Flashcards in The Heart Deck (61)
Where is the SA node located?
At the juncture of the superior vena cava and the right atrium
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
How od cardiac impulses spread?
From endocardium to epicardium
At what level does the SNS enter for cardiac innervation?
What cranial nerve innervated the heart causing PSNS responses?
What chamber of the heart is most anterior?
What is left ventricular apex called and where is it located?
Point of Maximal Impulse (PMI) fifth intercostal space midclavicular line
What are the only normal sounds that should be heard when auscultating the heart?
Only the closing of the heart valves
What produces the first heart sound (S1)?
Closing of the AV valves
What produces the second heart sound (S2)?
Closing of the semilunar valves
When can opening valves be heard?
When they are damaged
When is an opening snap heard versus an ejection click?
AV valve = opening snap
Semilunar valve = ejection click
What is the time between the closure of the AV valves and the opening of the semilunar valves?
What is the time between the opening and the closing of the semilunar valves?
The systolic period of ejection
What is the S2 heart sound split into?
What is the time between the closure of the semilunar valves and the opening of the AV valves?
When does rapid filling of the ventricle occur?
When the AV valves open, 80% filling occurs at this point
When is S3 heard if present?
After S2 (Kentucky)
What population is S3 heart sound normal?
Children and young adults
What can a S3 heart sound indicate in adults greater than the age of 30?
Volume overload to the ventricles
When might a S4 heart sound be heard?
Prior to S1 (Tennessee)
What populations might a S4 heart sound be considered a normal finding?
Children and young adults
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
Where is S1 heard the best?
At the apex of the heart
Where might splitting of S1 be heard?
The tricuspid areas
Where is S2 heard the best?
At the base of the heart
How does inspiration affect the distance between A2 and P2?
The split is widened during inspiration
What does the dicrotic notch represent?
The closure of the aortic valve
What measures the lateral pressure exerted by a column of blood against the arterial wall?
Arterial blood pressure
What determines blood pressure?
The volume ejected
Viscosity of blood
Pressure in vessels after last ejection
In a healthy adult, which extremity is BP higher?
SPB in legs is 15-20mmHg greater than in the arms
What is the difference between the systolic pressure and the diastolic pressure?
The pulse pressure
How much is a normal pulse pressure?
There is normally a 10mmHg decrease in SBP during quiet inspiration
What is the most common cause of right sided heart failure?
Left sided heart failure
What causes angina?
Consequence of hypoxia of the myocardium resulting from an imbalance of coronary supply and myocardial demand
What are four types of syncope?
What is xanthomata and what pathology is it indicative of?
Stony hard slightly yellowish masses, hypercholesterolemia
What is Lichtstein's sign and what pathology is indicated?
Ear lobe creases seen in patients with CAD/CHF
What is considered normal BP?
Systolic: less than 120
Diastolic: less than 80
What is considered preHTN BP?
What is considered stage one HTN?
What is considered stage 2 HTN?
Systolic: greater than 160
Diastolic: greater than 100
How can jugular venous pressure be estimated?
Adding 5cmH2O to the amount calculated above the sternal angle
Measure 3cmH2O + 5 = 8cmH2O estimated JVP
Where is the cardiac rate typically assessed?
What sound is typically heard before the carotid pulse is felt?
Typically what is the size of the PMI?
2-3cm in diameter
When might a thrill be felt?
Indicates a large murmur is present
What heart sounds are heard better with the diaphragm of the stethoscope?
High pitched sounds such as:
What sounds are typically heard better with the bell of the stethoscope?
Low pitched sounds such as:
Murmur AV stenosis
What are the five auscultatory areas of the heart?
Where is the aortic heart sound located?
Right side, second intercostal space, at the sternal border
Where is the pulmonic heart sound located?
Left side, second intercostal space, at the sternal border
Where is Erb's point located?
Left side, third intercostal space, sternal border
Where is the tricuspid heart sound located?
Left side, fourth intercostal space, sternal border
Where is the mitral heart sound located?
Left side, fifth intercostal space mid-clavicular line
When is splitting of S2 beast heard?
During inspiration at the pulmonic area
At what grade murmur does a thrill become apparent?
What would make the mitral component of S1 louder?
A faster rate of rise of left ventricular pressure and increased contractility
What would make S1 as a whole louder?
Stiffened AV valves
What would increase the intensity of S2?