1 A Cardiac Assessment
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| S1 Is it heard best at the base or the apex? | loudest at the Apex
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| S1 is it heard in Systole or Diastole? | Beginning of Systole
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| S1 which valves closing make this sound? | AV valves Mitral and Tricuspid
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| S2 is it heard best at the base or the apex? | loudest at the base
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| S2 is it heard in Systole or Diastole? | Beginning of Diastole
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| S2 What valves closing make this sound? | Semilunar valves Aortic and Pulmonic
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| S3 is it heard in systole or diastole? | Early Diastole after S2
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| What causes the sound of S3? | Rapid filling of the ventricles which causes turbulence and vibrations.
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| S3 is heard with what disease processes? | CHF and MI
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| Is S3 ever a normal sound? | S3 may be normal in children and young adults.
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| S3 is it an atrial or ventricular gallop? | Venticular
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| S4 is it heard in Systole or Diastole? | Late diastole before S1
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| What causes the sound of S4? | Atrial kick into a noncompliant ventricle.
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| S4 is heard with what disease processes? | CAD, Hypertension, Aortic Stenosis
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| S4 is this ever a normal sound? | S4 is generally considered an abnormal sound
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| S4 is this an atrial or ventricular gallop? | Atrial
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| What is the best patient position to hear S3 and S4? Supine? Semi Fowlers? Left lateral position? | Lying in the left lateral position shifts the heart closest to the chest wall
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| Which of the four heart sounds is the only one heard during systole? | S1
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| Systolic murmur is heard after which valves close? | AV valves
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| Systolic murmur does it occur between S1 and S2 or between S2 and S1? | Between S1 and S2
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| Diastolic murmur is heard after which valves close? | Semilunar valves (Aortic and Pulmonic)
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| Does Diastolic murmur occur between S1 and S2 or between S2 and S1 | between S2 and S1
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| What is Hemodynamics? | The Physics of Blood flow
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| What is Compliance? | The amount a vessel will stretch due to a change in pressure.
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| Which is more compliant veins or arteries? | Veins-Think vericose veins how they stretch
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| Which is less compliant veins or arteries? | Arteries-Think of hardening of the arteries
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| What is Isovolumetric contraction? | The point at which all 4 heart valves are closed for an instant just after the ventricles have filled
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| Does Isovolumetric contraction happen during Systole or Diastole? | At the beginning of Systole
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| Does Isovolumetric contraction happen before or after S1? | After S1 and before S2
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| What is Isovolumetric relaxation? | The point at which all 4 heart valves are closed for an instant just after the atrium have filled
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| Does Isovolumetric relaxation happen during Systole or Diastole? | At the beginning of Diastole
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| Does Isovolumetric relaxation happen before or after S1? | Before S1 and after S2
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| What does a pericardial friction rub sound like? Soft and Quiet? or High pitched and scratchy like sandpaper? | High pitched and scratchy like sandpaper
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| What patient position is best to hear a pericardial friction rub? Supine taking a deep breath in? or Sitting up, leaning forward, with breath held in expiration? | Sitting up, leaning forward, with breath held in expiration.
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| What is a mnemonic to remember the order of the valves in the heart? | Tissue Paper My Assets=Tricuspid, Pulmonic from the right side, Mitral, Aortic from the left side.
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| Where do you listen to the Aortic valve sound? | 2nd intercostal space at the right sternal border.
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| Where do you listen to hear the Pulmonic valve sound? | 2nd left intercostal space
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| Where do you listen to hear Erb's point? | 3rd left intercostal space
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| Where do you listen to hear the Tricuspid valve sound? | 4th left intercostal space
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| Where do you listen to hear the Mitral valve sound? | 5th left intercostal space
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| Where do you auscultate the Apical pulse? | 5th left intercostal space midclavicular line
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| Where do you palpate the point of maximal impulse (PMI) or apical impulse? | 5th left intercostal space midclavicular line
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| What is a mnemonic for remembering where to listen to the valve sounds? | APE To Man=Aortic, Pulmonic, Erb's point, Tricuspid, Mitral, starting from 2nd right intercostal space across to 2nd left and then down
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| Why do you listen to the heart valves in a different location than where the valves are? | Because the sound radiates with the direction of blood flow.
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| Of S1, S2, S3, S4. Which heart sound coincides with the Carotid Artery Pulse? | If you feel the carotid and auscultate at the apex the sound you hear when you feel each pulse is S1
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| What can you do to hear the heart sounds better? | Have the Patient sit up and lean forward or roll to their left (and “breathe out” and “hold it” but not too long) to place the heart closest to the chest wall, Turn down the TV, close the door, place the stethoscope on skin not over clothing.
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| If the point of maximal impulse (PMI) is palpated at the 6th intercostal space. Is that normal or abnormal? | Generally considered Abnormal
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| What could be a cause of the heart sounding muffled or distant? | Fluid around the heart-Cardiac Tamponade
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| What would cause the PMI to be palpable at the 6th (ICS)-intercostal space? | (Cardiomegaly)-Enlargement of the heart or (Myocardiopathy)- any disease causing enlargement of the heart.
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| What would cause enlargement of the heart? Swelling your chest as you breathe in deeply? Increased ventricular volume? Increased ventricle wall thickness? | Increased ventricular volume and Increased ventricle wall thickness.
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| Which of these medical conditions would cause the heart to enlarge when ventricular volume increases or the ventricle wall thickens? Hypertension, CAD, Heart failure, Cardiomyopathy? | All of them.
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| If the heart is enlarged how could this be veiwed? (EKG-ECG)-Electrocardiogram? Echocardiogram? Xray? Angiogram? | An enlarged heart with a shifted PMI (at the 6th intercostal space or greater) could be seen on Xray.
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| Are the superior and inferior Vena cava on the left or right side of the heart? | Right
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| Do the superior and inferior vena cava carry oxygenated or unoxygenated blood to the heart? | They carry unoxygenated blood from the body back to the right atrium
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| Does the Aorta carry oxygenated or unoxygenated blood out to the body? | Oxygenated
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| Is the Aorta on the right or left side of the heart? | Left side
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| Which carries “unoxygenated blood”- Pulmonary Arteries or Pulmonary Veins? | Pulmonary “ARTERIES” carry unoxygenated blood. The pulmonary system is the only place that arteries carry unoxygenated blood and veins carry oxygenated blood
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| Do the pulmonary arteries carry blood to the heart or the lungs? | Pulmonary arteries carry unoxygenated blood from the right side of the heart to the lungs
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| Do the pulmonary veins carry oxygenated or unoxygenated blood? | The pulmonary veins carry oxygenated blood.
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| Do the pulmonary veins carry blood to the left atrium or the lungs? | The pulmonary veins carry oxygenated blood from the lungs to the left atrium
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| Are there valves in the arteries or in the veins of our legs? | Their are valves in the veins of our legs that keep the blood from flowing back down with gravity.
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| Are there valves in the veins of your head? | The veins in our head have no valves they drain into our jugular veins that drain directly into the superior vena cava and into the right atrium.
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| If the right side of the heart fails to pump well and blood backs up how might this be seen? In the carotid arteries or In the Jugular veins? | Blood would back up and cause (JVD) Jugular vein distension.
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| What position of the patient might be best to observe JVD? Supine-lying down flat, Sitting straight up, or with the bed at a 30 to 45 degree angle? | With the bed at a 30 to 45 degree angle. (Lying down flat the jugular veins would not be so visible. Sitting straight up the veins would flatten and not be so visible.)
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| Is Jugular vein distension a sign of right sided or left sided heart failure? | Right sided heart failure as the right side fails to pump well the blood backs up into the “veins”.
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| Does JVD reveal pressure changes in the right side of the heart or volume changes in the right side of the heart? | Both. JVD would be a sign of right sided heart failure
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| True or False? Abnormally high pressure in the right side of the heart shows up in the neck veins and the abdomen. | True. This would be a sign of right sided heart failure
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| True or False? Abnormally high volume in the right side of the heart would show up in JVD, enlarged liver and spleen, dependant edema-(swollen hands and feet) and fatigue? | True. These are signs of right sided heart failure. Just think of where the veinous blood would back up to on the right side of the body and how gravity would take it back down to the liver and the hands and feet
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| True o False? Abnormally high pressure or volume in the left side of the heart would back blood up to the lungs? | True.
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| True or False? Abnormally high pressure or volume in the left side of the heart may show up as crackles in the lungs, cough, dyspnea on exertion, cyanosis, and increased “pulmonary”-capillary wedge pressure and blood tinged sputum? | True. These are all signs of Left sided heart failure.
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