Case Study 1

Question 1

What does the jugular venous pressure give?

Answer 1

It gives you an index of whats going on in the right atrium. if right atrial pressur goes up then so does jugeular because it feeds off IVC. A failure in the right side of the heart causes a rise in the jugular venous pressure.

Question 2

What does swelling of the ankle indicate?

Answer 2

If there is no swelling in the ankle then it indicates that the right side of the heart is working normally bcause if not then you would get back pressure to the lower limb.

Question 3

What is a murmur?

Answer 3

It is an abnormal sound from the heart due to turbulent blood flow.

Question 4

Define BMI and how to calculate it?

Answer 4

is a measure that uses your height and weight to work out if your weight is healthy. To calculate, kg/m^2,

Question 5

How does BMi afect cardiac fucntion in the long term?

Answer 5

the total blood volume increases. This results in increased stroke volume, and cardiac output

Question 6

Normal SBP, DBP, PP and HR for 20 year old vs 60?

Answer 6

20:
SBP - 120 ish 
DBP - 80 ish 
PP - 40
HR - 

60:
SBP - 135 ish 
DBP - 80 ish 
PP - 55
HR -

Question 7

Describe the cardiac cycle for the left side of the heart with respect to pressure and volumes in the atrium, ventricle, and aorta?

Answer 7

Aorta - diastole: 80 and systole: 120
Left vetnricular- diastole: 0 and systole: 120
Check diagram

Question 8

What is incisura or dicrotic notch?

Answer 8

Aortic valve closes, it is caused when ventricular pressure falls below arterial pressure

Question 9

Where are the sounds of the heart in the cardiac cycle?

Answer 9

1. ) Closure of the mitral and tricuspid valves, the start of ventricular systole
2. ) Closure of the aortic and pulmonary valves (semilunar). Start of diastole
3. ) passive ventricular filling in the early stages of diastole. Not heart in adults, detected by phonocardiography.
4. ) Rapid ventricular filling after atrial contraction. In atrial systole. Not heard, only in phonocardiography.

Question 10

Why does aortic blood pressure never fall to 0 in normal circumstances?

Answer 10

elasticity of the large arteries helps to maintain pressure during ventricular relaxation, sustains diastolic pressure.

Question 11

What’s wrong with the patient that has is 60 years old and has a blood pressure of 120/97 and a pulse pressure of 23?

Answer 11

He has a small pulse pressure and his diastolic blood pressure is high because of an increase in TPR to maintain the MAP.

Question 12

What is Starling’s law of the heart and how will it be affected by sympathetic stimulation and myocardial infection (reduction in left ventricular mass)?

Answer 12

States that the stroke volume of the left ventricle will increase as the left ventricular volume increases due to the myocyte stretch causing a more forceful systolic contraction.

Every point on the starling curve has the same contractility. Sympathetic stimulation will increase the contractility by causing the starling curve to rise higher. There will be a higher SV for the same EDV.

Question 13

What is myocardial contractility and how is it measured?

Answer 13

It is the stroke volume for a given end-diastolic volume. (the ability of the heart to contract).

it can be measured through: During isovolumetric phase of systole, ventricular pressure rises and the maximum rate at which this ventricular pressure rises is called the dP/dtmax. This slope is a good measure for myocardial contractility.

Question 14

What causes a plateau in starling’s curve?

Answer 14

The plateau of the cardiac performance curve shows that there is a limit to the heart’s ability to accommodate increases in venous return. If venous return increases beyond this limit, blood wells up in the heart and raises atrial pressure drastically.

Question 15

What factors affect stroke volume and why?

Answer 15

1. ) Preload: The filling pressure of the heart at the end of diastole.
2. ) Contractility: The inherent vigor of contraction of the heart muscles during systole.
3. ) Afterload: The pressure against which the heart must work to eject blood during systole.

Question 16

What affects end-systolic volume?

Answer 16

contractility and afterload. Contractility describes the forcefulness of the heart’s contraction. Increasing contractility reduces end-systolic volume, which results in a greater stroke volume and thus greater cardiac output.

Question 17

What is an apex beat and where would you expect to find it?

Answer 17

The apex is formed by the left ventricle and the tapping of the left ventricle on the chest wall creates a palpable beat called the apex beat in the 5th intercostal space in the mid clavicular line, 10 cm from the midline.

Question 18

Where does the apex beat move with left ventricular hypertrophy and aortic insufficiency?

Answer 18

Left ventricular hypertrophy - apex beats will be deviated outside and down compared with the normal position

Aortic insufficiency - because there exists an increased outflow in systemic circulation, the apex beat will be very strong at palpation as apex shock in the ball. clinically a possible valve disease.

Right Ventricular hypertrophy - Harzer sign in which you will feel palpations in the epigastric area.

Question 19

Abnormal Heart Sounds (Murmurs) :

Answer 19

Valve stenosis – a narrow, tight, stiff valve, limiting forward flow of blood.
Valve regurgitation – a valve that does not close completely, allowing backward flow (a “leaky” valve).

Aortic Stenosis: murmur occurs during systole between S1 and S2 peaking mid systole.

Aortic Incompetence: Murmur occurs in early diastole

Mitral Incompetence: murmur occurs throughout systole

Mitral Stenosis: Low frequency rumbling mid-diastolic murmur, with presystolic component possible

https://depts.washington.edu/physdx/heart/tech.html

Question 20

How is ventricular wall thickness measured by echo cardiography?

Answer 20

It is measured by echocardiography which is when a non invasive technique records the motion of heart walls and valves. Essentially, a beam of ultra high frequency sound is directed across the heart from an emitter and the sounds is reflected back by the structures of the heart such as the walls and valves. This reflected sound is processed by the computer to build a picture of the cardiac structure and function.

Question 21

What is the cause of thickening of the wall of the left ventricle ?

Answer 21

Cardiac hypertrophy occurs when there is an increased after load (aortic stenosis). What happens is that the walls grow thicker and they expand into the ventricle. This makes the ventricle wall stiffer and so ventricular relaxation. becomes impaired. Diastolic filling of the ventricle is reduced and the heart must perform more work to eject SV against the high arterial pressure.

Question 22

What is it called when a wall is thickened ?

Answer 22

Cardiac hypertrophy

Question 23

How to tell if someone has left ventricular hypertrophy when looking at an ECG?

Answer 23

Look at V1, V2, V5, V6

V1, V2 = deepest S wave must be greater than 35mm (3.5mV) when added to R wave
V5, V6 = tallest R wave must be greater than 35 mm (3.5mV) when added to S wave

Question 24

How do you measure the radial pulse?

Answer 24

2 fingers under the thumb area near the wrist

Question 25

What is a pulse that is small in volume and slow in rise pressure?

Answer 25

It is when the left ventricle has difficulty pumping blood out into he aorta due to the increased resistance of the aortic stenosis (narrowing). The stroke volume does not enter the aorta in one ejection and must squeeze through the stenosis.

Question 26

What is the origin of the tightness in the chest when the patient exercises?

Answer 26

It is because of coronary circulation. Essentially, the coronary arteries are the first branches off the aorta and during exercise the blood flow rises to meet the increased O2 demand of the cardiac muscle. In Aortic stenosis the heart can’t increase cardiac output to meet the needs of the body during exercise. So basically the O2 demand becomes greater than the O2 being supplied and it causes the muscles to become ischaemic which causes pain.

Question 27

Aortic stenosis solution?

Answer 27

surgery - Aortic valve replacement