Cardiac Workbook Flashcards
(13 cards)
What are some common causes of hyperkinetic pulses?
Anxiety Exercise Slow heart rate Aortic regurgitation Large arterial fistula High cardiac output states (fever, anemia, pregnancy, hyperthyroidism) Rigid aorta
What are some common causes of a hypokinetic pulse?
Hypovolemia Heart failure Low cardiac output Shock Aortic valve obstruction Localized carotid obstruction
What makes the a wave?
Atrial contraction
What are the components of the jugular venous pulse?
A, C, V
What is the y descent?
Y descent is the decrease in jugular venous pulse during diastole
Tricuspid obstruction will decrease the Y descent because it obstructs flow to the right ventricle from the right atrium during diastole
What would be a consequence of local disease of the superior vena cava?
Obstruction will increase the jugular venous pulse pressure
What happens in transmission distortion of the jvp?
There may have been preveious HEENT surgery that distorted or obscured the jugular pulse
Or there could an incompetency of the valves
What is the V waves?
Filling of the atrium
What happens in volume overload of the left ventricle?
The impulse will be displaced down and out
(usually due to mitral/aortic regurg or a left to right shunt what wastes portions of the ventricle volume
This leads to compensatory maneuvers by the heart to upregulate its SV
Hypertrophies and Dilates
Brisk and tapping impulse
What happens in pressure overload of the ventricle
The impulse will be in the same area but the ventricle must HYPERTROPHY to pump against a higher pressure gradient
NO DILATION
MORE SUSTAINED IMPULSE
Leads to strain due to increased muscle without increase supply of O2 and contractility begins to fall
Items that affect this are aortic valve obstruction and systemic hypertension
What will increase the vigor of left ventricular contraction?
Exercise, anxiety
Failure due to intrinsic muscle disease of the left ventricle
What factors affect impulse transmission?
Attenuated cardiac transmission
-Hyperinflated lungs: Emphysema, barrel chest deformity, fluid in pleural cardiac space, gross obesity
Accentuated cardiac transmission: Thin patients with narrow chest, previous surgery involving rib resections or removal of left pectoralis major muscle
What are some determinants of the the second heart sounds character?
The thickness of the valve: Thicker is louder
The pressure in the aorta or pulmonary arteries correlates to loudness
