| Question |
Answer |
| What is the base of the heart? |
broader upper portion of the heart |
| What is the apex of the heart? |
Narrow lower tip of the heart |
| What is the primary muscle mass of the heart? |
ventricles |
| What is the anterior surface? |
right ventricle |
| What is posterior surface? |
left ventricle |
| What is the left border of the heart? |
left ventricle |
| What is responsible for the apical impulse? |
the left ventricle |
| What is the right border? |
the right atrium |
| What is preload |
pressure stretching the ventricles of the heart cause by venous return |
| What is afterload? |
pressure that the left ventricle must squeeze against to eject blood into the aorta |
| What is systole? |
The ventricles contracting and ejecting blood from the left ventricle into the aorta and from the right ventricle into the pulmonary artery |
| What is diastole? |
The atria contract and the ventricle dilate (blood moves from the atria to the ventricles) |
| Where do electrical impulses originate? |
SA node |
| Where is the SA node located? |
Right atrium |
| What is the path of the electrial impulses in the heart? |
SA Node -> AV Node -> Bundle of His -> Purkinje Fibers |
| Where is the AV node located? |
atrial septum |
| Where is the bundle of His and the purkinje fibers |
Ventricles |
| How do ventricles contract? |
At apex and spread to base |
| How does the fetus compensate for nonfunctional lungs? |
umbilical vessels |
| Where does the right ventricle pump blood in the fetus? |
ductus arteriosus |
| When does teh ductus arteriosus close? |
after birth in approximately 24-48 hours |
| When does the foramen ovale close? |
As pressure rises in the left atrium at birth |
| How much does blood increase in pregnant women? |
40-50% |
| Why does blood increase in pregnant women? |
increased plasma volume |
| How does the heart compensate during pregnancy? |
The left ventricle increases in wall thickness and mass? |
| Why does the heart compensate during pregnancy? |
to allow for increased work load |
| What happens to the heart in older adults |
The left ventricle wall thickens and valves tend to fibrose and calcify |
| What causes changes to the heart in older adult? |
stress on the heart due to HTN, heart disease, etc. |
| One finger to chest pain indicates? |
non-cardiac pain |
| N/Vomiting/Diaphoresis with chest pain is? |
cardiac till proven otherwise |
| What does jaw pain indicate? |
ischemia and pericarditis |
| What does sharp chest pain and hemoptysis indicate? |
pulmonary embolism or tumor |
| What does pain with swallowing indicate? |
esophageal spasm or pericarditis |
| What does fever with chest pain indicate? |
pneumonia |
| What does sighing and mood issues with chest pain indicate? |
anxiety and depression |
| What are cardiac risk factors? |
age
hyperlipidemia
family Hx
obesity
sedentary lifestyle
tobacco
diabetes
personality
hypertension
gender |
| If a person has hyperlipidemia, tobacco use or diabetes, the odds on having cardiac issues are what? |
8x more likely |
| What are the 5 points of auscultation? |
Aortic
Pulmonic
Erbs Point
Tricuspid
Mitral |
| Where is the aortic auscultation point? |
2nd intercostal space on the RIGHT side |
| Where is the pulmonic auscultation point? |
2nd intercostal space on the LEFT side |
| Where is the Erbs point? |
3rd intercostal space on the left side |
| Where is the tricustpid auscultation point? |
4th intercostal space on the left side |
| Where is the mitral valve auscultation point? |
5th intercostal space on the left side |
| What is Erbs Point? |
where S2 is best auscultated |
| What is the point of maximal impulse? |
5th intercostal space, left mid-clavicular line |
| Where does PMI shift in left ventricular hypertrophy? |
downward and laterally |
| what is S1? |
during ventricle systole when the mitral and tricuspid valves are closing |
| What is S2? |
During ventricular diastole when the aortic and pulmonic valves close. |
| What is S3? |
rapid filling of left ventricle in diastole. |
| When is an S3 sound normal? |
normal into 3rd decade |
| What does S3 indicate in an older adult? |
sign of heart failure |
| What does S4 heart sound? |
Atrial diastolic gallop caused by vibration of valves and ventricular walls |
| What causes an S4 heart sound? |
aortic stenosis |
| What is a grade I murmur? |
barely audible in quiet room |
| What is a grade II murmur? |
quiet but clearly audible |
| What is a grade III murmur |
moderately loud |
| What is a grade IV murmur? |
Loud with thrill |
| What is a grade V murmur? |
Very loud with thrill and easily palpable |
| What is a grade VI murmur? |
very loud, audible without a stethoscpe not in contact with chest, thrill palpable and visible. |
| What is a thrill? |
fine palpable rushing vibration. Innocent murmurs do NOT have thrills |
| What are the two systolic murmurs? |
Aortic stenosis and mitral regurgitation |
| Where is aortic stenosis heard? |
2nd intercoastal space and radiating to carotids |
| Where is mitral regurgitation heard? |
best at teh apex and radiating to the left axilla |
| What are the two diastolic murmurs? |
Aortic regurgitation and mitral stenosis |
| Where is aortic regurgiation heard? |
right 2nd intercostal space with teh patient leaning forward using the diaphragm of the stethoscope |
| Where is mitral stenosis heard? |
Left mid-clavicular line, 5th intercostal space with the patient lying in the left lateral recumbent position using the bell of the stethoscope |
| What murmurs are always pathological? |
Diastolic Murmurs (Aortic regurg and mitral stenosis) |
| What needs to be inspected and palpated for the peripheral vascular system? |
skin temperature, color, texture, pulses, any pain/tenderness, presence of edema, varicosities, hair distribution, muscle tone |
| How do you grade a normal pulse? |
+2 |
| What is the scale to grade pulses? |
0 - +4 |
| What is Homan's Sign |
calf pain with dorsiflexion of ankle indicating DVT |
| What is JVD? |
Jugular Vein Distension
Asymmetry of the jugular veins seen on inspection of patient sitting at 45 degrees |
| What does JVD indicate? |
Right sided heart failure |
| What is the hepato-jugular reflex? |
press lightly for 30 seconds on the right upper quadrant. If you see an increase in JVD then there could be right ventricular dysfunction. |
| What are bruits? |
heard over renal arteries, carotids, abodminal aorta, iliac arteries, temporal arteries, and orbital arteries |
| How do you hear bruits? |
With the bell of the stethoscope |
| What do bruits sound like? |
"whooshing" |
| What do bruits indicate? |
a build up of plaque |
| What does pitting edema indicate? |
right sided heart failure |
| What is +1 pitting edema? |
1-2mm |
| What is +2 pitting edema? |
2-4mm |
| What is +3 pitting edema? |
4-6mm |
| What is +4 pitting edema? |
6-8 mm |
| What are the 5 P's of arterial occusion? |
Pain
Pallor
Paralysis
Paresthesia
Pulselessness |
mr. charles11
