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Terms in this set (56)
Point of maximal impulse (PMI)
Where heartbeat is best palpable on chest wall; 5th intercostal space, medial to midclavicular line (or 7-9 cm lateral to the midsternal line).
Displacement of the PMI lateral to the midclavicular line or greater than 10cm lateral to the midsternal line suggests:
- Ventricular dilation from MI
What does a thrill signify?
Turbulent blood flow and directs you to locate the origin of loud murmuris.
A heave refers to :
Palpable impulse that noticeably lifts your hand.
A thrill refers to :
Tactile equivalent of a murmur and is palpable vibration.
Midline sternotomy scar usually indicates :
Aortic valve replacement.
Left submammary scar usually indicates :
Infraclavicular scar usually indicates :
Pacemaker or defibrillator implantation.
Most lateral and inferior position where the cardiac impulse can be felt is known as :
Double apical impulse is characteristic of ?
The most common thrill is?
That of aortic stenosis
Sites where the thrill of aortic stenosis can be palpated are?
-At the apex.
-At the lower sternum.
-In the neck.
The thrill caused by a VSD is best felt at :
Lt & Rt sternal edges.
Apical impulse in LV hypertrophy :
The S1 heart sound is best heard at :
The S2 heart sound is best heard at :
Left sternal edge.
Splitting of S2 is best heard at :
Left sternal edge.
The S3 heart sound is best heard at :
S3 heart sound is a nL finding in :
Causes of loud S1 :
Causes of quiet S1 :
-Poor LV fx
-Rheumatic mitral regurg
Variable intensity of S1 may indicate :
-Complete heart block
The most common causes of S3 after the age of 40 years are?
1- LV failure.
2- Mitral regurg.
S3 gallops are associated w/_____?
volume overload implying decreased ejection fraction
S4 gallop is pathologic and can indicate what? (3)
LV diastolic dysfunction
2nd ICS, Lt sternal border
2nd ICS, Rt sternal border
3rd ICS, Lt sternal border
5th ICS, Lt sternal border
5th ICS, midclavicular line
Mitral area /apex area
Causes of Fixed splitting of S2
ASD (L→R shunt causes ↑ R heart pressures regardless of breathing)
Causes of reversed splitting of S2
Causes of wide splitting of S2
Summary of S2 splitting
Opening snap is best heard at :
Opening snap is heard in what condition?
when and where is it best heard?
-MS (rarely TS).
-Early diastole ( just after S2).
#High-pitched sounds that occur early in systole at the onset of ejection.
#Just after S1.
#Congenital pul or aortic stenosis.
-Mitral valve prolapse.
-Beast heard at the apex.
Heart murmurs are caused by?
Turbulent blood flow across an abnormal valve, spetal defect, outflow obstruction.
Innocent murmurs are caused by?
1-Inc velocity of flow thru a nL valve
2-Inc SV ; pregnancy, athletes, febrile pts
What are the three phases of diastole?
1-Early diastole "isovolumic relaxation".
Assessing a murmur
Grading of a murmur
1 : Heard by an expert in optimum conditions
2: Heard by a non-expert in optimum conditions
3: Easily heard; no thrill
4: A loud murmur; w/ a thrill
5: Very loud, can be heard w/ a stethoscope barely touching the chest
6: Extremely loud, heard w/o a stethoscope
What type of murmur occurs in :
-Mitral valve prolapse?
In terms of duration, the murmurs occur in each of aortic / pul stenosis are?
Ejection systolic murmurs
The ejection systolic murmur of aortic or pul stenosis begins after S1 reaches maximal Intensity in ______?
The pansystolic murmur of mitral regurg radiates towards : _______?
The murmur of VSD radiates towards :______?
Rt sternal edge
The murmur of aortic stenosis radiates towards :_________?
Aortic regurg murmur :
early diastolic murmur
Graham Steell murmur
PV regurgitation - pulmonary hypertension
Austin Flint Murmur
diastolic murmur caused by regurgitation on anterior mitral valve leaflet -> sign of severe aortic regurgitation -> need to replace aortic valve
The most common cause of continuous murmurs is :
Continuous murmur-PDA :
-Best heard at?
-Upper Lt sternal border
What is the most common cause of direct pump failure?
What are some nursing considerations for Beta Blockers?
how does HTN cause congestive heart failure?
What is the management of chronic heart failure?
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