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Flashcards in okayy Deck (251):
1

The ____________ occupies most of the anterior cardiac surface.

Right Ventricle

2

The inferior border of the right ventricle lies below the junction of the _______ and _________.

Sternum; Xiphoid process

3

The base of the heart is at the ______ end.

superior

4

The apex of the heart is at the ______ end.

inferior

5

The base of the heart is located at the _______ intercostal space.

2nd

6

________ produces the apical impulse.

The apex on the left ventricle

7

The _________ is the external area of the body where the heart is located.

precordium

8

The PMI might not be readily felt in a ___________________.

healthy patient with a normal heart

9

The PMI is felt over the _________.

apex

10

The PMI can be palpated at the _______ intercostal space, _________ to the ___________ line.

5th; 7-9 cm lateral; midsternal

11

In supine patients, the diameter of the PMI may be as large as ________________.

a quarter (1 to 2.5 cm)

12

A PMI greater than ________ is evidence of ____________, or enlargement.

2.5 cm; left ventricular hypertrophy (LVH)

13

The PMI is also known as the ___________.

precordial impulse

14

Displacement of the PMI lateral to the _______________ suggests ___________ or enlargement.

midclavicular line; LVH

15

In patients with chronic obstructive pulmonary disease, the PMI may be in the ___________________ as a result of ___________.

xiphoid or epigastric area; right ventricular hypertrophy

16

Above the heart lie the _________.

great vessels

17

The ________ curves upward from the left ventricle to the level of the __________.

aorta; sternal angle

18

On the ________ border of the heart, the superior and inferior vena cava channel _________ from the upper and lower portions of the body into the ____________.

medial; venous; right atrium

19

Because of their positions, the tricuspid and mitral valves are often called _________ valves.

atrioventricular

20

The aortic and pulmonic valves are called __________ valves because each of their leaflets is shaped like a ____________.

semilunar; half moon

21

_______ is the period of ventricular contraction.

systole

22

The normal resting pressure of the left ventrical is _____ mm Hg, while the the normal peak pressure during contraction is _______ mm Hg.

5; 120

23

During systole, the aortic valve is _______.

open

24

Late in __________, ventricular pressure rises slightly during inflow of blood from _____________.

diastole; atrial contraction

25

During systole, the mitral valve is _______.

closed

26

During diastole, the aortic valve is _________ and the mitral valve is _________.

closed; open

27

Valves close in order to prevent __________.

backflow or regurgitation

28

The hear sounds S1 and S2 are heard when ___________.

the valves close

29

Closure of the ______ valve produces S1.

mitral (and tricuspid)

30

During ______ pressure in the blood filled left atrium slightly exceeds that in the relaxed left ventricle, and blood flows from left atrium to left ventricle.

diastole

31

Just before the onset of __________, atrial contraction produces a slight pressure rise in both chambers.

ventricular systole

32

During systole, the ________ starts to contract and __________ pressure rapidly exceeds __________ pressure, shutting the mitral valve.

left ventricle; ventricular; left atrial

33

Normally the _____________ corresponds to the systolic blood pressure.

maximal left ventricular pressure

34

As the __________ pressure continues to rise, it quickly exceeds the pressure in the aorta and forces the ________ open.

left ventricular; aortic valve

35

In some pathologic conditions, _________________ accompanies the opening of the aortic valve.

an early systolic ejection sound (Ej)

36

As the _____________ ejects most of its blood, ventricular pressure begins to fall.

left ventricle

37

When left ventricular pressure drops below aortic pressure, _________________.

the aortic valve shuts

38

________ produces the second heart sound.

aortic valve closure

39

Diastole begins when _______________.

the aortic valve shuts; S2

40

In ________, left ventricular pressure continues to drop and falls below left atrial pressure. The _____ opens.

diastole; mitral valve

41

____________ is usually silent, but may be audible as a pathologic opening snap (OS).

The mitral valve opening

42

Blood flows early in _______ from left atrium to left ventricle.

diastole

43

After the _____________, there is a period of rapid left ventricular filling.

mitral valve opens

44

In children and young adults, a third heart sound (S3) may arise from ________________________.

rapid deceleration of the column of blood against the ventricular wall

45

The 3rd heart sound is sometimes called ____________.

S3 gallop

46

In older adults, ________ usually indicates a pathologic change in ventricular compliance.

S3

47

Right ventricular and pulmonary pressures are ________________ than corresponding pressures on the left side.

significantly lower

48

Right-sided events usually occur ___________ than those on the left side of the heart.

slightly later

49

Instead of a single heart sound, you may hear two discernible components: ______ & _______.

A2 & P2

50

The split S2 occurs during ______, and is fused during ________.

inspiration; exhalation

51

_______ & _________ in the pulmonary vascular bed contribute to the "hangout time" that delays P2.

Distensibility; Impedence

52

Because the walls of veins ___________, the venous system has more capacitance than the arterial system and ______________.

contain less smooth muscle; lower systemic pressure

53

Of the two components of S2, ______ is normally louder.

A2

54

The ___________ can only be heard in the areas of the 2nd and 3rd left intercostal spaces, close to the sternum.

split S2

55

S1 can be heard at its loudest at ___________.

the apex

56

The split S1 can only be heard _____________________.

over the lower left sternal border

57

Splitting of S1 does not vary with ____________.

inspiration

58

Heart murmurs are distinguishable from heart sounds by their _______________.

longer duration

59

Heart murmurs are attributed to ____________.

turbulent blood flow

60

A ________ valve obstructs blood flow, and creates a characteristic murmur.

stenotic

61

A valve that does not fully close is usually the cause of a murmur called:

aortic regurgitation or insufficiency

62

Sounds and murmurs arising from the _______ are heard best at the cardiac apex.

mitral valve

63

Sounds and murmurs arising from the _______ are heard best at the left sternal border.

tricuspid valve

64

Sounds and murmurs arising from the _______ are heard best at the 2nd & 3rd left intercostal spaces (near the sternum).

pulmonic valve

65

Murmurs originating in the ________ may be heard anywhere from the right 2nd intercostal space to the apex.

aortic valve

66

Each normal electrical impulse of the heart is initiated in the __________.

sinus node

67

The ____________ acts as the cardiac pacemaker and automatically discharges an impulse about __________ times a minute.

Sinus node; 60-100

68

From the sinus node, the impulse travels through _______ to the _____________ (located low in the _________)

both atria; atrioventricular (AV) node; atrial septum

69

The electrical impulse is delayed at the ______ before passing down the bundle of his and its branches to the ______________.

AV Node; ventricular myocardium

70

During the conduction cycle, the _____ contract first, then the _______.

atria; ventricles

71

The ECG consists of _____ ______ leads in the ______ plane, and _____ ______ leads in the _______ plane.

6; limb; frontal; 6; chest/precordial; transverse

72

________ records the events of the electrical conduction system.

ECG

73

Electrical vectors ______________ a lead cause positive, or upward reflection.

approaching

74

Electrical vectors ______________ a lead cause negative, or downward deflection.

moving away from

75

When positive and negative vectors valance, they are _________, appearing as a _____________.

isoelectric; straight line

76

The ________ on an ECG represents atrial depolarization.

P wave

77

The ________ on an ECG represents ventricular depolarization.

QRS complex

78

The ________ on an ECG represents septal depolarization.

Q wave

79

The ________ on an ECG represents an upward deflection from ventricular depolarization.

R wave

80

The ________ on an ECG represents a downward deflection from ventricular depolarization.

S wave

81

The ________ on an ECG represents ventricular repolarization, or recovery.

T wave

82

The ___________ slightly precedes the myocardial contraction that it stimulates.

electrical impulse

83

_________ is the volume of blood ejected from each ventricle during 1 minute.

Cardiac output

84

heart rate X stroke volume =

cardiac output

85

________ is the volume of blood ejected with each heartbeat.

Stroke volume

86

Stroke volume depends on ________, _________, & _________.

preload; myocardial contractility; afterload

87

Preload refers to the load that ___________________________.

stretches the cardiac muscle before contraction

88

The volume of blood in the right ventricle at the end of diastole constitutes its __________ for the next beat.

preload

89

Right ventricular preload is increased by increasing __________________.

venous return to the right heart

90

Physiologic causes of increased preload include:

inspiration & increased volume of blood flow from exercise

91

The increased blood volume in a dilated right ventricle of congestive heart failure increases __________.

preload

92

Causes of decreased right ventricular preload include:

decreased left ventricular output, pooling of blood in the capillary bed or the venous system

93

_________ refers to the ability of cardiac muscle, when given a load, to shorten.

Myocardial contractility

94

Contractility increases when stimulated by the ________ and decreases when ____________________.

sympathetic nervous system; blood flow or oxygen delivery to the myocardium is impaired

95

_______ refers to the degree of vascular resistance to ventricular contraction.

afterload

96

The term _________ is now preferred over __________ because not all patients have volume overload on initial presentation.

heart failure; congestive heart failure

97

Sources of resistance to left ventricular contraction include:

the tone in the walls of the aorta, the large arteries, and the peripheral vascular tree, as well as the volume of blood already in the aorta.

98

Pathologic increase in preload is called ___________.

volume overload

99

Pathologic increase in afterload is called ___________.

pressure overload

100

Volume overload & pressure overload can be detected through:

palpation and auscultation

101

The pressure wave of blood that is ejected from the ______ is felt as the ___________.

left atrium; arterial pulse

102

The _______ travels quickly, many times faster than the actual blood.

pressure wave

103

Blood pressure in the arterial system peaks at _________ and falls to its trough at _________.

systole; diastole

104

The difference between the systolic and diastolic pressure is the ______________.

pulse pressure

105

Name 4 factors that influence arterial pressure:

1) Left ventricular stroke volume 2) Distensibility of the aorta and the large arteries 3) Peripheral vascular resistance 4) Volume of blood in the arterial system

106

The ____________ provide an important clinical index of right heart pressures and cardiac function.

jugular veins

107

_________ reflects right atrial pressure, which in turn equals central venous pressure (CVP) and _________________.

Jugular venous pressure; right ventricular end-diastolic pressure

108

The JVP is best estimated from the ________________.

right external jugular vein

109

The right external jugular vein is a useful and accurate method for estimating _________.

CVP

110

JVP falls with _________, and rises with ___________, ___________, _______________, and _____________.

blood loss; right or left heart failure; pulmonary hypertension; tricuspid stenosis; pericardial compression or tamponade

111

The internal jugular veins lie deep to the _______________ in the neck.

sternomastoid muscles

112

The venous jugular pulsations should not be confused with _____________.

the carotid artery

113

To estimate the level of the _________, find the highest point of oscillation in the internal jugular vein. Or, if necessary, the point above which the __________________________.

JVP; external jugular vein appears collapsed

114

The JVP is measured in vertical distance above the __________.

sternal angle

115

_________ is the bony ridge adjacent to the 2nd rib where the sternum meets the manubrium.

The sternal angle

116

Jugular venous pressure measured at more than _____ cm above the sternal angle, or more than ______ cm above the right atrium is considered elevated or abnormal.

4; 9

117

The sternal angle is approximately _______ cm above the right atrium.

5

118

The undulating pulsations of the internal jugular veins are composed of:

two quick peaks and two troughs

119

The 1st elevation of the internal jugular pulsation is the ________, the second elevation is the __________.

a wave; v wave

120

_______ occurs just before S1 and before the carotid pulse.

a wave

121

_______ reflects the slight rise in atrial pressure that accompanies atrial contraction.

a wave

122

The trough after the a wave is ___________.

x descent

123

The x descent begins with ____________.

atrial relaxation

124

________ occurs when the tricuspid valve is closed and the the atrium is filling, causing atrial pressure to rise.

v wave

125

________ occurs when the tricuspid valve opens, the blood drains into the right atrium, and atrial pressure drops.

y descent

126

The ___________ are the most obvious events in the normal jugular pulse.

two descents (x & y)

127

What is the sequence of jugular pulse?

atrial contraction (a wave), atrial relaxation (x descent), atrial filling (v wave), atrial emptying (y descent)

128

______ may affect the location of the apical impulse, the pitch of heart sounds and murmurs, the stiffness of the arteries, and blood pressure.

aging

129

The apical impulse is usually felt easily in _____________.

children & young adults

130

_______ & __________ may be more difficult to detect in older patients.

splitting of S2; apical impulse

131

At some time over the lifespan, almost everyone has a ______________.

heart murmur

132

Most murmurs occur without _____________________.

other evidence of cardiovascular abnormality

133

Mot murmurs may be considered ____________.

normal variants

134

Murmurs may originate in __________ as well as in the heart.

large blood vessels

135

The ___________ which is common in children, may still be heard through young adulthood.

jugular venous hum

136

A _________________ is innocent in children but suspicious for arterial obstruction in adults.

cervical systolic murmur

137

What are the four common or concerning cardiac symptoms?

Chest pain, palpitations, shortness of breath, and swelling/edema

138

Annual incidence of exertional angina is 1 per ________ in the population of 30 years or older.

1000

139

_________ is seen in 50% of patients with acute myocardial infarction.

Angina pectoris

140

__________ is classic exertional pain, pressure, or discomfort in the chest, shoulder, back, neck, or arm.

Angina pectoris

141

__________ is the 2nd leading cause of visits to the ED.

Chest pain

142

__________ is the 1st leading cause of visits to the ED.

Abdominal pain

143

Coronary heart disease currently affects _______ people in the US.

15 million

144

Of the 15 million people in the US with coronary heart disease, _______ have angina pectoris, and ______ have had a myocardial infarction.

9; 8

145

________ is the leading cause of death for both men and women, accounting for 1 ____ US deaths.

Coronary heart disease; 5

146

Death rates for coronary heart disease are highest amongst _______________.

African American men and women

147

__________ is used to refer to any of the clinical syndromes caused by acute myocardial ischemia, including unstable angina, non-ST elevation myocardial infarction, and ST elevated infarction.

Acute coronary syndrome

148

__________ presents with anterior chest pain, often tearing or ripping, often radiating into the back or neck.

Acute aortic dissection

149

________ involve an unpleasant awareness of the heartbeat.

Palpitations

150

Palpitations may result from _____________________, ___________________, or ___________________.

irregular heartbeat; rapid increase/decrease of heart rate; increased forcefulness of cardiac contraction

151

Palpitations do not necessarily mean ____________.

heart disease

152

The most serious dysrhythmias, such as ___________________ do not produce palpitations.

ventricular tachycardia

153

Sudden dyspnea occurs in ___________, _____________, and ___________.

pulmonary embolus; spontaneous pneumothorax; anxiety

154

Shortness of breath may represent __________, _________ or ________________.

dyspnea; orthopnea; paroxysmal nocturnal dyspnea

155

_________ is an uncomfortable awareness of breathing that is inappropriate to a given level of of exertion.

Dyspnea

156

________ is dyspnea that occurs when the patient is lying down and improves when the patient sits up.

Orthopnea

157

_________ is seen in left ventricular heart failure or mitral stenosis; also seen in obstructive lung disease.

Orthopnea

158

Orthopnea is typically quantified by ____________________.

the number of pillows that the patient uses for sleeping (only if the reason for sleeping upright is shortness of breath)

159

___________ describes episodes of sudden dyspnea and orthopnea 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.

Paroxysmal nocturnal dyspnea (PND)

160

_________ is seen in left ventricular heart failure or mitral stenosis; may be mimicked by nocturnal asthma attacks.

Paroxysmal nocturnal dyspnea (PND)

161

_______ refers to accumulation of excessive fluid in the extravascular interstitial space.

Edema

162

___________ appears in the lowest body parts: the feet and lower legs while sitting or the sacrum when bedridden.

Dependent edema

163

Causes of _________ may be cardiac (congestive heart failure), nutritional (hypoalbuminemia), or positional.

Dependent edema

164

Interstitial tissue can absorb several liters of fluid, accommodating up to a ___% weight gain before ____________ appears

10; pitting edema

165

Edema occurs in ______ and ______ disease.

liver; renal

166

Cardiovascular disease affects _______ U.S. adults and includes __________, ___________, _______________, _______________, and _____________________.

80 million; hypertension; coronary heart disease; heart failure; stroke; congenital cardiovascular defects

167

Cardiovascular disease account for approximately ________ of all U.S. deaths.

one third

168

________ accounts for 35% of all myordial infarctions and strokes, 49% of all episodes of heart failure, and 24% of all premature deaths.

Hypertension

169

Blood pressure screening is recommended for ____________________________.

all people 18 years or older

170

Normal blood pressure is defined as:

below 120/80

171

Pre-hypertension is defined as __________, and warrants __________________.

120-139 (systolic) / 80-89 (diastolic); lifestyle change interventions

172

Stage 1 hypertension is defined as ____________, and warrants ____________.

140-159 (systolic) / 90-99 (diastolic); initiation of antihypertensive drug therapy

173

The blood pressure target for patients with diabetes and chronic kidney disease is ______________.

below 130/80

174

Individuals who are normotensive at 55 years have a _______% lifetime risk of developing hypertension.

90

175

More than 1 out of every _____ adults of the age 60 has hypertension.

2

176

For individuals aged 40 to 70 years, each increment of ____ mm HG in systolic BP or ______ mm Hg in diastolic BP doubles risk of CVD across the entire BP range from 115/75 to 185/115.

20; 10

177

Only _____ % of the young and middle-aged population is at low cardiovascular risk.

10-May

178

__________ leads to a gain of 5.8 to 9.5 years in life expectancy.

Low cardiovascular risk

179

Risk factors for hypertension include:

physical inactivity, microalbuminuria or estimated GFR less than 60 mL/min, family history of premature CVD (earlier than 55 in men, earlier than 65 in women), excess intake of dietary sodium, insufficient intake of potassium, and excess intake of alcohol.

180

AHA recommends screening for risk of CVD and stroke beginning at age _______.

20

181

AHA recommends "global absolute CHD risk estimation" for all adults aged _____ and over.

40

182

What are the risk factors that need to be checked for CHD?

Family history of CHD, smoking, diet, alcohol intake, physical activity, blood pressure, BMI, waist circumference, pulse (to detect atrial fibrillation), fasting lipoprotein profile, fasting glucose.

183

______ is the primary target of cholesterol lowering therapy.

LDL

184

________ is more closely correlated than _______ with risk factors for metabolic syndrome.

Waist circumference; BMI

185

________ reflects pressure in the right atrium, or central venous pressure, and is best assessed from pulsations in the ______________.

JVP; right internal jugular vein

186

Jugular veins and pulsations are not easily seen in ________________, so they are not useful for evaluating the cardiovascular system of this group.

children younger than 12 years

187

The usual starting point for JVP is to elevate the head of the bed to __________.

30 degrees

188

In hypovolemic patients, to see the JVP you will need to position the bed _____________.

lower, sometimes at 0 degrees

189

In hypervolemic patients, to see the JVP you will need to position the bed _____________.

higher (raise the head)

190

What are the steps for assessing JVP?

Make the patient comfortable, place head on a pillow, raise head of bed to 30 degrees, turn patient's head to the left, using tangential lighting find the external jugular first, then the internal jugular, identify the highest point of pulsation in the right internal jugular, extend a ruler horizontally from this point, and a ruler vertically from the sternal angle, make a right angle between the two and measure the height, add 5 to the measurement to obtain JVP.

191

Increased JVP suggests _______________________.

right sided congestive heart failure (or less commonly, constrictive percarditis, tricuspid stenosis, or superior vena cava obstruction).

192

__________ pulsations are rarely palpable, while ________ pulsations are readily palpable.

Internal Jugular Pulsations; Carotid Pulsations

193

___________ pulsations have a soft, biphasic, undulating quality, usually with two elevations and two troughs per heart beat.

Internal Jugular Pulsations

194

__________ pulsations have a vigorous thrust with a single outward component.

Carotid pulsations

195

__________ pulsations are eliminated by light pressure on the veins just above the sternal end of the clavicle.

Internal Jugular Pulsations

196

__________ pulsations are not eliminated by light pressure.

Carotid pulsations

197

The height of _______ pulsations is changed with position.

Internal Jugular Pulsations

198

The height of _______ pulsations do not change with position.

Carotid pulsations

199

The height of _______ pulsations usually falls with inspiration.

Internal Jugular Pulsations

200

The height of _______ pulsations do not change with inspiration.

Carotid pulsations

201

In patients with ___________, venous pressure may appear elevated on expiration only; the veins collapse on inspiration. This finding does not indicate _____________.

obstructive lung disease; congestive heart failure

202

Venous pressure measured at greater than ____ cm above the sternal angle is considered elevated/abnormal.

3

203

An elevated _________ is 98% specific for an increased left ventricular end diastolic pressure and low left ventricular ejection fraction, and it increases risk of death from _________.

JVP; heart failure

204

If you cannot see pulsation in the internal jugular vein, look for the in the _____________.

external jugular vein and use the point above which the external collapses

205

You should observe JVP on the _____ side.

both (left & right)

206

____________ is the usual cause of unilateral distention of the external jugular vein.

Local kinking or obstruction

207

Systole occurs between _____ & _____.

S1; S2

208

Diastole occurs between ______ & ______.

S2; S1

209

When feeling jugular venous pulsations: the ____ wave just precedes S1 and the _______ pulse. The ____ descent can be seen as a systolic collapse. The _____ wave almost coincides with S2. The _____ descent follows ______ early in diastole.

a; carotid; x; v; y; S2

210

Prominent _____ waves are seen in increased resistance to right atrial contraction, as in tricuspid stenosis (also in first-degree atrioventricular block, supraventricular tachycardia, junctional rhythms, pulmonary hyertension, and pulmonic stenosis).

a

211

Absent a waves are seen in ______________.

atrial fibrillation

212

Large ____ waves are seen in tricuspid regurgitation & constrictive pericarditis.

v

213

The _____________ provides valuable information about cardiac function and is especially useful for detecting stenosis or insufficiency of the aortic valve.

carotid pulse

214

A ____________ carotid artery may produce a unilateral pulsatile bulge.

tortuous and kinked

215

Causes of decreased carotid pulsations include:

decreased stroke volume and local factors in the artery such as atherosclerotic narrowing or occlusion.

216

To assess amplitude and contour of the right carotid artery:

use right index and middle fingers or left thumb, press just inside the medial border of the sternomastoid muscle

217

Never press ________ at the same time, this may induce syncope.

both carotids

218

Pressure on the _______ may cause a reflex drop in pulse rate or blood pressure.

carotid sinus

219

When palpating the carotid artery, the __________ correlates reasonably well with the pulse pressure.

amplitude of the pulse

220

Small, thready or weak carotid pulse is seen in ________.

cardiogenic shock

221

Bounding carotid pulse is seen in ____________.

aortic insufficiency

222

Delayed carotid upstroke is seen in __________.

aortic stenosis

223

Normal carotid upstroke occurs between _____ & ______.

S1; S2

224

Which is normally shorter: systole or diastole?

systole

225

_________ may radiate to the neck and sound like a carotid bruit.

Aortic valve murmur

226

During palpation of the carotid artery, you may detect humming vibrations, or __________ that feel like the throat of a purring cat.

thrills

227

You should auscultate the carotid arteries for _________, a __________ sound of vascular rather than cardiac origin.

bruit; murmur-like

228

If the carotid artery is inaccessible, you should use the _______ artery.

brachial

229

During the heart exam, the clinician should stand on the patient's _______ side.

right

230

Which heart sound is usually louder at the base?

S2

231

Which heart sound is usually louder at the apex?

S1

232

At a heart rate of about _______ bpm, the durations of systole and diastole become indistinguishable.

120

233

Both the carotid upstroke and apical impulse occur during __________.

systole (just after S1)

234

Sounds or murmurs coinciding with the carotid upstroke and apical impulse are _________.

systolic

235

Sounds or murmurs occurring after the carotid upstroke and apical impulse are _________.

diastolic

236

_______ is decreased in a first degree heart block.

S1

237

________ is decreased in aortic stenosis.

S2

238

_________ may accompany loud, harsh, or rumbling murmurs as in aortic stenosis, patent ductus arteriosus, and ventricular septal defect.

Thrills

239

__________ is when a patient's heart is found on the right side.

dextrocardia

240

In ___________ the heart, liver, and stomach are all on the opposite sides.

situs inversus

241

A right sided heart with a normally placed liver and stomach is usually associated with ______________.

congenital heart disease

242

You should use _________________ to check for thrills.

the ball of your hand placed firmly against the chest

243

How do you determine S1 and S2 by palpation only?

Place your right hand on the chest wall, and your left fingers on the carotid. The carotid upstroke occurs between S1 and S2.

244

The aortic area of the heart is located where?

right 2nd intercostal space

245

The pulmonic area of the heart is located where?

left 2nd intercostal space

246

The right ventricular area is located where?

left sternal border

247

The left ventricular area is located where?

apex of the heart

248

Where should you assess the right ventricle?

the right ventricular area (left sternal border) and subxiphoid area

249

Name some pathological conditions that could produce a more prominent PMI:

enlarged right ventricle, dilated pulmonary artery, or aneurysm of the aorta

250

The apex beat is palpable in only ________ % of healthy adults in the supine position, and ______ % of healthy adults in the left lateral decubitus position.

25-40; 50

251

If you cannot find the apical impulse, what should you do?

Ask the patient to roll onto their left side (left lateral decubitus position) and/or ask the patient to exhale completely and hold.