Exam #3: Heart

Question 1

Angina

Answer 1

Severe, often constricting pain; caused by reduced arterial blood to myocardium, which reduces oxygen supplied to the myocardial cells; causes injury and ischemia and the sharp precoridal pain directly related to cardiac ischemia; usually referred to as angina pectoris

Question 2

Arrhythmia

Answer 2

Loss of rhythm; denotes especially an irregularity of the heartbeat

Question 3

Atherosclerotic Heart Disease

Answer 3

Narrowing of the small blood vessels of the heart

Question 4

Bradycardia

Answer 4

Slow beating of the heart, usually at a rate of less than 60 per minute

Question 5

Bruit

Answer 5

Harsh or musical intermittent auscultatory sound, especially an abnormal one

Question 6

Bacterial Endocarditis

Answer 6

Bacterial infection of the endothelial layer of the heart and valves

Question 7

Cardiac Tamponade

Answer 7

Excessive fluid accumulation between the pericardium & the heart

Question 8

Congestive Heart Failure

Answer 8

a failure of the heart to pump effectively resulting in congestion within the pulmonary and systemic circulation of the heart

Question 9

Cor pulmonale

Answer 9

Enlargement of the right ventricle secondary to chronic lung disease

Question 10

Myocardial Infarction

Answer 10

ischemic myocardial necrosis due to decreased blood flow to a segment of the myocardium

Question 11

Myocarditis

Answer 11

Inflammation of the myocardium

Question 12

Myocardium

Answer 12

Middle layer of the heart

Question 13

Palpitations

Answer 13

Forcible or irregular pulsation of the heart, perceptible to the patient, usually with an increase in frequency or force, with or without irregularity in rhythm

Question 14

Pericarditis

Answer 14

Inflammation of the pericardium

Question 15

Pericardium

Answer 15

Fibrous sac encasing the heart

Question 16

Tachycardia

Answer 16

Rapid beating of the heart, conventionally applied to rates over 100 bpm

Question 17

Thrill

Answer 17

A fine, palpable sensation

Question 18

Parasternal Heave

Answer 18

• Place right hand to left of sternum with fingers toward neck
• Note if heel of hand is lifted w/ each heartbeat (heave)

Question 19

Aortic Valve Auscultation

Answer 19

2nd right intercostal space at right sternal border

Question 20

Pulmonic Valve Auscultation

Answer 20

2nd left intercostal space at the left sternal border

Question 21

Erb’s Point

Answer 21

• Aortic & Pulmonic Sounds

- 3rd intercostal space at the left sternal border

Question 22

Tricuspid Valve Auscultation

Answer 22

4th left intercostal space at left lower sternal border

Question 23

Mitral Valve Auscultation

Answer 23

5th left intercostal space at midclavicular line

Question 24

Grade I Murmur

Answer 24

Very faint, heard only after the listener has “tuned in;” may not be heard in all positions

Question 25

Grade II Murmur

Answer 25

Quiet, but heard immediately after placing the stethoscope on the chest

Question 26

Grade III Murmur

Answer 26

Moderately Loud

Question 27

Grade IV Murmur

Answer 27

Loud, with palpable thrill

Question 28

Grade V Murmur

Answer 28

Very loud, with thrill. May be heard when the stethoscope is partly off the chest

Question 29

Grade VI Murmur

Answer 29

Very loud, with thrill. May be heard with the stethoscope entirely off the chest.

Question 30

Which layer of the pericardium is sensitive to pain?

Answer 30

Parietal

Question 31

How does the phrenic nerve relate to angina felt during MI?

Answer 31

- Signals from the phrenic nerve project to the dermatomes in anginal pain - "C3,4, &5 keep the diaphragm alive"

Question 32

C3

Answer 32

Jaw

Question 33

C4

Answer 33

Neck

Question 34

C5

Answer 34

Arm Pain

Question 35

S1

Answer 35

The "first" heart sound produced by turbulence created when the mitral & tricuspid valves close

Question 36

S2

Answer 36

- The "second" heart sound produced by turbulence when the aortic & pulmonic valves close - Note that A2 precedes P2 b/c of higher aortic pressure

Question 37

S3

Answer 37

- Third heart sound created when blood flows passively from atria to ventricle - In young athletic individuals, this is normal - In the elderly, this is abnormal

Question 38

S4

Answer 38

- Fourth heart sound created by turbulent blood flow in a ventricle as the atrium contracts to eject any remaining blood during late diastole - Occurs when there is diminished ventricular compliance e.g. hypertrophy

Question 39

What is the diaphragm of the stethoscope best for?

Answer 39

S1, S2 & Lung Sounds

Question 40

What is the bell of the stethoscope best for?

Answer 40

S3, S4 & Murmurs

Question 41

How are heart murmurs named?

Answer 41

1) Grade 2) Where in the cycle 3) Sound Shape 4) Sound Quality 5) Heart Loudest 6) Radiation

Question 42

Ejection Click

Answer 42

Turbulence produced when blood flow is abnormal across a semilunar valve

Question 43

Aortic Ejection Click

Answer 43

- Heard early in systole - High-pitched - Often radiates into the carotids - NOT affected by respiration

Question 44

Pulmonic Ejection Click

Answer 44

- Heard in early systole - Less intense than aortic - Intensifies on expiration - Diminishes on inspiraiton

Question 45

Opening Snap

Answer 45

Sound of a deformed mitral valve opening during diastole, heard in cases of mitral valve stenosis - High pitched - Sharp snap or click - Not affected by respiration