Cardiac And Peripheral

Question 1

Preload

Answer 1

Measures volume overload

Question 2

Contractility

Answer 2

Ventricles contract during systole

Question 3

Afterload

Answer 3

Measures of pressure overload

Question 4

Cardiac output

Answer 4

Stroke volume x HR

Question 5

Systole

Answer 5

S1 into S2

The ventricles contract- shorter phase

• right ventricle pumps blood into the pulmonary arteries (pulmonic valve is open _
• left ventricle pumps blood into the aorta (aortic valve is open)

Question 6

Diastole

Answer 6

The ventricles relax - longer phase

• blood flows from the right atrium to right ventricle (tricuspid valve open)
• blood flows from the left atrium to left ventricle ( mitral valve is open)

S2 into S1

Question 7

Physical exam components

Answer 7

Inspect, palpate, auscultate

No percuss

Question 8

Xanthelasma

Answer 8

Yellow plaques on the inner parts on the eye

• indication of CAD

Question 9

Carotid pulse - palpating

Answer 9

Upstroke

Brisk = normal

Delayed= aortic stenosis

Bounding = aortic insufficiency

Question 10

Thorax - palpation

Answer 10

Right hand across pt left chest - covering the area of the heart

• heel of hand rest along the eternal border with extended fingers lying below the left nipple

Heel - listen for thrills = turbulent blood flow

Finger pads - lifts, pulsation and heaves - enlarged ventricle or atrium

Question 11

Auscultation

Answer 11

The diaphragm = high pitched sounds like s1, S2, and s4 and most murmurs

Bell = low pitched sounds like s3, the rumble of mitral stenosis

Question 12

Normal sounds

Answer 12

S1 = LUB - closure of tricuspid and mitral valve

S2= DUB - closure of aortic and pulmonic valve

Question 13

Abnormal sounds

Answer 13

S3 and S4 = ventricular filling

Murmurs - turbulent blood flow

Question 14

Listening areas

Answer 14

Aortic - 2nd ICS RSB
- S2 louder than S1

Pulmonic - 2nf ICS LSB
- S2 louder than S1

Tricuspid - 4th or 5th ICS LSB
- S1 louder than S2

Mitral - 5ht ICS MCL
- S1 louder than S2

Question 15

S3 “ what is it “

Answer 15

An “extra” sound that occurs early in diastole - called a “ventricular gallop”

• normal in children and athletes
• heard best at the apex with bell
• related too
• decreased myocardial contractility
• HF
• Volume overloading of ventricle
  - mitral regurgitation / tricuspid regurgitation

Question 16

S4 “ what is it”

Answer 16

An extra sound that occurs LATE in diastole - called atrial gallop

• due to increased resistance to ventricular filling
• related to increased stiffness of ventricular myocardium
• associated with
  
  • HTN, CAD, Pulmonary HTN, pulmonic stenosis

Question 17

S3 and S4 - abnormal sounds

Answer 17

Both = summation gallop = myocardial disease

Question 18

Ejection Sounds

- Aortic and Pulmonic

Answer 18

Aortic ejection

• shortly after S1
• due to dilated aorta or aortic valve disease

Pulmonic ejection

• shortly after s1
• intensity often decreases w/ inspiration
• heard best 2nd and third ICS

Question 19

Ejection sounds

Systolic clicks

Answer 19

• usually mid to late systole
• usually caused by mitral valve prolapse
• usually single, followed by a murmur

Question 20

Ejection sounds

- opening snap

Answer 20

Occurs early in diastole

- produced by the opening of a stenosis or narrowed mitral valve

Question 21

Murmurs

Answer 21

Sounds that occur during systole or diastole as a result of turbulent blood flow

Can be

• innocent
• physiologic
  
  • high flow through a normal valve due to temporary increase in the blood flow
• pathologic
  
  • structural abnormalities

Question 22

Murmur categorized as

Answer 22

Regurgitant Or insufficient - blood leaking across a valve that is suppose to be closed

Stenosis
- blood flow across valve is disrupted due to valve not fully opened

Question 23

How to describe murmurs

Answer 23

Timing- systolic or diastolic
Location of maximal intensity - where heard best

Radiation - does it spread, where

Intensity- loudness, graded 1- VI

Pitch - high or low pitched

Quality - blowing, rumbling, musical, harsh

Question 24

Intensity grades

Answer 24

Grade 1 to VI

Grade 1 : barely audible

Grade VI : may be heard with Steph entirely off chest

Question 25

Valve Regurgitation

Answer 25

Happens when the valve doesn’t not close tightly enough after blood flows through the valve into the lower chamber of the heart. This allows blood leak back into the upper chamber of the heart.

Question 26

Valve prolapse

Answer 26

Valve flaps bulge backward when blood is pumped out of the heart.

Question 27

Valve Stenosis

Answer 27

Valve becomes stiff or scarred or the valve flaps become partially joined together and doesn’t open as widely as it should. As a result, not as much blood can flow into or out of the ventricle

Question 28

Systolic murmurs

Answer 28

Occur between S1 and S2

Question 29

Systolic murmur | - Aortic Stenosis

Answer 29

Caused by Aortic Stenosis - forward flow through the valves and have a crescendo- decrescendo pattern ``` Location - R 2nd interspace Radiate : to the neck Intensity : soft to loud sound Pitch : medium harsh quality Quality : often harsh Aids : heard best with patient sitting and leaning forward ```

Question 30

Mitral Regurgitation - systolic murmur

Answer 30

Mitral Regurgitation and Mitral Prolapse - when the blood is forced backward in to the atrium and have a pan-systolic pattern ``` Location : heard at the apex Radiate : to L axils Intensity : soft to loud, blowing Pitch : medium to high Quality : holo-systolic Aids: increases with squat, hand grip, decreases with standing ```

Question 31

Diastolic Murmurs

Answer 31

Occur btw S2 and S2 - indicative of heart disease

Question 32

Diastolic murmurs - mitral stenosis

Answer 32

Associated with forward flow through the valves ``` Location- heard in the apex Radiate- toward apex Intensity - 1-4 Pitch - rumble, decrescendo Quality - rumble, decrescendo Aids - Left Lateral position, have patient excerise for few minute ```

Question 33

Diastolic murmurs - Aortic Regurgitation / Insufficiency

Answer 33

Associated when the blood is forced backwards into the atrium and have a decrescendo pattern ``` Location : 2nd to 4th left interspace Radiation; to apex maybe RSB Intensity- grades 1-3 Pitch - high - use diaphragm Quality - blowing decrescendo Aids - sitting up and leaning forward ```