Health Assessment Chapter 21 Part 1

Front 1

the tricuspid valve, composed of three cusps, is located

Back 1

between the right atrium and the right ventricle

Front 2

the biscuspid (mitral valve) is located

Back 2

between the left atrium and left ventricle

Front 3

function of the chordae tendinae

Back 3

anchor av valves flaps to papillary muscles

Front 4

A tough, inextensible, loose fitting, fibroserous sac that attaches to the great vessels and surrounds the heart

Back 4

pericardium

Front 5

the outer surface of the heart

Back 5

epicardium

Front 6

thickest layer of the heart

Back 6

myocardium

Front 7

forms the innermost layer of the heart and is continuous with the endothelial lining of blood vessels

Back 7

endocardium

Front 8

what regulates the events associated with the filling and emptying of the cardiac chambers

Back 8

the generation and conduction of the electrical impulses by specialized sections of the myocardium

Front 9

t or f

Back 9

the atria contract simultaneously

Front 10

the pacemaker of the heart is

Back 10

the SA node

Front 11

Pathways of electrical conduction

Back 11

SA node, AV node, AV bundle (Bundle of His), Purkinje Fibers

Front 12

During Diastole

Back 12

the AV valves are open and ventricles relaxed

higher pressure in the atria than ventricles

Front 13

During Systole

Back 13

the AV valves are shut

Front 14

Closure if the AV valves produces

Back 14

the first heart sound (S1), which is the beginning of Systole

Front 15

the second heart sound (S2) is produced when

Back 15

the Semilunar valves close; this signals the end of the systole

Front 16

during isometric contraction

Back 16

all four valves are closed and the ventricles contract

Front 17

S1 is heard best at the

Back 17

apex of the heart; even though it can be heard over the entire precordium

Front 18

S2 is heard best at the

Back 18

base of the heart

Front 19

an accentuated S1 is louder than S2 and occurs when

Back 19

the mitral valve is wide open and closes quickly

Front 20

Accentuated S1 occurs when

Back 20

1. hyperkinetic states in which blood velocity increases such as fever, anemia , hyperthyroidism

2. mitral stenosis

Front 21

Diminished S1 is softer than S2 and occurs when

Back 21

mitral valve is not fully open at the time of the ventricular contraction an valve closing

Front 22

Diminished S1 occurs in

Back 22

1. delayed conduction from the atria to the ventricles as in 1st degree heart block

2. mitral insufficiency in which extreme calcification of the valve limits mobility

3. delayed or diminished ventricular contraction; noncompliant ventricle, severe pulmonary or systemic hypertension

Front 23

Split S1 occurs when

Back 23

the left and right ventricles contract at different times

Front 24

Examples of Split S1

Back 24

1. conduction delaying the cardiac impulse to one of the ventricles, as in bundle branch block

2. Ventricular ectopy in which the impulse starts in one ventricle, contracting it first, and then spreading to the second ventricle

Front 25

Varying S1 occurs when

Back 25

the mitral valve is in different position when contraction occurs

Front 26

Examples of Varying S1

Back 26

1. rhythms in which the atria and ventricles are beating independently of each other

2. totally irregular rhythm such as atrial fibrillation

Front 27

Accentuated S2 means that S2 is louder than S1 and occurs in conditions which

Back 27

the aortic or pulmonic valve has a higher closing pressure

Front 28

Examples of Accentuated S2

Back 28

• increased pressure in the aorta from exercise, excitement, or systemic hypertension (a booming s2 is heard with systemic hypertension)

• increased pressure in the pulmonary vasculature, which may occur with mitral stenosis or congestive heart failure

• calcification of the semilunar valve, in which the valve is still mobile, as in pulmonic or aortic stenosis

Front 29

Diminished S2 means that S2 is softer than S1 and occurs in conditions which

Back 29

the aortic o pulmmonic valves have decreased mobility

Front 30

Examples of Diminished S2

Back 30

• decreased systemic blood pressure, which weakens the valves, as in shock

• Aortic or pulmonic stenosis, in which the valves are thickened and calci- fied, with decreased mobility

Front 31

normal split S2 can be heard over the second or third intercostal space and is usually heard best during

Back 31

inspiration; and disappears during expiration

Front 32

Splitting that does not disappear during expiration is suggestive of

Back 32

heart disease

Front 33

Wide spit S2 is an increase in the usual spitting that persistts throughout the entire respiratory cycle and widens on expiration. it occurs when there is

Back 33

delayed electrical activation of the right ventricle

Front 34

An example of wide split S2

Back 34

right bundle branch block which delays pulmonic branch closing

Front 35

Fixed split S2 is wide splitting that does not vary wit respiration. it occurs when

Back 35

there is delayed closure of one of the valves

Front 36

Example of Fixed Split S2

Back 36

atrial septal defect and right ventricular failure which delays pulmonic valve closing

Front 37

Reversed split S2 appears on expiration and disappears on inspiration (paradoxical split). Occurs when

Back 37

closure of the aortic valve is abnormally delayed, causing A2 to follow P2 in expiration.]

Ex. Left bundle branch block

Front 38

S2 and S3 result from

Back 38

ventricular vibrations secondary to rapid ventricular filling

Front 39

S3 (ventricular gallop)

Back 39

can be heard early in diastole

Front 40

S4 (atrial gallop)

Back 40

can be heard late in diastole

Front 41

Conditions that contribute to turbulent blood flow include

Back 41

1. increased blood velocity

2. structural valve defects

3. valve malfunction

4. abnormal chamber openings (septic defects)

Front 42

the amount of blood pumped by the ventricles during a given period of time

Back 42

Cardiac output

(5 to 6 L/min)

Front 43

Formula for CO

Back 43

SV*HR

Front 44

The amount of blood pumped from the heart with each contraction

Back 44

Stroke volume

(70 ml on left ventricle)

Front 45

Stroke Volume is influenced by

Back 45

• The degree of stretch of the heart muscle up to a critical length before contraction (preload); the greater the preload, the greater the stroke volume. This holds true unless the heart muscle is stretched so much that it cannot contract effectively.

• The pressure against which the heart muscle has to eject blood during contraction (afterload); increased afterload results in decreased stroke volume.

•Synergy of contraction (i.e. the uniform, synchronized contraction of the myocardium); conditions that cause an asynchronous contraction decrease stroke volume.

• Compliance, or distensibility, of the ventricles; decreased compliance decreases stroke volume.

• Contractility, or the force of contractions, of the myocardium under given loading conditions; increased contractility increases stroke volume.