prevent backflow

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12
Q

During diastole the aortic valve is ___ and the mitral valve is ____ open.

A

Closed

Open

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13
Q

S1 is produced by:

A

Closure of the mitral valve (normal)

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14
Q

S2 is produced by:

A

Closure of the aortic valve (normal)

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15
Q

S3 and s4 are produced by:

A

Atrial contraction and are generally pathologic in adults (heart failure, MI)

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16
Q

Right sided cardiac events usually occur slightly ___ than those on the left.

A

Later

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17
Q

A split s2 is caused by:

A

Left sided closure of the aortic valve and right sided closure of the pulmonic valve

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18
Q

Where can you hear a split s2?

A

2nd-3rd intercostal space near sternum.

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19
Q

When will a split s2 happen?

A

During inspiration (right heart filling time is increased, which increases rv stroke volume and the duration of rv ejection compared with the LV)

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20
Q

Split S1 is the result of:

A

An earlier mitral and later tricuspid sound

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21
Q

M1 of a split S1 is heard best ___ while the T1 is best heard ____.

A

Cardiac Apex

LLSB

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22
Q

Splitting of S1 does or does not vary with respiration?

A

Does not

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23
Q

Distinct heart sounds distinguishable by their pitch and their longer duration and are attributed to turbulent blood flow.

A

Heart murmurs

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24
Q

Heart murmurs are usually:

A

Diagnostic or a valvular heart disease

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25
Q

This has an abnormally narrowed valvular orifice that obstructs blood flow:

A

Stenotic valve

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26
Q

When a valve allows blood to leak backward in a retrograde direction:

A

Regurgitate murmur

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27
Q

Murmurs in children may be innocent flow murmurs T/F?

A

True

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28
Q

Aortic valve can beat be heard:

A

Right 2nd intercostal space

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29
Q

Pulmonic valve can best be heard:

A

left 2nd-3rd interspaces close to the sternum

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30
Q

Tricuspid valve can beat be heard:

A

LLSB

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31
Q

Mitral valve can beat be heard:

A

At/around the apex/PMI (5th intercostal)

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32
Q

What is to be included in description of murmurs?

A

Location, timing, shape, maximal intensity, grade of intensity, direction of radiation and quality

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33
Q

The p wave is:

A

Atrial depolarization- atrial systole begins (atria forces blood into ventricles)

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34
Q

The qrs complex is:

A

Ventricular depolarization- ventricular systole (first phase: ventricular contraction pushes av valves closed)

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35
Q

Q wave is:

A

Downward septal depolarization

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36
Q

R wave is:

A

Upward ventricular depolarization

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37
Q

S wave is:

A

Downward

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38
Q

T wave is:

A

Ventricular repolarization- ventricular diastole

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39
Q

Where is atrial repolarization?

A

Buried in the QRS

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40
Q

What does upward mean in terms of the EKG?

A

Impulse toward the lead

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41
Q

What does downward mean in terms of the EKG?

A

Moving away from lead

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42
Q

What does the straight (flat) line indicate on EKG?

A

Positive and negative impulses balanced

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43
Q

Cardiac output=

A

Stroke volume x HR

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44
Q

Cardiac output is the:

A

Volume of blood ejected from each ventricle during 1 minute

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45
Q

Stroke volume is

A

The volume of blood ejected with each heartbeat

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46
Q

Stroke volume is dependent on:

A

Preload, myocardial contractility, and afterload

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47
Q

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:

A

Preload

48
Q

Refers to the ability of the cardiac muscle, when given a load, to shorten.

A

Myocardial contractility

49
Q

Refers to the degree of vascular resistance to ventricular contraction.

A

Afterload

50
Q

Most common symptom of coronary heard disease which is the leading killer or both males and females.

A

Chest pain

51
Q

Exertional angina is:

A

A classic symptom of CHD

52
Q

As you evaluate your patients history of chest pain, always consider:

A

Life-threatening diagnoses such as angina pectoris, MI, dissecting aortic aneurysms, and PE.

53
Q

Involve and unpleasant awareness of the heartbeat with descriptions of skipping, racing, fluttering, pounding, or stopping of the heart.

A

Palpitations

54
Q

Awareness of breathing that is inappropriate given level of exertion.

A

Dyspnea

55
Q

Dyspnea that occurs when the patient is supine and improves with sitting.

A

Orthopena

56
Q

Sudden dyspnea and orthopnea that awaken patients from sleep.

A

Paroxysmal nocturnal dyspnea - fluid in lungs and classic sign of heart failure

57
Q

Orthopnea and PND occur in

A

LV heart failure, mitral stenosis, and obstructive lung disease

58
Q

Refers to the accumulation of excessive fluid in the extra vascular interstitial space.

A

Edema

59
Q

Most common type of syncope?

A

Neurocardiogenic (vasovagal)

60
Q

The jugular venous pressure reflects:

A

Right atrial pressure, which in turn equals the CVP and RV end-diastolic pressure

61
Q

The JVP is best estimated from the:

A

Right internal jugular vein, which has the most direct channel into the RA

62
Q

What is an abnormal JVP?

A

Greater than 3 cm above sternal angle

63
Q

An elevated JVP is greater than 95 percent specific for an:

A

Increase LV end-diastolic pressure and low LV EF

64
Q

How to assess the carotid pulse?

A

Supine, HOB at 30 degrees, inspect for pulsations ; index and middle finger on the R carotid

65
Q

Amplitude of the carotid pulse correlates with:

A

Pulse pressure

66
Q

The speed of upstroke, duration of its summit, and the speed of the downstroke of the carotid pulse.

A

Contour

67
Q

Rhythm regular, force alternates between strong and weak.

A

Pulsus alternans

68
Q

Pulsus alternans is associated with:

A

LV dysfunction

69
Q

Vibration of the carotid artery:

A

Thrill

70
Q

Murmur like sound

A

Bruit

71
Q

Cardiac exam patient positioning:

A

Stand on patients right side
Patient supine
HOB at 30 degrees

72
Q

How to assess the PMI and for S3 or S4:

A

Ask patient to turn to left side (left lateral decubitus position- which brings the ventricular apex closer to the chest wall)

73
Q

To bring the LV outflow tract closer to the chest wall and improve detection of aortic regurgitation, patient should:

A

Sit up, lean forward, and exhale

74
Q

In left lateral position a low pitched extra sound such as an S3, opening snap, and diastolic rumble is indicative of:

A

Mitral stenosis

75
Q

When patient is sitting and leaning forward a soft decrescendo higher pitched diastolic murmur is indicative of:

A

Aortic regurgitation

76
Q

S1 is usually louder than s2 at the ___; S2 is usually louder than S1 at the ___.

A

Apex

Base

77
Q

S1 is finished in ____; S2 is diminished in ___.

A

1st degree heart block

Aortic stenosis

78
Q

With your palm or finger pads obliquely against the chest, these are sustained impulses that left fingers:

A

Heavens and lifts

79
Q

Heavens and lifts can be indicative of:

A

Enlarged RV or LV or atrium, ventricular aneurysms

80
Q

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:

A

Thrills

81
Q

Can be found in left lateral decubitus position and listen lightly on the apical pulse with bell of stethoscope:

A

Mitral stenosis

82
Q

Can be found with patient sitting, leaning forward, listening with the diaphragm of the stethoscope for a soft, decrescendo murmur:

A

Aortic regurgitation

83
Q

Systolic murmurs fall between:

A

S1 and S2

84
Q

Diastolic murmurs fall between:

A

S2 and s1

85
Q

Murmurs that coincide with carotid upstroke are:

A

Systolic

86
Q

Normal dysrhythmias in peds:

A

HR increases on inspiration

Decreased on expiration

87
Q

3rd heart sounds (low pitched, early diastolic sounds can be:

A

Normal in peds

88
Q

This murmur is G I-II/ VI, musical, vibratory, early and midsystolic, LLSB; diminishes from supine to sitting.

A

Stills murmur

89
Q

Heart murmur plus central cyanosis in peds equals:

A

Congenital heart failure

90
Q

Thrills are always:

A

Pathologic

91
Q

What grade of murmur starts to have a thrill?

A

Grade IV

92
Q

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:

A

Aortic valve stenosis

93
Q

Aortic valve stenosis is best heard in:

A

The right upper sternal border; transmits to neck

94
Q

A type of systolic murmur that is grade II-III/VI regurgitation murmur, may be holisystolic, May be loud in mid-precordium:

A

Mitral regurgitation

95
Q

Mitral regurgitation is best heard:

A

At the apex; transmits to left axillae in infants

96
Q

Type of systolic murmur that is a grade II-III/VI continuous machine like murmur, with or without a thrill, and bounding pulses:

A

PDA

97
Q

Where can a PDA best be heard?

A

Upper left sternal border, left infraclavicular area

98
Q

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:

A

Pulmonary valve stenosis

99
Q

Peripheral pulmonary stenosis before age 6 months is or is not pathologic?

A

Is not

100
Q

Pulmonary valve stenosis is best heard at the:

A

Upper left sternal border; transmits to back

101
Q

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.

A

Characteristics of pathologic murmurs

102
Q

Begins after S1 and stops before S2 with brief gaps between the murmur and the heart sounds.

A

Midsystolic murmur

103
Q

Starts with S1 and stops at S2, without a gap between murmur and heart sounds.

A

Pansystolic murmur

104
Q

Usually starts in mid or late systole and persists up to S2.

A

Late systolic murmur

105
Q

Starts immediately after S2 with a discernible gap, the usually fades into silence before the next S1

A

Early diastolic murmur

106
Q

Starts a short time after S2. It may fade away, or merge into a late diastolic murmur

A

Middiastolic murmur

107
Q

Starts late in diastole and typically continues up to S1

A

Late diastolic (presystolic) murmur

108
Q

Diastolic murmurs usually represent:

A

Valvular heart disease

109
Q

Systolic murmurs point to:

A

Valvular disease by can be physiologic flow murmurs arising from normal heart valves

110
Q

Midsystolic murmurs typically arise from:

A

Blood flow across semilunar valves

111
Q

Pansystolic murmurs often occur with:

A

Regurgitant flow across AV valves

112
Q

A late systolic murmur is the murmur of:

A

Mitral valve prolapse and is often, but lot always preceded by a systolic click

113
Q

Early diastolic murmurs typically reflect:

A

Regurgitant flow across incompetent semilunar valves

114
Q

Middiastolic and presystolic murmurs reflect:

A

Turbulent flow across the AV valves

115
Q

Common innocent murmurs in kids:

A

Classic vibratory murmur

Stills murmur

116
Q

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.

A

Stills murmur

117
Q

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.

A

Stills murmur

Nurp 500: Health Assessment (11 decks)

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