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185 Cards in this Set
- Front
- Back
What costal cartilage does the heart span?
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3rd to 6th
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The area of the chest overlying the heart is the ___
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precordium
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In a tall, slender person, the heart tends to hang ____ and to be positioned ___
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vertically,centrally
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With increasing stockiness and shortness, it heart tends to lie more to the ___and more ___
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left, horizontally
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heart may be positioned to the right, either rotated or displaced, or as a complete mirror image of the expected
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dextrocardia
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heart and stomach are placed to the right and the liver to the left, this habitus is termed ____.
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situs inversus
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tough, double-walled, fibrous sac encasing and protecting the heart.
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pericardium
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thin outermost muscle layer, covers the surface of the heart and extends onto the great vessels
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epicardium
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thick muscular middle layer, is responsible for the pumping action of the heart
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myocardium
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innermost layer, lines the chambers of the heart and covers the heart valves and the small muscles associated with the opening and closing of these valves
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endocardium
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The left heart and right heart are divided by a blood-tight partition called the ____
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cardiac septum
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Most of the anterior surface of the heart is formed by the___
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right ventricle
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The ____ is positioned behind the right but extends anteriorly, forming the left border of the heart.
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left ventricle
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apical impulse usually felt in the___ at the midclavicular line.
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fifth left intercostal space
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The adult heart is about __ cm long, __ cm wide at the widest point, and __ cm in its anteroposterior diameter
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12cm, 8cm, 6cm
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The __ valve, which has ___ cusps (or leaflets), separates the right atrium from the right ventricle
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tricuspid, three
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The __ valve, which has __ cusps, separates the left atrium from the left ventricle
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mitral , two
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The two semilunar valves each have ___ cusps
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three
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The ___ valve separates the right ventricle from the pulmonary artery
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pulmonic
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The __ valve lies between the left ventricle and the aorta
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aortic
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During diastole, the ___ dilate, an ___ effort that draws blood into the ventricles as the atria contract, thereby moving blood from the atria to the ventricles
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ventricles, energy-requiring
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Which valves close to make the Lubb sound?what heart sound is this?
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mitral and tricuspid valves closed, S1
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Which valves close to make the Dubb sound?what heart sound is this?
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aortic and pulmonic , S2
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A2 is produced by ___ closure
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aortic valve
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P2 is produced by ___ closure
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pulmonic valve
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What makes the S3 heart sound?
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Diastole is a relatively passive interval until ventricular filling is almost complete. This filling sometimes produces a third heart sound (S3).
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What makes the S4 heart sound?
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Then the atria contract to ensure the ejection of any remaining blood. This can sometimes be heard as a fourth heart sound (S4).
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What is split S2 heart sound?
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aortic valve closes slightly before the pulmonic, so that S2 is often heard as two distinct components
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In ECG, ___ the spread of a stimulus through the atria (atrial depolarization)
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P wave
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In ECG, ___ -the time from initial stimulation of the atria to initial stimulation of the ventricles,
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PR interval
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In ECG, ___ and ___ are return of stimulated ventricular muscle to a resting state (ventricular repolarization).
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ST segment and T wave
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In ECG,___ a small deflection sometimes seen just after the T wave
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U wave
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In ECG, ___ is the time elapsed from the onset of ventricular depolarization until the completion of ventricular repolarization. The interval varies with the cardiac rate.
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Q-T interval
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PR interval is usually __ seconds
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usually 0.12 to 0.20 second.
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QRS is usually __ seconds
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less than 0.10 second
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When the heart is beating at a rate of ___ beats per minute, ventricular systole is shorter than diastole
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68 to 72
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as the heart rate increases to about __ because of stress or pathologic factors, the two phases of the cardiac cycle tend to approximate each other in length.
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120beats/min
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The fetal circulation, the right ventricle pumps blood through the ___ rather than into the lungs
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patent ductus arteriosus
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The fetal circulation, The right and left ventricles are equal in weight and muscle mass because__________
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they both pump blood into the systemic circulation
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The heart lies more ___ in the chest in infants and young children than in the adult, and as a result the apex of the heart rides higher, sometimes well out into the ____
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horizontally,fourth left intercostal space
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In most cases, the adult heart position is reached by the age of ___years.
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7
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The maternal blood volume increases ___ to __ over the pre-pregnancy level.
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40% to 50%
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On the average, plasma volume increases __ with a single pregnancy and as much as __ with a twin pregnancy
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50%, 70%
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When is cardiac output highest in pregnancy?
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25 to 32 weeks of gestation
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In pregnancy, The cardiac output increases approximately __ over that of the nonpregnant state
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30% to 40%
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In older adults, The left ventricular wall ___ and the valves tend to ___
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thickens, fibrose and calcify
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In Older Adults, The heart rate ___ (although resting heart rate may not be significantly influenced by age), stroke volume ___, and cardiac output during exercise declines by___
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slows,decreases, 30% to 40%
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In Older Adults, The endocardium ___ The myocardium becomes ___
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thickens,less elastic and more rigid
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Older Adults, Cardiac function is further compromised by___ in the region of the SA node and in the heart valves (particularly the mitral valve and aortic cusps), by ___ tone, and by decreased ___sensitivity.
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fibrosis and sclerosis, increased vagal, baroreceptor
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____ is traditionally described as a pressure or choking sensation substernally or into the neck
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Angina pectoris
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Angina pectoris, may radiate to the __ and down the ___
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jaw, left (and sometimes the right) arm
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The ____, for example, is a sudden, sharp, relatively brief pain that does not radiate, occurs most often at rest, and is unrelated to exertion and may not have a discoverable cause. It may cause concern.
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precordial catch
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What are common causes of cardiac pain in kids?
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trauma, exercise-induced asthma, cocaine
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sudden turning of neck
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carotid sinus effect
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looking upward could be a sign of ___
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vertebral artery occlusion
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Type of Chest Pain: Substernal, provoked by effort, emotion, eating; relieved by rest and/or nitroglycerin; often accompanied by diaphoresis, occasionally by nausea
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Anginal
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Type of Chest Pain:Precipitated by breathing or coughing- usually described as sharp- present during respiration- absent when breath held
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Pleural
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Type of Chest Pain: Burning, substernal, occasional radiation to the shoulder- nocturnal occurrence, usually when lying flat- relief with food, antacids, sometimes nitroglycerin
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Esophageal
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Type of Chest Pain:Almost always infradiaphragmatic and epigastric- nocturnal occurrence and daytime attacks relieved by food- unrelated to activity
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From a peptic ulcer
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Type of Chest Pain: Usually under right scapula, prolonged in duration- often occurring after eating- will trigger angina more often than mimic it
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Biliary
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Type of Chest Pain: Usually lasts for hours- local tenderness and/or pain with movement
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Arthritis/bursitis
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Type of Chest Pain: Associated with injury- provoked by activity, persists after activity- painful on palpation and/or movement
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Cervical
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Type of Chest Pain:Intensified or provoked by movement, particularly twisting or costochondral bending- long lasting- often associated with focal tenderness
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Musculoskeletal (chest)
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Type of Chest Pain: Associated with/after anxiety- poorly described- located in intra-mammary region
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Psychoneurotic
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Exercise Intensity: Walking 10 to 15 steps, preparing a simple meal for one, retrieving a newspaper from just outside the door, pulling down a bedspread, brushing teeth
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Light
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Exercise Intensity: Making the bed, dusting and sweeping, walking a level short block, office filing
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Moderate
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Exercise Intensity: Climbing one or two flights of stairs, lifting full cartons, long walks, sexual intercourse
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Moderately heavy
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Exercise Intensity:Jogging, vigorous athletics of any kind, cleaning the entire house in less than a day, raking a large number of leaves, mowing a large lawn, shoveling deep snow
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Heavy
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St. Vitus dance aka
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Sydenham chorea
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About ___ persons has a congenital heart problem; once it occurs in a family, the likelihood of its recurring increases to ___ times the incidence in the general population, particularly with a ___-sided lesion
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1 in 100, three to five, left
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How do you calculate pack-years?
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number of years smoking times number of packs per day
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What is the illegal drug known as poppers?
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amyl nitrate
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What is this personality, characterized by negative emotions, pessimistic attitude, and failure to share emotions
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type D personality
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What is this personality, characterized by hostile attitudes, inability to relax, and compulsive behavior
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type A personality
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potassium ___ (weakness, bradycardia, hypotension, confusion)
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excess
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potassium ___ (weakness, fatigue, muscle cramps, dysrhythmias)
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depletion
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which drug has these side effects: anorexia, nausea, vomiting, diarrhea, headache, confusion, dysrhythmias, halo, yellow vision
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digitalis toxicity
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What are these signs of crackles in the lungs, engorgement of the liver, and peripheral edema?
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signs of heart failure
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Osler nodes or Janeway lesions of ___
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bacterial endocarditis
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Proper order for assessing cardiac function
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inspection and proceeding to palpation, percussion, and then auscultation
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apical impulse should be visible at about the ___ line in the ___ intercostal space
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midclavicular, fifth left
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A readily visible and palpable impulse when the patient is ___suggests an intensity that may be the result of a problem.
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supine
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The absence of an apical impulse in addition to faint heart sounds, particularly when the patient is in the left lateral recumbent position, suggests some ___
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intervening extracardiac problem, such as pleural or pericardial fluid
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The size of a apical impulse is about
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1cm
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If the apical impulse is more vigorous than expected, lasting as long as systole, characterize it as a __
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heave or lift
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An apical impulse that is more forceful and widely distributed, fills systole, or is displaced laterally and downward may indicate ___ or ___
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increased cardiac output or left ventricular hypertrophy.
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A lift along the left sternal border may be caused by_____.
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right ventricular hypertrophy
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A loss of thrust may be related to ___ or ___
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overlying fluid or air or to displacement beneath the sternum
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Displacement to the right without a loss or gain in thrust suggests ___, ___, ___, or ___
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dextrocardia, diaphragmatic hernia, distended stomach, or a pulmonary abnormality
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fine, palpable, rushing vibration, a palpable murmur, often, but not always, over the base of the heart in the area of the right or left second intercostal space
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thrill
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Thrills, generally indicates a disruption of the expected blood flow related to some defect in the closure of one of the ___ , ___, or ___
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semilunar valves (generally aortic or pulmonic stenosis), pulmonary hypertension, or atrial septal defect
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The carotid pulse and ___ are practically synchronous
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S1
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The carotid pulse is located just medial to and below the___
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angle of the jaw
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Thrill during Systole: Suprasternal notch and/or second and third right intercostal spaces
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Aortic stenosis
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Thrill during Systole: Suprasternal notch and/or second and third left intercostal spaces
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Pulmonic stenosis
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Thrill during Systole: Fourth left intercostal space
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Ventricular septal defect
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Thrill during Systole: Apex
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Mitral regurgitation
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Thrill during Systole: Left lower sternal border
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Tetralogy of Fallot
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Thrill during Systole: Left upper sternal border, often with extensive radiation
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Patent ductus arteriosus
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Thrill during Diastole: Right sternal border
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Aortic regurgitation, Aneurysm of ascending aorta
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Thrill during Diastole: Apex
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Mitral stenosis
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The right ventricle tends to enlarge in the ___diameter rather than___
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anteroposterior , laterally
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best position to hear relatively high-pitched murmurs with the stethoscope diaphragm
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Patient sitting up and leaning slightly forward and, preferably, in expiration
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best position to hear the low-pitched filling sounds in diastole with the stethoscope bell
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Patient left lateral recumbent
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best position for evaluating right rotated heart of dextrocardia
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Patient right lateral recumbent
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auscultatory area: second right intercostal space at the right sternal border
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Aortic valve area
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auscultatory area:second left intercostal space at the left sternal border
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Pulmonic valve area
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auscultatory area:third left intercostal space at the left sternal border
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Second pulmonic area
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auscultatory area:fourth left intercostal space along the lower left sternal border
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Tricuspid area
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auscultatory area:at the apex of the heart in the fifth left intercostal space at the midclavicular line
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Mitral (or apical) area
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Which heart sounds marks the beginning of systole
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S1
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What heart sound coincides with the rise (upswing) of the carotid pulse?
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S1
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What heart sound marks the initiation of diastole
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S2
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Split S2 is best heard in the____ area.
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pulmonic auscultatory
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Where is S1 BEST heard louder then S2?
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toward the apex
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Which heart sound is louder at the base of the heart, S1 or S2?
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S2
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How does the S1 compare to S2?
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lower in pitch and a bit longer than S2, and it occurs immediately after diastole
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What conditions can cause blood velocity to be increased in the heart?
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anemia, fever, hyperthyroidism, anxiety, and during exercise.
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What can produce a louder S1? 2 things
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Blood velocity increased, mitral valve stenotic
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How does S2 intensity change:Systemic hypertension, syphilis of the aortic valve, exercise, or excitement
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Increases
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How does S2 intensity change:Pulmonary hypertension, mitral stenosis, and congestive heart failure
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Increases
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How does S2 intensity change:The valves are diseased but still fully mobile; the component of S2 affected depends on which valve is compromised.
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Increases
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How does S2 intensity change:A shocklike state with arterial hypotension causes loss of valvular vigor.
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Decreases
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How does S2 intensity change:The valves are immobile, thickened, or calcified
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Decreases
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How does S2 intensity change:Aortic stenosis affects A2
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Decreases
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How does S2 intensity change:Pulmonic stenosis affects P2
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Decreases
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How does S2 intensity change:Overlying tissue, fat, or fluid
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Decreases
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Where is a split of S1 beat heard?
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tricuspid area
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Which heart sound result of closure of the semilunar valves, indicates the end of systole
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S2
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Where is S2 best heard?
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aortic and pulmonic areas
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How does S2 compare to S1 at the base of the heart?
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It is of higher pitch and shorter duration than S1. S2 is louder than S1 at the base of the heart
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How does S2 compare to S1 at the apex of the heart?
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softer than S1 at the apex
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failure of the mitral and tricuspid valves or the pulmonic and aortic vales to close simultaneously
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Splitting
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When is splitting of S1 best heard?
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may be audible in the tricuspid area, particularly on deep inspiration.
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S2 is actually two sounds that merge during ___
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expiration
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The closure of the ___ contributes most of the sound of S2
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aortic valve (A2)
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Where is S2 heard?
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aortic or pulmonic areas
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During ___, P2 occurs slightly later, giving S2 two distinct components; this is a split S2
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inspiration
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If P2 is heard outside the ___ area, it is most often unusually loud or delayed.
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pulmonary
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Splitting of S2 is greatest at the peak of ___
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inspiration
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Ejection times tend to equalize when the breath is held in ___, so this maneuver also tends to eliminate the split
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expiration
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The degree of S2 splitting is most evident during ___
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inspiration
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Which heart sound, During diastole, the ventricles fill in two steps: an early, passive flow of blood from the atria is followed by a more vigorous atrial ejection. The passive phase occurs relatively early in diastole, distending the ventricular walls and causing vibration.
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S3
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Which heart sound, In the second phase of ventricular filling, vibration in the valves, papillae, and ventricular walls
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S4
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Wide splitting of __ also occurs when stenosis delays closure of the pulmonic valve, when pulmonary hypertension delays ventricular emptying, or when mitral regurgitation induces early closure of the aortic valve
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S2
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The split becomes ___ when there is delayed activation of contraction or emptying of the right ventricle resulting in delay in pulmonic closure
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wider
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The split becomes narrower and is even eliminated or paradoxic when closure of the aortic valve is delayed, such as in ___.
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left bundle branch block
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A RBBB which make a S1 S2 split _
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Wider
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Splitting is said to be ___ when it is unaffected by respiration
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fixed
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This occurs with delayed closure of the pulmonic valve when output of the right ventricle is greater than that of the left
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Fixed splitting
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What type of split is caused by large atrial septal defects?
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Fixed splitting
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What type of split is caused by septal defect with left to right shunting?
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Fixed splitting
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What type of split is caused by right ventricular failure?
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Fixed splitting
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____ occurs when closure of the aortic valve is delayed (such as in left bundle branch block) so that P2 occurs first, followed by A2
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Paradoxic splitting
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Paradoxic (Reversed) Splitting, In this case, the interval between P2 and A1 is heard during ___ and disappears during ___.
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expiration,inspiration.
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asking the patient to raise a leg
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Increase Venous return
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asking the patient to grip your hand vigorously and repeatedly
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Increase Arterial Pressure
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When S3 becomes intense and easy to hear, the resultant sequence of sounds simulates a ____
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gallop; this is the protodiastolic gallop rhythm
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S3 may be ___ if filling pressure is increased or if ventricular compliance is reduced
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louder
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Best position to hear S3
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left lateral decubitus (recumbent) position
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Heart sound change with increased resistance to filling because of loss of compliance of the ventricular walls (e.g., in hypertensive disease and coronary artery disease)
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increased S4
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Heart sound change with the increased stroke volume of high-output states (e.g., in profound anemia, pregnancy, and thyrotoxicosis)
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increased S4
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The rhythm of the heart sound when an ___ is heard resembles the rhythm of pronouncing the word Ken-TUCK-y
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S3
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When an__ is heard, it resembles the rhythm of pronouncing the word TEN-nes-see
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S4
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___ may produce an opening snap (mitral valve), ejection clicks (semilunar valves), or mid-to-late nonejection systolic clicks (mitral prolapse).
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Valvular stenosis
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The pulmonary ejection click is best heard on __ and is seldom heard on ___
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expiration, inspiration
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___ are less sharp, are less involved with S1, and may be heard as distant as the anterior axillary line
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aortic ejection clicks
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Extra heart sounds often accompany __ and should always be considered indicative of a pathologic process.
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murmurs
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Pericardial friction rub may have three components that are associated in sequence with the__, __, __
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atrial component of systole, ventricular systole, and ventricular diastole
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A ___ is a grating sound that may be intense enough to obscure the heart sounds.
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three-component friction rub
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If there are only one or two components friciton rub, the sound may not be intense or machine-like and may then be more difficult to distinguish from an ___
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intracardiac murmur
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prosthetic mitral valve, listen for a distinct click early in __ loudest at the ___ and transmitted precordially
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diastole, apex
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A prosthetic aortic valve causes a sound in ___
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early systole
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Extra Heart Sounds: Bell at apex; patient left lateral recumbent Early diastole, low pitch
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Increased S3
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Extra Heart Sounds: Bell at apex, patient supine or in the left lateral recumbent position Late diastole or early systole, low pitch
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Increased S4
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Extra Heart Sounds: Bell at apex; patient supine or left lateral recumbent position Presystole, intense, easily heard
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Gallops
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Extra Heart Sounds:Diaphragm medial to apex, may radiate to base. any position, second left intercostal space Early diastole briefly, before S3. high pitch, sharp snap or click; not affected by respiration, easily confused with S2
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Mitral valve opening snap
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Extra Heart Sounds:Diaphragm; patient sitting or supine
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Ejection clicks
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Extra Heart Sounds:Apex, base in second right intercostal space Early systole, intense, high pitch; radiates; not affected by respirations
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Aortic valve Ejection clicks
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Extra Heart Sounds:Second left intercostal space at sternal border Early systole, less intense than aortic click. intensifies on expiration, decreased on inspiration
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Pulmonary valve Ejection clicks
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Extra Heart Sounds:Widely heard, sound clearest toward apex May occupy all of systole and diastole. intense, grating, machine-like. may have three components and obliterate heart sounds; if only one or two components, may sound like murmur
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Pericardial friction rub
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___ are caused by some disruption in the flow of blood into, through, or out of the heart
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Murmurs
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____ are relatively prolonged extra sounds heard during systole or diastole; they often indicate a problem
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Heart murmurs
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When the leaflets are thickened and the passage narrowed, forward blood flow is ____
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restricted (stenosis)
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When valve leaflets, which are intended to fit together snugly, lose competency, the slack openings allow____
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backward flow of blood (regurgitation).
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