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66 Cards in this Set

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Systole
the ventricles contract

The right ventricle pumps blood into the pulmonary arteries (pulmonic valve is open)

The left ventricle pumps blood into the aorta (aortic valve is open)
Diastole
the ventricles relax

Blood flows from the right atrium → right ventricle (tricuspid valve is open)

Blood flows from the left atrium → left ventricle (mitral valve is open)
Cardiac output=
stroke volume x heart rate
Blood pressure=
cardiac output x systemic vascular resistance
Systolic blood pressure
Pressure generated by the left ventricle (LV) during systole, when the LV ejects blood into the aorta and the arterial tree
Pressure waves in the arteries create pulses
Diastolic blood pressure
Pressure generated by blood remaining in the arterial tree during diastole, when the ventricles are relaxed
jugular veins reflect....
right atrial pressure
Delayed carotid upstroke pulse suggests....
aortic stenosis
Bounding carotid upstroke pulse suggests....
aortic insufficiency
Brisk carotid upstroke pulse suggests....
Normal
Thrills
turbulence transmitted to the chest wall surface by a damaged heart valve
Heaves or Lifts in the chest are from....
abnormal ventricular movements
PMI
Point of Maximal Impulse

Locate the PMI by interspace and distance in centimeters from the midsternal line

Assess location, amplitude, duration, and diameter
Tapping PMI suggests....
Normal
Sustained PMI suggests....
LV hypertrophy from hypertension or aortic stenosis
Diffuse PMI suggests....
a dilated ventricle from congestive heart failure or cardiomyopathy
listen at the heart apex with...
the bell
The diaphragm is best for...
detecting high-pitched sounds like S1, S2, and also S4 and most murmurs
The bell is best for...
detecting low-pitched sounds like S3 and the rumble of mitral stenosis
If the murmur coincides with the carotid upstroke
it is systolic
Murmur Grades 4 through 6 must have...
an accompanying thrill
Harsh 2/6 medium-pitched holosystolic murmur best heard at the apex describes...
mitral regurgitation
Soft, blowing 3/6 decrescendo diastolic murmur best heard at the lower left sternal border describes...
aortic regurgitation
The PMI locates...
the left border of the heart and is normally found in the 5th interspace 7 cm to 9 cm lateral to the midsternal line, typically at or just medial to the left midclavicular line.

may not be readily felt in a healthy patient with a normal heart
A PMI greater than 2.5 cm is evidence of...
left ventricular hypertrophy (LVH), or enlargement.
Displacement of the PMI lateral to the midclavicular line or greater than 10 cm lateral to the midsternal line also suggests..
LVH, or enlargement.
in patients with chronic obstructive pulmonary disease, the most prominent palpable impulse or PMI may be...
in the xiphoid or epigastric area as a result of right ventricular hypertrophy.
S1
the first heart sound, produced by closure of the mitral valve
Ej
an early systolic ejection sound that accompanies the opening of the aortic valve in some pathologic conditions
S2
the second heart sound produced by aortic valve closure after which another diastole begins
OS
opening snap
pathologic and audible mitrial valve opening if the valve leaflet motion is restricted, as in mitirial stenosis
S3
third heart sound
In children and young adults may arise from rapid deceleration of the column of blood against the ventricular wall.
In older adults, is sometimes termed “an S3 gallop,” usually indicates a pathologic change in ventricular compliance.
S4
fourth heart sound
not often heard in normal adults
marks atrial contraction
immediately precedes S1 of the next beat and also reflects a pathologic change in ventricular compliance.
S2 Components
two discernible components, the first from left-sided aortic valve closure, or A2, and the second from right-sided closure of the pulmonic valve, or P2.

During expiration, these two components fuse into a single sound, S2
Of the two components of the S2, A2 is...
normally louder, reflecting the high pressure in the aorta. It is heard
Of the two components of the S2, P2 is...
relatively soft, reflecting the lower pressure in the pulmonary artery.
It is heard best in its own area—the 2nd and 3rd left interspaces close to the sternum.
It is here that you should search for splitting of the S2.
S1 has two components..
an earlier mitral and a later tricuspid sound.
The earlier, louder mitral component may mask the tricuspid sound, however, and splitting is not always detectable.
Splitting of S1 does not vary with respiration.
Mitrial S1 Sound
principal component, is much louder, reflecting the high pressures on the left side of the heart.
can be heard throughout the precordium and is loudest at the cardiac apex.
Tricuspid S1 Sound
softer component
heard best at the lower left sternal border, and it is here that you may hear a split S1.
Heart murmurs are attributed to...
turbulent blood flow and may be “innocent,” as with flow murmurs of young adults, or diagnostic of valvular heart disease.
stenotic valve
has an abnormally narrowed valvular orifice that obstructs blood flow, as in aortic stenosis, and causes a characteristic murmur.
aortic regurgitation/insufficiency
a valve that fails to fully close
Such a valve allows blood to leak backward in a retrograde direction and produces a regurgitant murmur.
Sounds and murmurs arising from the mitral valve are usually heard best at....
around the cardiac apex
Sounds and murmurs arising from the tricuspid valve are usually heard best at....
near the lower left sternal border
Sounds and murmurs arising from the pulmonic valve are usually heard best at....
the 2nd and 3rd left interspaces close to the sternum but at times may also be heard at higher or lower levels
Sounds and murmurs arising from the aortic valve are usually heard best at....
anywhere from the right 2nd interspace to the apex.
Preload
refers to the load that stretches the cardiac muscle before contraction.

The volume of blood in the right ventricle at the end of diastole, then, constitutes its preload for the next beat.
Right ventricular preload is increased by...
increasing venous return to the right heart.
Physiologic causes include inspiration and the increased volume of blood flow from exercising muscles.
The increased blood volume in a dilated right ventricle of congestive heart failure also increases preload.
Causes of decreased right ventricular preload include....
exhalation, decreased left ventricular output, and pooling of blood in the capillary bed or the venous system.
Myocardial contractility
refers to the ability of the cardiac muscle, when given a load, to shorten.
Myocardial Contractility increases when.....
stimulated by action of the sympathetic nervous system
Myocardial Contractility decreases when.....
blood flow or oxygen delivery to the myocardium is impaired.
Afterload
refers to the degree of vascular resistance to ventricular contraction.
Sources of resistance to left ventricular contraction include...
the tone in the walls of the aorta, the large arteries, and the peripheral vascular tree (primarily the small arteries and arterioles), as well as the volume of blood already in the aorta.
volume overload
pathologic increase in preload
pressure overload
pathologic increase in afterload
arterial pulse
ensuing pressure wave that moves rapidly through the arterial system with each contraction as the left ventricle ejects a volume of blood into the aorta and into the arterial tree.
Blood pressure in the arterial system...
varies during the cardiac cycle, peaking in systole and falling to its lowest trough in diastole
pulse pressure
The difference between systolic and diastolic pressures
Factors Influencing Arterial Pressure:
Left ventricular stroke volume

Distensibility of the aorta and the large arteries

Peripheral vascular resistance, particularly at the arteriolar level

Volume of blood in the arterial system
Jugular venous pressure (JVP) reflects...
right atrial pressure
right atrial pressure equals...
central venous pressure (CVP) and right ventricular end-diastolic pressure
The JVP is best estimated from...
the right internal jugular vein, which has a more direct anatomical channel into the right atrium.
JVP falls with...
loss of blood
JVP increases with...
right or left heart failure, pulmonary hypertension, tricuspid stenosis, and pericardial compression or tamponade.
Jugular venous pressure is considered elevated or abnormal when....
measured at more than 4 cm above the sternal angle, or more than 9 cm above the right atrium