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157 Cards in this Set

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