Module 2&3

Question 1

Interatrial Septum

Answer 1

wall shared by left and right atrium- separates them.

Question 2

Inferior Vena Cava

Answer 2

Bring deoxygenated blood to the right atrium from the organs and lower extremeties

Question 3

Superior Vena Cava

Answer 3

Brings deoxygenated blood from the head and upper extremities into the right atrium

Question 4

Pulmonary Veins

Answer 4

Brings oxygenated blood from the lungs into the left atrium

4 of them-> 2 from each lung

Question 5

Coronary Sinus

Answer 5

opening in the right atrium that return deoxygenated blood from circulation of the myocardial muscle

Question 6

Pulmonary Atery

Answer 6

Brings deoxygenated blood from the right ventricle into the lungs.
Bifurcates to left and right sides

Question 7

Tricuspid Valve

Answer 7

AV valve between right atrium and right ventricle
2 cusped valve preventing backflow from ventricle to atria during RV systole.
Movement controlled by chordae tendinae

Question 8

Right Ventricle

Answer 8

Pumps deoxygenated blood into pulmonary artery.
Consists of a inflow tract with irregular muscle bridges and a smooth outflow tract.
low pressure with a thing outer wall

Question 9

Mitral Valve

Answer 9

2 Cusped AV valve between left atrium and ventricle.
prevents backflow during left ventricle systole.
movement is controlled by chordae tendinae (more numerous and stronger than right ventricle)

Question 10

Parts of the Stethoscope

Answer 10

Bell- low frequency sounds

Diaphragm- high frequency sounds

Question 11

Left Ventricle

Answer 11

Cone shaped- larger than right ventricle
9-11mm muscular walls, high pressure to overcome high resistance of the aorta.
smooth outflow tract
heavy trabeculated inferior region with more and thicker trabeculae than RV

Question 12

Interventricular Septum

Answer 12

Wall dividing left and right ventricles. Stiffens to become a fixed fulcrum during systole.

Question 13

Basic Components of a Cardiovascular exam

Answer 13

1) Identify the patient & take history
2) Blood pressure & pulse
3) Assess jugular venous pressure
4) Palpitation
5) Auscultation
6) Check vitals, chest X-ray, ECG, blood test

Question 14

Aorta

Answer 14

3 branches- brachiocephalic, left common carotid, left subclavian.
Carries oxygenated blood from LV from body circulation

Question 15

Why is cardiac history important

Answer 15

Most important diagnostic tool. More than 50% of patient assessment the correct diagnosis can be made after taking a history.

Question 16

Pulmonary Valve

Answer 16

Semi lunar valve between RV and Pulmonary artery
prevent backflow into RV during diastole
no chordae tendinae or papillary muscles

Question 17

Right Atrium

Answer 17

recieves deoxygenated blood from the inferior and superior vena cava as well as the coronary sinus.

Question 18

Atrial Kick

Answer 18

When the atria contract to fill ventricle.

when specific arrhythmias occur atrial kick is used to assess patients ventricular output

Question 19

How much does the heart pump?

Answer 19

5-30 litres of blood/min

75ml of blood into circulation with each beat

Question 20

Heart Rate

Answer 20

average adult 60-90 bpm

85000 beats/day

Question 21

Describe the shape and size of the heart

Answer 21

size of a mans fist
weighs less than 500g
conical in shape

Question 22

Pericardium

Answer 22

2 layers- Visceral & Parietal with a thin film of pericardial fluid between to minimize friction.
Visceral (epicardium) adheres to the external wall of the heart and reflects back on itself. The second layer lines the outer fibrous layer securing heart to sternum and mediastinal portion of L&R pleurae
Parietal- Second layer between epicardium and fibrous layer

Question 23

Myocardium

Answer 23

middle layer of cardiac wall
heart muscle- striated skeletal muscle- involuntary
electrical excitations spread quickly through myocardium
can produce self excitation

Question 24

Subendocardium

Answer 24

tissue containing fibroblasts, elastic & collagen fibres, veins, nerves and branches of conduction system.
Continuous with connective tissue of myocardium
below endocardium

Question 25

Circumflex Artery

Answer 25

Travels left AV groove | branches to form large obtuse marginal branches to supply lateral and posterior walls of LV

Question 26

Aortic Valve

Answer 26

3 cusped Semi lunar valve located between LV and Aorta Prevents backflow into LV during diastole secured by fibrous ring surrounding valve

Question 27

Fourth Heart Sound | "atrial gallop"

Answer 27

"extra diastolic heart sound"- pitch best heard at apex caused when left or right atrium vigorously contract against rigid ventricle. (late diastole) sign of ischemia or hypertrophy (enlargement of the heart) a-STIFF-wall S4 S1 S2

Question 28

Third heart sound | "ventricular gallop"

Answer 28

low frequency, best heard with bell normal in children and young adults-indicates congestive heart failure in middle aged and elderly or rapid filling of ventricle (tricuspid regurgitation) heard in early diastole following opening of AV valves SLOSH' - ing - in S1 S2 S3

Question 29

Paradoxical Splitting

Answer 29

Seperation of A2 + P2 during expiration but not inspiration Indicated LBBB or Aortic stenosis

Question 30

Fixed splitting

Answer 30

A2 + P2 occur with an abnormally large gap in between throughout cardiac cycle Indicates atrial septal defect (hole in the septum)

Question 31

Widened splitting

Answer 31

abnormal heart wound when A2 + P2 are heard as separate sounds even during expiration Indicates RBBB or pulmonary valve stenosis

Question 32

Cardiac auscultation | "heart sounds"

Answer 32

process of listening to the heart with a stethoscope S1- First heart sound- high freq- represent closing of mitral and tricuspid valves S2- Second hear sound- high freq- closing of semi lunar aortic and fractionally delayed pulmonary valves. Inspiration- splits in A2 + P2 Expiration- one sound

Question 33

Assessing palptation

Answer 33

detecting evidence of disease by placing hands and fingers on external surface of body (usually done at apex-5th intercostal space in mid clavicle line) look for scars indicating surgery 2 apex beats: HEAVING- high afterload THRUSTING- high preload

Question 34

How to assess jugular venous pressure (JVP)

Answer 34

Patient is reclined at 45 degree angle JVP= height of waveform in cm above sternal angle JVP helps identify right heart failure or pulmonary embolism

Question 35

3 types of abnormal pulses | characteristics and causes

Answer 35

1) pulsus paradox- exaggerated drop in pulse on inspiration. caused by cardiac tamponade or acute asthma 2) Bounding- Large volume. Caused by anemia, hepatic failure or type 2 respiratory failure. 3) Pulsus alternons- alternate high and low pulses. Caused by bigeminy.

Question 36

Coarction

Answer 36

The narrowing of the aorta | assessed by looking at radial-femoral delay (should occur at same time)

Question 37

How to determine pulse rate

Answer 37

Count # pulses/sec | sites to measure- carotid, brachial, radial

Question 38

Aortic dissection screening

Answer 38

check both radial pulses simultaneously aortic dissection- when a tear is formed in the artery and blood can flow between the layers of the vessels wall. results in low blood flow (ischemia) to organs or aortic rupture

Question 39

Describe general inspection of physical appearance

Answer 39

Patients with acute cardiac illness show signs of cyanosis(blueish), pallor, or sweatiness In more stable patients we look for cachexia (weight loss) because it is a prognostic sign of heart failure

Question 40

How to calculate BMI

Answer 40

Normal range = 18.5-24.9 (male and female) ``` BMI = body weight / height in meters squared BMI = kg/m2 ```

Question 41

Left anterior descending coronary artery (LAD)

Answer 41

Courses anterior Interventricular groove toward apex Supply anterior 2/3 of Interventricular septum via septal branches Supply anterior surface of left ventricle via diagonal branches

Question 42

Right coronary artery (RCA)

Answer 42

courses posteriorly between right atrium and ventricle branches to from posterior descending artery. supplies inferior and posterior wall of ventricles and 1/3 interventricular septum. supply SA node 70% of the time via SA nodal artery supply posterior descending artery and AV nodal arteries 85% of the time

Question 43

Left main coronary artery

Answer 43

between pulmonary trunk and left atrium to reach AV groove | bifurcates into left anterior descending coronary artery and circumflex artery

Question 44

Endocardium

Answer 44

innermost layer of cardiac chambers, valves and vessels smooth single layer minimizes trauma to red blood cells and accumulation of platelets

Question 45

Coronary veins

Answer 45

similar to coronary arteries but the vessels return blood from myocardial capillaries to coronary sinus (RA) major veins most often lie superficial to the arterial counterpart within epicardial fat

Question 46

Left Atrium

Answer 46

Forms base of heart, extending around pulmonary artery receives oxygenated blood from pulmonary veins 2mm walls -> thicker than right atrium low pressure chamber