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157 Cards in this Set
- Front
- Back
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What are heart murmurs?
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They are abnormal heart noises, either abnormalities of 1st & 2nd heart sounds or additional abnormal noises.
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How are heart murmurs generated?
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They are generated by turbulent blood flow through altered valves, abnormal openings or extracardial events
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What are the abnormal openings that can help generate a heart murmur?
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ductus arteriosus, foramen ovale, ventricle septum defect, stenotic vessels
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What extracardial events can generate a heart murmur?
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fibrinous pericarditis
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What is fibrinous pericarditis?
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rubbing of heart & pericardium
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How are heart murmurs graded?
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By their intensity
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What is a Grade 1 heart murmur?
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nearly imperceptible (quiet room, stethoscope right over the punctum maximum)
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What is a Grade 2 heart murmur?
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soft, but definite (audible right over the punctum maximum)
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What is a Grade 3 heart murmur?
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low to moderate (audible also at some distance to the punctum maximum)
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What is a Grade 4 heart murmur?
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loud (audible all over the chest, but no palpable “thrill”
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What is a Grade 5 heart murmur?
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very loud (audible throughout the chest with a palpable “thrill”)
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What is a Grade 6 heart murmur?
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very loud
(audible even when the stethoscope is not in contact with the chest wall,and palpable “thrill”) |
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What is stenosis?
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the term for an acquired or congenitally undersized valve or vessel.
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How does stenosis generate a heart murmur?
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Blood being pushed through the (semilunar valves) during the systole or (AV valves)during the diastole generates the murmur.
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What are insufficiency's or incompetency?
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is the term for a leakage of a valve during its closure.
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How are heart murmurs generated from insufficiency or incompetency?
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blood squeezes through the opening in the reverse (wrong) direction during systole (AV valves) or diastole (semilunar valves) generates the murmur
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________ are involved in the generation, but are not the source of heart sounds.
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valve
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What is mitral insufficiency?
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It is the failure of the mitral valve to close & allows backflow of blood from the left ventricle into the left atrium.
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When does mitral insufficiency begin & end.
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Begins during QRS complex (systole) & ends during the T wave (end of systole).
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What murmur is caused by mitral insufficiency?
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Systolic murmur
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What murmur is caused by mitral stenosis?
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diastolic murmur
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What murmur is caused by aortic insufficiency?
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extended diastole murmur
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What murmur is caused by aortic stenosis?
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systolic murmur
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What type of murmur is caused by patent ductus arteriosus?
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machinery murmur
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What are the causes of a machinery murmur?
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combination of stenosis & insufficiency
patent ductus arteriosus |
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What are the 3 shunts during fetal development?
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ductus arteriosus
foramen ovale ductus venosus |
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_________ has no relationship to heart sounds & murmur
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ductus venosus
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What 2 shunts have high resistance through collapsed lung?
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ductus arteriosus
Foramen ovale |
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A patent ductus arteriosus causes a systolic-diastolic murmur called ______.
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machinery murmur
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_________ reverses the flow of oxygenated blood through the ductus arteriosus
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patent ductus arteriosus
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In the course of birth the inflation of the lung reverses the blood pressures in the left/right heart causing ______.
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PDA
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________ is hardly diagnosed b/c the atrial pressures are too low to generate audible murmurs.
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patent foramen ovale
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What are 2 causes of conduction system failure?
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Cardiac electrical abnormalities
cardiac structural abnormalities |
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What are 2 examples of Cardiac electrical abnormalities?
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excitation disturbances
conduction disorder |
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What are 2 examples of cardiac structural abnormalities?
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morphological abnormalities
functional abnormalities |
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What is an example of excitation disturbances?
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failure of the SA node
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What is an example of conduction disorder?
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AV block
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What is an example of morphological abnormalities?
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hypertrophy of the right ventricle
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What is an example of functional abnormalities?
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cardiac infarction
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Conduction system failures become __________.
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technical alterations
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What are 2 examples of excitation disturbances?
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nomotopic dysfunctions
heterotopic dysfunctions |
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What are 3 examples of nomotopic dysfunctions?
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Sinus arrhythmia
Sinus tachycardia Sinus bradycardia |
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What are some examples of heterotopic dysfunctions?
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Escape rhythm
Extrasystoles Shifting pacemaker Supraventricular tachycardia Atrial flutter Atrial fibrillation Ventricular tachycardia Ventricular flutter Ventricular fibrillation |
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___________ are abnormalities in the cardiac rhythm.
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Arrhythmias
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_________ are physiological in dogs! Increase during inspiration, decrease during expiration (=> vagal tone)
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Arrhythmias
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Normal P waves preceding regularly the QRST intervals indicate that each sequence is initiated by the SA node in a ___________.
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Sinus Arrhythmia
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In __________ the SA node is the pacemaker, but initiates APs at a rate to high (higher than the normal physiological heart rate)
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Sinus Tachycardia
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In __________ the SA node is the pacemaker, but initiates APs at a rate to low (lower than the normal physiological heart rate)
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sinus bradycardia
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In an extreme sinus bradycardia the intrinsic rate of the AV node exceeds the sinus rate and the AV node takes over, this is an example of __________.
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escape Rhythm
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If the cause is a failing AV node (=AV block) then one of the lower auxiliary pacemakers takes over (bundle of His, etc), this an example of ________.
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escape rhythm
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When a double P wave occurs due to an extra SA Node signal before firing, this is referred to as ________.
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supraventricular extrasystole
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Name 3 characteristics of a supraventricular extrasystole.
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Premature stimulus generated by heterotopic atrial focus.
“Normal” SA stimulus has no effect. Next systole follows at the interval dedicated by the sinus rhythm |
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________ is when the SA node fails & the ectopic atrial pacemaker takes over causing the pacemaker to shift.
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shifting pacemaker
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In a ECG a __________ alters the P wave & the PQ segment.
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shifting pacemaker
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Premature stimulus generated by heterotropic ventricular focus & systole follows at the interval dedicated by the sinus rhythm, describes _________.
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ventricular extrasystole
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_________ is caused by high rate of APs generated in the atrium & different P wave shapes that indicate ectopic atrial pacemakers.
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supraventricular tachycardia
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_______ are physiological noises generated by oscillations of blood & vibrations of muscles & valves.
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heart sounds
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Auscultations on the left side of the body consists of what?
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Pulmonary valve
Aortic valve Bicuspid valve |
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Auscultations on the right side of the body consists of what?
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tricuspid valve
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3 out of 4 heart sounds are ________ sounds
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diastolic
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What does the first heart sound consist of?
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systole, causing closure of the AV valves & ventricle contraction
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What does the second heart sound consist of?
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diastole, causes closure of the semilunar valves & interruption of blood flow
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Which heart sound is the loudest one?
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first
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Myocardial infarctions alter what deflections of the ECG?
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QRS
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What is an atrial flutter?
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Heterotopic excitation disturbances that causes a high atrial rate of 220-350 beats/min, not terminal.
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What is an atrial fibrillation?
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Heterotopic excitation disturbances that causes a high atrial rate of 350-600 beats/min
causes death |
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In __________ tachycardia, the P wave comes from the atria & all other waves come from the ventricle
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ventricular
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What heterotopic excitation disturbance can cause functional failure of both atria?
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atrial flutter & fibrillation
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The absence of regular preceding P waves indicates that the R waves are generated by a ventricular pacemaker, this is caused by ________.
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ventricular tachycardia
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Ventricular flutter & fibrillation have different ________.
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paper speeds
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In ________ flutter & fibrillation, multifocal excitation ceases pumping function.
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ventricular
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What is an AV Block?
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Different conditions either decrease the rate of conduction of the impulse through the AV node & the Bundle of His or block the impulse entirely
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During ______ the only means an AP can ordinarily pass from the atria into the ventricle is through the AV node & Bundle of His.
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AV Block
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The conduction through the AV node & the bundle of His can be affected by what?
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ischemia
compression inflammation extreme vagal tone |
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_________ can increase during inspiration, decrease during expiration & cause vagal tonus.
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arrhythmias
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What is ischemia?
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reduced or no blood supply
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In a _______ AV block, AV conduction is abnormally slow.
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first degree
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PQ segment would be missing during a ______ AV block.
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first degree
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_______ AV block causes dropped beats.
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second degree
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______ AV blocks cause random P waves with no ventricular contractions
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second degree
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_______ AV block would cause conduction to fail completely.
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third-degree
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________ AV block has no propagation & causes a total block.
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third degree AV block
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In a _______ AV block a decreased rate of conduction through the AV node & bundle of His prolongs the PQ interval beyond its physiological value.
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first degree
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Normally the PQ interval decreases w/ increasing heart rate & vice versa during _______ AV Block.
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first degree
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What is a dropped beat?
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It is when conduction from the atrium to the ventricle fails causing the atrium to depolarize & generate only a P wave & drops the other deflections.
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During a ________ AV block, the ventricle doesn't contract.
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second degree
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______ AV block causes the connection between the atrium & ventricle to break.
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third degree
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During _______ AV block the atrium & ventricle beat at a different rate
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third degree
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During a third degree AV block, the ventricle needs a _________ to take over & then the ventricle beats independently.
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auxiliary pacemaker
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Hypertrophy is an example of what type of conduction system failure?
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morphological abnormalities
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________ causes an increase in cardiac muscle cell size.
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hypertrophy of the right ventricle
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________ of the right ventricle can cause a shift in the cardiac vector to the right.
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hypertrophy
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What are the 3 causes of conduction system failure?
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cardiac electrical abnormalities
cardiac structural abnormalities technical alterations |
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What are 2 examples of technical alteration abnormalities
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electrical interference
trembling patient |
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______ is caused by no contact or poor contact of leads, dry skin, powerful electrical equipment nearby & causes alterations to the ECG.
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electrical interference
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_______ can resemble an atrial flutter or fibrillation in an ECG.
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electrical interference
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_______ can cause skeletal muscle contractions to interfere w/ the ECG signals.
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trembling patient
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_________ means failure of the heart to pump blood adequately to meet the needs of the body, usually caused by some malfunction of the heart.
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heart failure
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What are the 3 ways heart failure may manifest?
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-a decrease in cardiac output
-a damming of blood behind left or right heart -overloading the heart through an increased cardiac output |
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What are the 3 types of heart failure?
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low output failure
high output failure high pressure failure |
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In _____ heart failure, the total cardiac output falls below the required minimum.
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low output failure
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What are the 3 types of low output heart failure?
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compensated
decompensated unilateral |
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________ heart failure is when the heart fails but recovers in so far as the minimum cardiac output is restored.
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compensated
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The cardiac reserve remains reduced during _______ heart failure.
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compensated
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________ heart failure is when the minimum cardiac output is not restored & death can ensue.
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decompensated
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________ heart failure is when only one side, either the right or left side of the heart fails.
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unilateral
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________ heart failure is when the heart is forced to pump more blood than required because of some bypass of the normal circulation.
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High output
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In ________ heart failure, continuous volume overload causes heart failure.
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high output
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In ________ heart failure, the heart is forced to develop more pressure than normally required b/c of an unphysiological high resistance in the circulation.
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high pressure
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In a healthy heart _______ & atrial pressure are related.
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cardiac output
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A higher atrial pressure (higher preload) results in turn in a better filling of the ventricles or _________
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higher enddiastolic volume
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When cardiac fibers are longer, they develop more force & the heart can _______.
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pump more blood
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________ pertains to "The longer-the stronger"
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cardiac muscle
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When tissues increase their metabolism & demand more blood, the heart responds by increasing _______
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cardiac output
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Higher _______ pressure results in a better filling of the ventricles(higher endodiastolic volume)
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atrial
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The ____ cardiac output is determined by the limitations to the heart, that is the maximal achievable heart rate & max stroke volume possible
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max
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The ______ CO is determined by all peripheral tissues.
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minimum
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What is the minimum cardiac output?
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blood volume required to maintain their metabolism w/o suffering.
ex. 5L/min |
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In a _______ the heart gets weak & loses its pumping ability (decreases contractility)
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heart failure
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In ________ the CO drops below the required minimum
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heart failure
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Because of low CO blood returning from the tissues, the blood backs up in the atria & causes an increase in _________.
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atrial pressure
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During heart failure when atrial pressure increases, within seconds a _________ stimulation strengthens the heart muscle
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sympathetic
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What are the 3 immediate counter measures of heart failure?
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Positive entropic effect
hormone release release of renin from kidney to stabilize blood pressure |
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During heart failure, as long as the required minimum in CO is not achieved _______ by the kidney continues.
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water & NaCL retention
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What can increase CO during heart failure?
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heart recovery & increase in preload, increase the CO
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During heart failure when the minimum CO is achieved ________ stops.
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water & NaCl retention
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What is the cause of fluid retention in the kidneys?
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decrease in blood pressure
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_______ after a moderate damage of the heart means that pumping ability is reduced to 40-50%.
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fluid retention
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What are the beneficial effects of fluid retention after moderate damage to the heart?
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-better systemic filling
-cardiac output may return to normal values. |
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What is fluid retention after a severe damage of the heart?
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It's pumping ability is less than 25-45% of normal.
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What are the detrimental effects of fluid retention after a severe damage of the heart?
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over stretching of the heart causing further weakening
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How does fluid retention after a severe damage of the heart effect the kidney?
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Causes perfusion of the kidneys to be too low to balance salt water intake & output causing fluid & salt retention.
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What is included in the reparative process following a myocardial infarction?
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remove bad tissue & replace w/ CT w/ new blood supply
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________ meets the needs of tissues at the expense of an increased atrial pressure
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CO
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During ________ heart failure, the kidneys continue to retain water & salt excessively, which causes blood volume to increase beyond its physiological limits.
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decompensated
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Decompensated heart failure causes ________ & ______ which both lead to death.
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progressive edema, overstretching of the heart
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During decompensated heart failure the ventricles become _______ & overstretches the cardiac muscle fibers causing overfilling of the vessels which is caused by ______.
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dialated
cardiac edema |
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__________ & _______ weaken the heart & trigger a vitious circle
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cardiac edema & ventricular dilation
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What does unilateral heart failure of the left side cause?
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edema in the lungs
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What does unilateral heart failure of the right side cause?
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cause edema in the body (ascites)
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When the mean pressure in the lung rises from 8 mmHg to 23 mmHg thus forcing more fluid into the interstitium causing _______.
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pulmonary edema
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The interstitium can keep a certain volume of excessive fluid during unilateral heart failure called _______.
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interstitial edema
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If interstitial edema occurs additional fluid volume can fill the lung alveoli causing _______.
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alveolar edema
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When does right heart failure occur?
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Usually only in conjunction w/ left heart failure
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When does high output heart failure occur?
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When the heart is forced to pump more blood than demanded by the tissues.
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What are the two causes for unphysiological high cardiac output in high output heart failure?
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arterio-venous shunts
low resistance to blood flow |
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During embryonic development the lung is bypassed by a shunt called the _________.
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ductus arteriosus
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What is considered the permanent loop if a ductus arteriosus remains after birth?
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left ventricle – lung – left ventricle
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What happens with a PDA with a large opening?
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a higher volume of the ejected blood flows to the lung rather than to the peripheral tissues.
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____________ increases the workload of the left ventricle & causes muscle hypertrophy over time.
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Ventricle septum defect
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What are the 3 embryological defects associated w/ tetralogy of Fallot?
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Dextra aorta
ventricle septum defect pulmonary stenosis |
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What are 4 incidences that are caused by high output failure?
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PDA
tertaology of fallot ventricle septal defect low resistance to blood flow |
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What is the physiological problem caused by tetralogy of Fallot?
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Causes the right ventricle to dilate due to high pressure
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Low resistance to blood flow can be caused by what metabolic disorder?
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Beriberi
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Dysfunction of the ANS can result in a metabolic disorder called _______.
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Beriberi
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Hypertrophy can be caused by ________.
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high pressure heart failure
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_______ means that the already existing muscle fibers grow in size, but no new ones are added.
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hypertrophy
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