What occupies the ant. surface of the heart
R Vent
Found behind sternum, along left lower parasternal area
Sign of R vent hypertrophy
Left parasternal heave can be palpated
pulmonary hypertension
Location of pulmonary art
2nd left interspace
What composes the cardiac apex
Lowermost tip of the left bentricle
Another name for apex beat
Point of maximum impulse
Where is ascending aorta found
Behind sternum, second Right interspace
What is known as the base of the heart
Pulm/aorta areas
What makes up right heart boarder
R atrium
What makes up posterior heart
L atrium
Heart sounds
Aortic valve
2nd right inter
Heart sounds
Pulmonary valve
2nd left inter
Heart sounds
Tricuspid
4/5 left inter
Heart sound
Mitral valve
apex
Where do you listen for aortic insufficiency and pulm valve
3/4 left interspace parasternally (erbs point)
Why cardiac pain during compromised blood flow
Vagus PS Dermatomes T1-4
What innervates pericardium
Intercostal nerves (somatic)
Cardiac preload
Venous return to atria
When does atrial systole kick occur
End of ventricular diastole
What would cause diastole to shorten
tachycardia
What initiates each cardiac cycle
SA node
discharges 60-90x a min
What occurs between S1 and S2
Systole
What occurs between S2 and S1
Diastole
How is S1 ID’d at the bedside
Occurs simultaneously with upstroke of the carotid pulse
When is duration of ventricular systole = to diastole
HR >100
What is the third heart sound S3
In children (S3) Rapid vent filling in early diastole
S4 heart sound
Atrial contraction causes late diastole
Seen in those with reduced left vent compliance
Janeway lesions
Found on palms
nontender lesions
Olsler nodes
Tender nodes found on fingers and toes
Why palpate trachea for central position
Used as index of mediastinal shift
JVP provides info on
Pressures in the right side of the heat
Pulsations of which jugular vein is measured
Internal jugular vein
How many pulsations do you find at the internal jugular per cardiac cycle
2
- Wave from R atrial systole before carotid pulse
- Wave from venous filling of the right atrium after carotid pulse
When do the jugular vein waves collapse
with slight pressure
Decrease with inspiration (inspiratory collapse)
What is the height for normal JVP
2-3 cmH2O
How do you estimate Central venous pressure
Add 5 cm to JVP measurement
How much does JVP increase normally after pressing on liver
1-3 sm H20
Only press 10 sec
Where is apical beat usually found
5th intercos
Where is apex beat found in those with cardiac dz
displaced downwards, laterally outside mid axillary line
Can also be seen in cardiac enlargement/ hypertrophy
What is the normal diameter of the apex beat
1 inch
What are thrills
Palpable murmurs
What part of your hand do you use to palpate pulsations/ thrills
MCP joints of hand
What part of hand do you use to palpate right ventricular heave
Ulnar surface of hand
How would abdominal aorta/ R vent pulsations feel different in those with right vent hypertrophy/ dilation
Pulsations are felt coming from below rib cage toward fingertips
Should normally feel below your hand
Where do you place your hand laterally to percuss the heart borders
Anterior axillary line
Use bell of steth to listen to
Low frequency sounds
Where is S1 heard with certainty
Caridac apex (mitral area)
Ventricular systole extends from…
S1 to S2
Ventricular diastole extends from….
S2 to S1
When would you find a short interval between S2 and S1
In HR <90
WHat is S3
Early diastolic sound
What is S4
Late diastolic or presystolic sound
What are you listening for when you ask pt to turn to the left and auscultate the mitral area
Mitral stenosis murmur or left vent S3/S4
Description of murmurs
- Loudness grade 1-6
- Freq/pitch high/med/ low
- Timing - systolic/diastolic
- Shape crescendo/ decrescendo/ plateau
- Location: point of max loudness
- site of radiation
Valsalva and squating is helpful for hearing
Mitral valve prolapse
Hyptertrophic obstructive cardiomyopathy
Aortic stenosis
