Lab Final Flashcards by Kirsten Sparley

Where is the auscultatory position for the aortic valve?

2nd intercostal space to the immediate right of the sternum

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Where is the auscultatory position for the pulmonary valve?

2nd intercostal space to the immediate left of the sternum

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Where is the auscultatory position for the tricuspid valve?

5th intercostal space to the immediate left of the sternum

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Where is the auscultatory position for the mitral valve?

5th intercostal space on the mid clavicuar line (over apex of heart)

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S1 and the mitral valve may sound louder if the patient:

leans forward and left while twisting a bit to their right.

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What is the S1 heart sound and what produces it?

“lub” is produced by the closing of atrioventricular valves at the beginning of ventricular systole (contraction/emptying)

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What is the S2 heart sound and what produces it?

“dub” is produced by the closing of semilunar valves at the beginning of ventricular diastole (relaxation/filling)

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IF you hear odd “swishing,” “clicking,” or “blowing sounds” between S1 and S2 you may be hearing :

Murmur

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What is the suggested sweep pattern for auscultation of the heart?

A P T M

I.e. aortic valve -> pulmonary valve -> tricuspid valve -> mitral valve

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arterial blood pressure is a consequence of two parameters:

1) cardiac output, and 2) peripheral resistance.

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What is the typical systolic blood pressure (SBP)?

120 mmHg

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What is the typical diastole blood pressure (DBP)?

80 mmHg

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The cyclical nature of the cardiac pumping action produces a pulse pressure, with is high systolic and low diastolic. What is the typical pulse pressure?

SBP-DBP which is 120-80= 40 mmHg

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Why is simple screening for high BP so important?

It is a way to catch many dangerous cardiovascular diseases before they actually develop

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In addition to assessing BP as part of routine 1st time patient screenings, when might chiropractors also record BP?

if a patient has chest pain
for a pre-sports or pre-employment physical
for a geriatric patient (where hypertension is common)
in patients where symptoms may indicate a heart problem (such as edema in the legs)

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What is the indirect way of measuring arterial blood pressure?

Sphygmomanometry which increases pressure on a tourniquet over the brachial artery while placing a stethoscope immediately downstream of the site of occlusion.

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What are Korotkov sounds?

“Thumping” sounds heard during sphygmomanometry due to turbulence in the vessel

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there are many potentially confounding factors that can seriously alter an accurate reading of arterial blood pressure. What are some of the most common ones?

missed auscultatory gap
cuff too narrow
cuff over clothing
patient arm unsupported
“white coat” reaction

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The white coat reaction can alter systolic blood pressure by how much?

11-28 mmHg

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The white coat reaction can alter diastolic blood pressure by how much?

3-15 mmHg

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excessively high pressure is termed:

hypertension (HTN)

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What is the SBP range for pre hypertension?

120-139 mmHg

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What is the DBP range for prehypertension?

80-89 mmHg

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What is the SBP range for stage 1 hypertension?

140-159 mmHg

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What is the DBP range for stage 1 hypertension?

90-99

What is the SBP for stage 2 hypertension?

160 mmHg or more

What is the DBP for stage 2 hypertension?

100 mmHg or more

What is an auscultatory gap?

When lowering the pressure in the cuff, there is a period when the sounds may lessen a bit and in some people the sound may temporarily disappear, termed a auscultatory gap. This would cause the examiner to mistakenly record SBP lower than it actually is

What procedure can be done to avoid inadvertently missing an auscultatory gap?

Palpatory systolic BP

How would you take a palpatory systolic BP?

palpate the radial pulse and rapidly inflate the cuff to the point at which the pulse disappears. This represents the approximate SBP.

When pumping up the blood pressure cuff, it should be inflated to a pressure that is ________ above the palpatory systolic pressure

20-30 mmHg

While checking blood pressure, the sphygmomanometer exhaust valve should be opened so that the pressure falls at what rate?

about 3-5 mmHg per sec

How are blood pressure values recorded?

As a fraction (DBP/ SBP i.e 120/80) and with even numbers

How do you calculate mean arterial pressure?

MAP = (SBP-DBP)/3 + DBP NOTE: it is usually around 93

Where should the stethoscope head be placed what checking blood pressure with a sphygmomanometer?

Slightly medial, just above the ante-cubital fossa

What should be the placement of the blood pressure cuff?

The bottom of the blood pressure cuff should be about 1” above the ante-cubital fossa and the “artery arrow” should be aligned with brachial artery also make sure you have a properly fitting cuff for patient size

The effect of ______ and ______ can play a profound role in measured BP

gravity and vascular resistance

What is VO2

Oxygen consumption measured in liters per minute

What is aerobic capacity?

The typically linear relationship between work load (of skeletal muscle) and oxygen consumption - as work load increases, so does oxygen consumption

There is a limit to aerobic capacity and it is represented by:

Max VO2

max VO2 is affected by a variety of conditions. What are they?

- body size - gender - age - heredity - training

How does body size affect maxVO2?

larger people have a higher maxVO2

How does gender affect max VO2?

males typically have a higher maxVO2 than females (may simply be due to body size)

How does age affect max VO2?

maxVO2 declines with years

How does training affect max VO2?

aerobic fitness increases ones maxVO2

Oxygen utilization (VO2) is a function of three cardiovascular parameters :

VO2 = Heart Rate X Stroke Volume X A-V O2 Difference Remember that heart rate x stroke volume is simply cardiac output, therefore by knowing A-V O2 and cardiac output, you can calculate VO2

What is A-V O2 Difference?

arterio-venous oxygen difference. It identifies the difference between oxygen content of the systemic arterial system and the systemic venous system - essentially a measure of oxygen extraction or consumption from metabolizing tissues

Who would have a higher stroke volume? A trained or untrained person?

Trained Therefore VO2 is also higher in trained people

In graphs of exercise physiology, the linear relationship between cardiac output and VO2 is due to the ______, and the difference in end-point is due to ________.

- heart rate - stroke volume This leads to two lines with different slopes

What is the rate-limiting agent when it comes to aerobic work?

The heart

Because work load is linearly related to VO2, and VO2 is linearly related to heart rate, then:

work load should be linearly related to heart rate

Submaximal tests measure VO2 and heart rate to at submaximal levels and then graphically estimate max VO2. Why are submaximal tests used to determine fitness?

Because of the linear relationship between oxygen consumption and heart rate, the slope of the heart rate/work load line should make it possible to determine how well-conditioned a person is at any point during some exercising activity. This eliminates the need to special equipment and potentially hazardous conditions required to measure max VO2 directly

What is the training effect (or training sensitive zone) for cardiovascular conditioning?

EXERCISE 3-5 times/week @ 50-85% of maxVO2 for 15-60 minutes

What is the pulse rate differential?

Exercise HR (aka pulse rate differential) = Resting HR + %maxVO2(Maximum HR – Resting HR) A ratio of ones exercising heart rate to their normal range used to approximately estimate whether or not an individual is performing at their training threshold.

What is ones maximum theoretical heart rate?

220 minus ones age in years although some believe that 206 minus ½ your age is a better method.

%maxVO2 represents:

the percent of ones maxVO2 (with 0.6 as the training threshold to obtain fitness)

With this example, calculate the target HR for the “training effect”: A 25 year old with a resting heart rate of 70 bpm

Using: Exercise HR = Resting HR + %maxVO2(Maximum HR – Resting HR) Resting HR = 70 Max HR = (220-30) = 195 %maxVO2 for training effect = 0.6 70 + 0.60(195 – 70) = 145 bpm TARGET PULSE

With this example, calculate the percentage of the persons max VO2 being utilized during aerobic exercise: A 38 year old with a resting heart rate of 55 bpm and a peak heart rate during the exercise of 128 bpm.

Using: Exercise HR = Resting HR + %maxVO2(Maximum HR – Resting HR) Resting HR = 55 Max HR = 220-38 = 182 Exercise HR = 128 128 = 55 + X(182 – 55) → X or %maxVO2 = 0.57 (just under training sensitive zone)

The science of measuring ventilation is termed:

spirometry

A spirometer records:

both the amount of air as well as the amount over time.

The routine amount of air moved by the lungs during breathing?

Tidal volume (TV) which is normally 500ml at rest but can rise to more than 3 liters during exercise!

The “spare” air than can be inhaled?

Inspiration reserve volume (IRV) and is normally around 3 liters

The “spare” air than can be exhaled?

Exploratory reserve volume (ERV) which is normal about 1 L

The total amount of air that can be moved by the lungs in a given ventilation cycle

Vital capacity (VC) which is the sum of tidal volume, IRV and ERV and normally about 4.5 liters

The total amount of air that can be forced out of the lungs (from a fully inhaled state) in a specified amount of time

Forced expiratory volume (FEV), usually measured over 1 second (sometimes 3 seconds), thus FEV1.0 (or FEV3.0).

What is the percentage of forced expiratory volume per forced vital capacity over 1 second (FEV1.0/FVC) for a normal adult?

65-85%

What is the percentage of forced expiratory volume per forced vital capacity over 3 second (FEV3.0/FVC) for a normal adult?

80-100%

The total amount of air that can be forced in and out over a specified amount of time

Maximum voluntary ventilation It is usually measure for about 10 seconds and then extrapolated to the total amount of air that could be moved in 1 minute

In a breath holding experiment, rank from shortest to longest duration: the expected breath holding times at rest, after hyperventilation and after hypoventilation

- after hypoventilation breath holding time would be shortest - at rest breath holding time would be intermediate - after hyperventilation breath holding time would be longest

the feeling of wanting to breathe, “breathing hunger”

Dyspnea

Target HR (straight up equation)

RHR + %maxVO@ (MHR - RHR)

%MaxVO2 (straight up equation)

(EHR - RHR) / (MHR - RHR)