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363 Quiz 6

Terms in this set (87)

acute chest pain that occurs when myocardial demand exceeds it's oxygen supply
Angina pectoris
(aortic insufficiencey) incompetent aortic valve that allows backward flow of blood into left ventricle during diastole.
Aortic regurgitation
calcification of aortic valve cusps that restricts forward flow of blood during systole
Aortic stenosis
the left semilunar valve separating the left ventricle and te aorta
Aortic valve
tip of the heart pointing down toward the 5th left intercoastal space
Apex of the heart
(point of maximal impluse, PMI) pulastion created as the left ventricle rotates against the chest wall during sytole, normally at the 5th left intercostal space in the midclavicular line.
Apical impulse
boarder area of the hearts outline located at the 3rd right and left intercoastal space
Base of the heart
cup- shaped endpeice used for soft, low-pitched heart sounds
Bell (of the stethescope)
slow heart rate, < 50 beats per min in the adult
Bradycardia
bulbous enlargement of the distal phalanges of the fingers and toes that occurs with chronic cyanotic heart and lung conditions
Clubbing
Coarctation of aorta
severe narrowing of the descending aorta, a congential heart defect
right ventricular hypertrophy and heart failure due to pulmonary hypertension
Cor pulmonale
dusky blue mottling of the skin and mucous membranes due to excessive amount of reduced hemoglbin in the blood
Cyanosis
flat endpeice of the stethescope used for hearing relatively high-pitched heart sounds
Diaphragm (of the stethescope)
the hearts filling phase
Diastole
difficult, labored breathing
Dyspnea
swelling of the legs or dependent body part due to increased interstitial fluid
Edema
traditional auscultory area in the 3rd left intercoastal space
Erb's point
occurs with closure of the atrioventricular (AV) valves signaling the begining of systole
First heart sound S1
(S4 gallop; atrial gallop) very soft, low-pitched ventricular filling sound that occurs in late diastole
Fourth heart sound (S4)
the addition of a 3rd or 4th heart sound makes the rhythm sound like the cadence of a galloping horse
Gallop rhythm
technique of moving the stethescope incrementally across the precordium through the auscultatory areas while listening to the heart sounds
Inching
increase in thickness of myocardial wall that occurs when the heart pumps against chronic outflow obstruction (e.g. aortic stenosis)
LVH (left ventricular hyertrophy)
imaginary ventrical line bisecting the middle of the clavical in each hemithorax
MCL (midcalvicular line)
(mitral insufficiency) incompetent mitral valve allows regurgitation of blood back into left atrium during systole
Mitral regurgitation
calcified mitral valve impedes forward flow of blood into left ventricle during diastole
Mitral stenosis
left AV valve separating left atria and ventricle
Mitral valve
uncomfortable awareness of rapid or irregular heart rate
Palpitation
opposite of a normal split S2 so that the split is heard in expiration, and in inspiration the sounds fuse to one sound
Paradoxical spliting
high-pitched, scratchy extracardiac sound heard when the precordium is inflamed
Pericardial friction rub
normal variation in S2 heard as two separate components during inspiration
Physiological splitting
area of the chest wall overlying the heart and great vessels
Precordium
(pulmonic insufficiency) backflow of blood through incompetent pulmonic valve into the right ventricle
pulmonic regurgitation
calcifiction of pulmonic valve that restricts forward flow of blood during systole
Pulmonic stenosis
right semilunar valve separating the right ventricle and pulmonary artery
Pulmonic valve
occurs with closure of the semilunar valves, aortic and pulmonic, and signals the end of systole
Second heart sounds (S2)
abnormal mid-diastolic heart sound heard when both the pathological S3 and S4 are present
Summation Gallop
temporary loss of consciousness due to decreased crebral blood flow (fainting), caused by ventriclular asystole, pronounced bradycardia, or ventricular fibrillation
Syncope
the heart's pumping phase
Systole
rapid heart rate, >90 beats per minute in the adult
Tachycardia
soft, low-pitched ventricular filling sound that occurs in early diastole (S3 gallop) and may be an early sign of heart failure
Third heart sound (S3)
palpable vibration on the chest wall accompanying severe heart murmur
Thrill
right AV valve separating the right atria and ventricle
Tricuspid valve
the precordium is..
the area on the anterior chest overlying the heart and great vessels
the tricuspid valve is
the right atriventricular valve
the function of the pukmonic valve is to
protect the orifice b/t the right ventricle and the pulmonary artery
Atrial systole occurs
during ventricular diastole
the second heart sound is the result of
closing of the aortic and pulmonic valves
the examiner has estimated the jugular venous pressure. describe a normal finding.
Patient elevated to 45 degrees, internal jugular vein pulsation at 4 cm above sternal angle
the examiner is palpating the apical impulse. the normal size of this impluse is
about 2 cm
the examiner wishes to listen in the pulmonic valve area. To do this, the stethoscope would be placed at the:
second left interspace
Make a statement that differentiates a split S2 from S3
S3 is lower pitched and is heard at the apex
The examiner wants to listen for a pericardial friction rub. What is the best method for this?
with the diaphraghm, patient sitting up and leaning forward, breath held in expiration
when ausclutating the heart, your first step is to:
identify S1 and S2
You will hear a split S2 most clearly in what area?
pulmonic
The stethescope bell should be pressed lightly against the skin so that:
it does not act as a diaphragm
A murmur heard after S1 and before S2 is classified as:
systolic (possibly benign)
When assessing the carotid artery, the examiner should palpate:
medial to the sternomastoid muscle, one side at a time
S1 is best heard at the _____ of the heart, whereas S2 is loudest at the _____ of the heart. S1 coincides with the pulse in the _____ and coincides with the ______ wave if the patient is on an ECG monitor.
apex, base, carotid artery, R
tough, fibrous, double-walled sac that surrounds and protects the heart
pericardium
thin layer of endothelial tissue that lines the inner surface of the heart chambers and valves
endocardium
reservoir for holding blood
atrium
ensures smooth, friction-free movement of the heart muscle
pericardial fluid
Muscular pumping chamber
ventricle
musclular wall of the heart
myocardium
Briefly relate the route of a blood cell from the liver to tissue in the body
Liver to right atrium via inferior vena cava, to right atrium, through tricuspid valve to right ventricle, through the pulmonic valve to the pulmonary artery, picks up oxygen in the lungs , returns to left atrium, to left ventricle via mitral valve, through aortic valve to aorta, and out to the body.
List the major risk factors for heart disease and stroke identified in the text
The major risk factors for heart disease and stroke are hypertension, smoking, high cholesterol, obesity, and diabetes. Physical inactivity, family hist of heart disease, and age are other risk factors.
Define the apical impulse and describe it's normal location, size, and duration.
Defined- the pulsation created as the left ventricle rotates against the chest wall during systole
location- occupies only one intercostal space, the 4th or 5th, and at or inside the midclavicular line
Size- 1x2 cm
duration- short, (1st 1/2 of systole)
Which NORMAL variations may effet the location of the apical impulse?
Obesity, thick chest walls ( with anxiety, fever, hyperthyroidism, anemia) might increase amplitude and duration.
Which ABNORMAL conditions may affect the location of the apical impulse?
CARDIAC ENLARGEMENT:
- LEFT VENTRICULAR DILATION (volume overload) displaces impulse down and to the left ans increases size more that one space.
-a SUSTAINED impulse wirh increased force and duration but no change in location occurs with LEFT VENTRICULAR HYPERTROPHY and no dilation (pressure overload)
- PULMONARY EMPHYSEMA makes it non-palpable from the lung sound overridding heart sound.
Describe the effect of respiration on the heart sounds.
more to the Right heart less to the left:
during inspiration, more venouse blood is able to enter the vena cava due to decreasing thoracic pressure which ncreases the amt of blood in the right side of heart thus increasign it's volume. Meanwhile on the left side a greater amt of blood is sequestered in the lungs momentarily dec amt returned to left side and thus volume shortening ventricluar systole allowing the aortic to close earlier (p460)
Describe the mechanism producing normal first and second heart sounds
First heart sound = closure of the AV valves (signaling beging of systole)
second heart sound= closure of semilunar valves (signaling end systole)
(p460)
Describe the charecteristics of the 1st heart sound and it's intensity at the apex of the heart and at the base
S1's mitral component (M1) slightly precedes the tricuspid compnent (T1) but u usually hear the 2 as one sound. The S1 can be heard all over the Precodium but loudest at apex. Is associated with the closure of the AV valves and signals the beginning of systole. S1 is lower pitch than S2 so they can be hear as one sometimes.
which conditions increase the intensity of S1 ?
1. Position of AV valve at start of systole--- wide open and no time to drift together.
2. Change in valve structure-- calcification of valve, needs increasing ventricular pressure to close the valve against increased atrial pressure
which conditions decrease intensity of S1?
1. position of AV valve -- delayed conduction from atria to ventricles. Mitral valve drifts shut b4 ventricular contraction closes it
2. Change in valve structure-- extreme calcification, which limits mobility.
3. More forceful atrial contraction into noncompliant ventricle; delays or diminishes ventricular contraction
Intensity of S1 depends on what 3 factors weather it is higher or lower intensity?
1. position of AV valve at the start of systole
2. structure of the valve leaflets
3. how quickly pressure rises in the ventricle
describe the 2nd heart sound
The S2 is associated with the closure of the semilunar valves. You can hear it with the diaphragm, over the entire precordium, although it is loudest at the base.
is the Lub
S1
Is the Dub
S2
what conditions increase the intensity of the S2?
1. higher closing pressure (ex systemic hypertension, rining or booming)
2. Exercise and excitement increase pressure in aorta (ex mitral stenosis or heart failure)
3. Pulmonary hypertension (ex aortic or pulmonic stenosis)
4. Semilunar valves calcified but still mobile
P488
what conditions decrease the S2 intensity
1 a fall in systemic blood pressure causes a decrease in valve strength (ex shock)
2. Semilunar valves thickened and calcified, decreased mobility (ex. aortic or pulmonic stenosis)
What is the physiological mechanism for normal splitting of S2 in the pulmonic valve area?
Occurs during inspiration, which separates the timing of the 2 valves (aortic 0.06 sec earlier than pulmonic) closure. So instead of just one Dup, you hear a spilt--T-DUP. During expiration it returns to normal.
Define the 3rd heart sound
Is a ventricular filling sound early in diastole during the rapid filling phase. Dull soft sound where as the S2 is a snap. (lightly hold bell against skin)
Location- at the Apex or left lower sternal border
Respiratory variation- The S3 does not vary in timing w/ respirations the S2 does.
Pitch- the S3 is lower pitched than the S2
Physiological S3 vs Pathological S3
Physiological- ceases when sitting up.
Pathological- persists when sitting up.
Fourth heart sound
is a ventricular filling sound late in Diastole when atria contracts right b4 S1. heard best at Apex w/ patient in left lateral position. (very difficult to hear need a good bell)
Position of valves during each phase of cardiac cycle
Diastole- AV valves (i.e. tricuspid and mitral) are open
Systole- AV valves shut producing S1. Aortic valves open to eject blood rapidly. then some back flow from psi equalizing b/t aorta and ventricles causes aortic valve to shut
Diastole again- all 4 valves closed, mitral valve opens and diastolic filling begins again
Define venous pressure and jugular venous pulse.
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