In supine patients the diameter of the PMI may be as large as a quarter, approximately _____ cm.
1 to 2.5
For example, in patients with chronic obstructive pulmonary disease (COPD), the most prominent palpable impulse or PMI may be in the xiphoid or ______ area due to right ventricular hypertrophy.
Rarely, in situs inversus and dextrocardia, the PMI is located on the _____ side of the chest.
A PMI >2.5 cm is evidence of _______ _____ ______ from hypertension or aortic stenosis.
left ventricular hypertrophy (LVH)
Displacement of the PMI lateral to the midclavicular line or>____ cm lateral to the midsternal line occurs in LVH and also in ventricular dilatation from myocardial infarction (Ml) or heart failure.
mitral and tricuspid valves are often called _______ valves.
The aortic and pulmonic valves are called semilunar valves because the valve leaflets are shaped like _____ moons.
In most adults over age 40 years, the diastolic sounds of S3 and S4 ________, are and are correlated with heart failure and acute myocardial ischemia.
In recent studies, anS3 corresponds to an abrupt deceleration of _____across the mitral valve, and an S4 to increased left ventricular end diastolic stiffness which decreases compliance.
Systole is the period of ventricular contraction. As shown in Figure 9-4, pressure in the left ventricle rises, from less than ____ mm Hg in its resting state, to a normal peak of ____ mm Hg. After the ventricle ejects much of its blood into the aorta, the pressure levels off and starts to fall.
____ is the period of ventricular relaxation. Ventricular pressure falls further to below 5 mmHg, and blood flows from atrium to ventricle.
Pressure in the blood- filled left atrium slightly exceeds that in the relaxed left ventricle, and blood flows from left atrium to left ventricle across the open mitral valve (Fig. 9-5). Just before the onset of ventricular systole, atrial contraction produces a slight pressure rise in both chambers.
The left ventricle starts to contract and ventricular pressure rapidly exceeds left atrial pressure, closing the mitral valve (Fig. 9-6). Closure of the mitral valve produces the first heart sound, S1.As left ventricular pressure continues to rise, it quickly exceeds the pressure in the aorta and forces the aortic valve open.
In some pathologic conditions, an earlysystolic ___ _______ accompaniesthe opening of the aortic valve.As the left ventricle ejects most of its blood, ventricular pressure begins to fall. When left ventricular pressure drops below aortic pressure, the aortic valve closesAortic valve closure produces the second heart sound, S2, and another diastole begins.
ejection sound (Ej)
In diastole,left ventricular pressure continues to drop and falls below left atrial pressure. The mitral valve opensthis event is usually silent, but may be audible as a pathologic opening snap (OS) if valve leaflet motion is restricted, as in ____ _____after the mitral valve opens, there is a period of rapid ventricular filling as blood flows early in diastole from left atrium to left ventriclein children and young adults, athird heart sound, S3, may arise from rapid deceleration of the column of blood against the ventricular wall. In older adults, andsometimes termedusually indicates a pathologic change in ventricular compliance.Finally, although not often heard in normal adults,
Afourth heart sound, ____,Marks atrial contraction it immediately precedes S3 of the next beat and can also reflect a pathologic change in ventricular compliance.Note that right-sided cardiac events usually occur slightlylaterthan those on the left. Instead of a hearing a single heart sound for S2, you may hear two discernible components, the first from left-sided aortic valve closure, or A2, and the second from right-sided closure of the pulmonic valve, or P2.
The second heart sound, S2, and its two components, A2 and P2, are caused primarily by closure of the
aortic and pulmonic valves
Of the two components of the S2, A2 is normally____, reflecting the high pressure in the aorta. It s heard throughout the precordium. In contrast, P2 is relativelysoft,reflecting the lower pressure in the pulmonary artery.
Si also has two components, an earlier mitral and a later tricuspid sound. The mitral sound—the principal component of Si—is much______,again reflecting the higher pressures on the left side of the heart. It can be heard throughout the precordium and is loudest at the cardiac apex. Thesoftertricuspid component is heard best at the lower left sternal border; it is here that you may hear a split Si.
_____ are distinct heart sounds distinguished by their pitch and their longer duration. They are attributed to turbulent blood flow and are usually diagnostic of valvular heart disease.
_____ valvehas an abnormally narrowed valvular orifice that obstructs blood.Such a valve allows blood to leak backward in a retrograde direction and produces aregurgitant murmur.
Electrical vectors approaching a lead cause a positive, or upward, ____?
Electrical vectors moving away from the lead cause a negative?
When positive and negative vectors balance, they are isoelectric and appear as a ______ ______.
The small ____ wave of atrial depolarization (duration up to 80 milliseconds; PR interval no to 200 milliseconds)
A downward deflection from septal depolarization?
An upward deflection from ventricular depolarization?
A downward deflection following an R wave
Ventricular repolarization, or recovery (duration relates to QRS)?
The volume of blood ejected from each ventricle during 1 minute, is the product of heart rate and stroke volume.
(the volume of blood ejected with each heartbeat) depends in turn on preload, myocardial contractility, and afterload.
____ refers to the load that stretches the cardiac muscle before contraction. The volume of blood in the RV at the end of diastole constitutes its
Right ventricular preload is increased by increasing______return to the right heart.
_____ ______refers to the ability of the cardiac muscle, when given a load, to shorten. Contractility increases when stimulated by action of the sympathetic nervous system and decreases when blood flow or oxygen delivery to the myocardium is impaired.
______ refers to the degree of vascular resistance to ventricular contrac¬ tion. Sources of resistance to contraction include the tone in the walls of the aorta, the large arteries, and the peripheral vascular tree (primarily the small arteries and arterioles), as well as the volume of blood already in the aorta.These are the levels that are measured with the blood pressure cuff, or sphygmomanometer. The difference between systolic and diastolic pressures is known as the pulse pressure.
Atrial contraction produces an ______?
the jugular veins just before S1and systole, followed by the _____ _____ of atrial relaxation.
As right atrial pressure begins to rise with inflow from the vena cava during right ventricular systole, there is a second elevation, ___ ______ followed by the y descent as blood passively empties into the RV during early and middiastole.
the v wave,
This section approaches chest symptoms from a cardiac standpoint, and includes the important symptoms of chest pain, palpitations, shortness of breath from
Or paroxysmal nocturnal dyspnea (PND), swelling from edema, and fainting. Study the various causes of chest pain, dyspnea, wheezing, cough, and even because these symptoms can be cardiac as well as pulmonary in origin.
Classic exertional pain, pressure, or discomfort in the chest, shoulder, back, neck, or arm in ___ _____. is seen in 18% of patients with acute Ml32; atypical descriptors also are common, such as cramping, grinding, pricking or, rarely, tooth or jaw pain.
Both men and women with acute coronary syndrome usually present with the classic symptoms of exertional angina; however, women, particularly those over age _____?
_____ involve an unpleasant awareness of the heartbeat. Patients use various terms to describe such as skipping, racing, fluttering, pounding, or stopping of the heart. ____ may be irregular, rapidly slow down or accelerate, or arise from the increased forcefulness of cardiac contraction.
PND describes episodes of sudden dyspnea and
_____ ____ that awaken the patient from sleep, usually 1 or 2 hours after going to bed, prompting the patient to sit up, stand up, or go to a window for air. occurs in pulmonary embolus, spontaneous pneumothorax, and anxiety.Causes are frequently cardiac (right or left ventricular dysfunction;
______is severe generalized edema extending to the sacrumabdomen. Look for the periorbital puffiness and tight rings ofnephrotic syndrome and an enlarged waistlinefrom ascites and liver failure.
The absence of clinically manifest CVD and the simultaneous presence of optimal levels of seven health metrics, including _______ four health behaviors (lean body mass index not smoking, being physically active, and following a healthy diet), and three health factors
NRML BP according to Adults—JNC 7, American Society of Hypertension is?
SBP <120 and DBP <80
Prehypertension BP according to Adults—JNC 7, American Society of Hypertension is?
SBP 120-139 and DBP 80-89
Stage 1 hypertension Age >18 to <60 yrs according to Adults—JNC 7, American Society of Hypertension is?
SBP 140-159 and DBP 90-99