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Flashcards in The Heart Deck (61)
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1

Where is the SA node located?

At the juncture of the superior vena cava and the right atrium

2

What occurs to the impulse once it gets to the AV node?

It is slowed before being transmitted to the bundle of his and parking fibers

3

How od cardiac impulses spread?

From endocardium to epicardium

4

At what level does the SNS enter for cardiac innervation?

T1-T5

5

What cranial nerve innervated the heart causing PSNS responses?

Vagus nerve

6

What chamber of the heart is most anterior?

Right ventricle

7

What is left ventricular apex called and where is it located?

Point of Maximal Impulse (PMI) fifth intercostal space midclavicular line

8

What are the only normal sounds that should be heard when auscultating the heart?

Only the closing of the heart valves

9

What produces the first heart sound (S1)?

Closing of the AV valves
Tricuspid
Mitral

10

What produces the second heart sound (S2)?

Closing of the semilunar valves
Aortic
Pulmonic

11

When can opening valves be heard?

When they are damaged

12

When is an opening snap heard versus an ejection click?

AV valve = opening snap
Semilunar valve = ejection click

13

What is the time between the closure of the AV valves and the opening of the semilunar valves?

Isovolumic contraction

14

What is the time between the opening and the closing of the semilunar valves?

The systolic period of ejection

15

What is the S2 heart sound split into?

A2
P2

16

What is the time between the closure of the semilunar valves and the opening of the AV valves?

Isovolumic relaxation

17

When does rapid filling of the ventricle occur?

When the AV valves open, 80% filling occurs at this point

18

When is S3 heard if present?

After S2 (Kentucky)

19

What population is S3 heart sound normal?

Children and young adults

20

What can a S3 heart sound indicate in adults greater than the age of 30?

Volume overload to the ventricles
Valvular regurgitation
CHF

21

When might a S4 heart sound be heard?

Prior to S1 (Tennessee)

22

What populations might a S4 heart sound be considered a normal finding?

Children and young adults

23

If a S4 heart sound is heard in an individual over the age of 30 what pathology is suspected?

It is indicative of a noncompliant or stiff ventricle

24

Where is S1 heard the best?

At the apex of the heart

25

Where might splitting of S1 be heard?

The tricuspid areas

26

Where is S2 heard the best?

At the base of the heart

27

How does inspiration affect the distance between A2 and P2?

The split is widened during inspiration

28

What does the dicrotic notch represent?

The closure of the aortic valve

29

What measures the lateral pressure exerted by a column of blood against the arterial wall?

Arterial blood pressure

30

What determines blood pressure?

The volume ejected
Distensibility
Viscosity of blood
Pressure in vessels after last ejection

31

In a healthy adult, which extremity is BP higher?

SPB in legs is 15-20mmHg greater than in the arms

32

What is the difference between the systolic pressure and the diastolic pressure?

The pulse pressure

33

How much is a normal pulse pressure?

There is normally a 10mmHg decrease in SBP during quiet inspiration

34

What is the most common cause of right sided heart failure?

Left sided heart failure

35

What causes angina?

Consequence of hypoxia of the myocardium resulting from an imbalance of coronary supply and myocardial demand

36

What are four types of syncope?

Postural
Vasovagal
Carotid sinus
Posttussive

37

What is xanthomata and what pathology is it indicative of?

Stony hard slightly yellowish masses, hypercholesterolemia

38

What is Lichtstein's sign and what pathology is indicated?

Ear lobe creases seen in patients with CAD/CHF

39

What is considered normal BP?

Systolic: less than 120
Diastolic: less than 80

40

What is considered preHTN BP?

Systolic: 120-139
Diastolic: 80-89

41

What is considered stage one HTN?

Systolic: 140-159
Diastolic: 90-99

42

What is considered stage 2 HTN?

Systolic: greater than 160
Diastolic: greater than 100

43

How can jugular venous pressure be estimated?

Adding 5cmH2O to the amount calculated above the sternal angle
Measure 3cmH2O + 5 = 8cmH2O estimated JVP

44

Where is the cardiac rate typically assessed?

Radial pulse

45

What sound is typically heard before the carotid pulse is felt?

S1

46

Typically what is the size of the PMI?

2-3cm in diameter

47

When might a thrill be felt?

Indicates a large murmur is present

48

What heart sounds are heard better with the diaphragm of the stethoscope?

High pitched sounds such as:
Valve closure
Systolic events
Regurgitant murmurs

49

What sounds are typically heard better with the bell of the stethoscope?

Low pitched sounds such as:
Gallop rhythms
Murmur AV stenosis

50

What are the five auscultatory areas of the heart?

Aortic
Pulmonic
Erb's point
Tricuspid
Mitral

51

Where is the aortic heart sound located?

Right side, second intercostal space, at the sternal border

52

Where is the pulmonic heart sound located?

Left side, second intercostal space, at the sternal border

53

Where is Erb's point located?

Left side, third intercostal space, sternal border

54

Where is the tricuspid heart sound located?

Left side, fourth intercostal space, sternal border

55

Where is the mitral heart sound located?

Left side, fifth intercostal space mid-clavicular line

56

When is splitting of S2 beast heard?

During inspiration at the pulmonic area

57

At what grade murmur does a thrill become apparent?

Grade IV

58

What would make the mitral component of S1 louder?

A faster rate of rise of left ventricular pressure and increased contractility

59

What would make S1 as a whole louder?

Stiffened AV valves

60

What would increase the intensity of S2?

Increased SBP

61

How does fibrosis affect AV valves versus semilunar valves?

Semilunar valves are morphologically different fibrosis does not cause an increase in intensity as in closure of the AV valve