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health assessment 2e
cardiovascular
| Question | Answer |
|---|---|
| variation in S1 | 1. position of AV valve at start of S 2. structure of valve leaflets 3. how quickly p rises in the ventricle |
| loud (accentuated) S1 | 1. wide open + no time to drift 2gether 2. calcification of balve, need increase ventricular p to close valve against increased atrial p |
| faint (diminished) S1 | 1. delayed conduction from atria to ventricles. Mitral valve drifts shut b4 ventricular contraction closes it 2. extreme calcification, limit mobility 3. more forceful atrial contraction in2 noncompliant ventricle; delays or diminishes vent contraction |
| varying intensit of S1 | 1. position of AV varies b4 closes from beat to beat 2. atria + ventricles beat independently |
| split S1 | mitral + tricuspid components r heard separately |
| accentuated S2 | 1. higher closing pressure 2. exercise + excitemet i pressure in aorta 3. pulmary hypetension 4. semilunar valves calcified but still mobile |
| diminished S2 | 1. fall in systemic BP causes a d in valve strength 2. semilunar valve thickend + calcified, w/decreased mobility |
| 1st heart sound (S1) | caused by closure of AV valves, signals beginning of systole -heard over entire percordium -loudest at apex S1=LUB S2= dup |
| 2nd heart sound (S2) | closure of semilunar valve -heard over entire percordium -loudest at base (lub -DUP) |
| spliting of S2 | occurs at end of inspiration -instead of DUP you hear T-DUP |
| fixed split of S2 | unaffected by respiration; split is always there |
| pardoxical split of S2 | -conditions that delay AV closure cause inspiration: P2 is normally delayed, sound fuse expiration: hear split in order of P2A2 |
| wide split of S2 | wen R ventricle has delayed electrical activation, split is very wide on inspiration + still there on expiration |
| ejection click | early systole at start of ejection bc open SL valve -SL open slighty (stenosis) makes sound (short + high pitched w/diaphargm) -aortic ejection: 2 r interspace + apex (loud) -pulmonic ejection: 2 L intespace+ softer w/inspiration -"ball in cage" |
| aortic prostheic valve sound | opening of aortic ball-in-cage produce early systole sound -less intense w/tilting disk; absent w/tissue disk |
| midsystolic (mitral) click | mitral valve prolapse: MV leaflets close with contraction but ballon back up into L atrium. During balloning, tensing of leaflets + chordea tend create click -2nd to mid/late systole + is short + high pitch -heard w/diapharm @ apex click followed sys m |
| opening snap | presence of stenosis, I hihger atrial p to open valve sharp + high pitched, w/snap sound after S2 + diapharm @ 3+4 L inerspace @ sternal border sign of mitral stenosi |
| mitral prosthetic valve sound | early diastyole opening click just after S2, loud over whole precordium + is loudest @ apex + L lower sternal border |
| Thrid Heart Sound | ventricular filling, early diastole during rapid filling -heard best @ apex/L lower sternal border -does nto vary w/respiration -lower pitched |
| physiologic S3 | -normal -heard frequently in children + yound adults -occassionally after 40 yrs(women), -disapperas wen sits up |
| pathologic S3/ ventricular gallop | wen sitting up -decreased compliance of ventricles, earliest sign of HF -from left or right |
| Fourth Heart Sound | ventricuar filling sound -occurs wen atria contract late in diastole -heard b4 S1, very soft sound + low pitch -bell, best at apex in L lateral position |
| physiologic S4 | >40/50 yrs with no evidence of cardio disease, especially after eercise |
| pathologic S4/atrail gallop | occurs w/decreased compliance of ventricle + systolic overload + hypertension - best heard @ apex in L lateral position |
| summation sound | wen physiologic + pathologic S4 present -during rapid rates, diastolic filling time shortens + S3 + S4 move closer |
| pericardial friction rub | inflammation of percordium -sound High pitched + scratchy, heard w/diaphargm w/sitting up + leaning forward + breath head in expiration -best @ apex |
| abn pulstion @ base | thrill: 2nd + 3rd R interspace w/severe aortic steonsis + systemic hypertension thrill: 2nd + #rd L interspace w/pulmonic stenois + pulmonic hypertension |
| abn pulsation @ L sternal border | lift(heave): w/ventricular hypertrophy -felt during systole -retraction @ apex bc L ventricle is rotated posteriorly by the enlarged R ventricle |
| abn pulsation @ apex (volume overload) | cardiac enlargemetn displaces apical impulse laterally + over wider area wen L ventricular hypertrophy + dilation present |
| abn pulsation @ apex (pressure overload) | apical impulse is increased in force + duration but not displaced |
| patent ductus arteriosus (PDA) | pulmonary artery + aorta join s: no symptoms in early childhood, common in fetus O: BP wide pulse pressure + bounding peripheral pulses; thrill palpable at L Upper SB; continous murmur heard in systole + diastole (machinary murmur) |
| atrial septal defect (ASD) | abn opening in artrial septum resulting in L-R shunt cause I in pulmonary blood flow S: mild fatigue + DOE O: sternal lift often present; fixed S2 w/P2 louder than A2' murmur systolic, ejection, medium pitch, heard beast in 2 L inerspace |
| ventricular septal defect (VSD) | abn opening in septum bw ventricles s: infants-DOE, slow weight, resp infections, HF o: loud, harsh holosystolic murmur heard @ L lower SB accompained by thrill |
| tetralogy of fallot | R ventricular outflow stenosis, VSD, R ventricular hypertrophy, overriding aorta; alot of blood directly in aorta, never O2 s: cyanosis, DOE, o: thrill palpable @ LLSB; S1 normal, S2 loud A2 +P2 diminsed; murmur systolic,loud, crescendo-decrescendo |
| coarctation of the aorta | severe narrowing of descending aorta, s: HF in infants o: U extremity hypertension over 20mmHG higher than lower extremity; absent or greatly diminished femoral pulses; systolic murmur heard @ LSB |
| aortic stenosis | s: fatigue, DOE, palpitation, dizzinness, fainting, anginal pain o: pallor, slow diminished radial pulse, L BP; apical impulse sustained + displaced to L; thrill in systole m: loud, ha |
| pulmonic stenosis | o:thrill in systole, ejection click after S1, diminished S2 m: systolic, medium pitch, coarse, crescendo-decrescendo |
| mitral regurgitation | s: fatigue, palpitation,PND o: thrill in s @ apex; lift @ apex; m: pansystolic, loud, blowing, best @ apex |
| tricuspid regurgitation | o: engorged pulsating neck veins, liver enlarged, thrill @ LLSB m: soft, blowing, pansystolic, increases with inspiration |
| diastolic rumbles of AV valves | filling murmus @ low pressures, best heard w/bell lightly touching skin -mitral stenosis, tricuspid stenosis |
| mitral stenosis | impedes forward flow blood in2 LV during diastole s: fatigue, palpitations,DOE, orthopnea, PND o:diminished; lift @ apex, diastolic thrill common @ apex; S1 accentuated m: low-pitched diastolic rumble, heard @ apex w/L later |
| tricuspid stenosi | impedes forward flow into RV during diastole o: diminished arterail p, JVP m: diastolic rumble, best heard @ LLSB, louder in inspiration |
| aortic regurgition | s: minor, then DOE, PND, angina, dizziness o: bounding "wter hammer" pulse (cartoid, brachial, femoral arty) apical pulse feels brief m: sim. w/S2; soft high pitched, blowing diastolic |
| pulmnic regurgitation | m: same as aortic regurgitation |
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xnyzlatinangelx
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