Heart Chpt 14 Seidel Part 1

Front 1

What costal cartilage does the heart span?

Back 1

3rd to 6th

Front 2

The area of the chest overlying the heart is the ___

Back 2

precordium

Front 3

In a tall, slender person, the heart tends to hang ____ and to be positioned ___

Back 3

vertically,centrally

Front 4

With increasing stockiness and shortness, it heart tends to lie more to the ___and more ___

Back 4

left, horizontally

Front 5

heart may be positioned to the right, either rotated or displaced, or as a complete mirror image of the expected

Back 5

dextrocardia

Front 6

heart and stomach are placed to the right and the liver to the left, this habitus is termed ____.

Back 6

situs inversus

Front 7

tough, double-walled, fibrous sac encasing and protecting the heart.

Back 7

pericardium

Front 8

thin outermost muscle layer, covers the surface of the heart and extends onto the great vessels

Back 8

epicardium

Front 9

thick muscular middle layer, is responsible for the pumping action of the heart

Back 9

myocardium

Front 10

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

Back 10

endocardium

Front 11

The left heart and right heart are divided by a blood-tight partition called the ____

Back 11

cardiac septum

Front 12

Most of the anterior surface of the heart is formed by the___

Back 12

right ventricle

Front 13

The ____ is positioned behind the right but extends anteriorly, forming the left border of the heart.

Back 13

left ventricle

Front 14

apical impulse usually felt in the___ at the midclavicular line.

Back 14

fifth left intercostal space

Front 15

The adult heart is about __ cm long, __ cm wide at the widest point, and __ cm in its anteroposterior diameter

Back 15

12cm, 8cm, 6cm

Front 16

The __ valve, which has ___ cusps (or leaflets), separates the right atrium from the right ventricle

Back 16

tricuspid, three

Front 17

The __ valve, which has __ cusps, separates the left atrium from the left ventricle

Back 17

mitral , two

Front 18

The two semilunar valves each have ___ cusps

Back 18

three

Front 19

The ___ valve separates the right ventricle from the pulmonary artery

Back 19

pulmonic

Front 20

The __ valve lies between the left ventricle and the aorta

Back 20

aortic

Front 21

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

Back 21

ventricles, energy-requiring

Front 22

Which valves close to make the Lubb sound?what heart sound is this?

Back 22

mitral and tricuspid valves closed, S1

Front 23

Which valves close to make the Dubb sound?what heart sound is this?

Back 23

aortic and pulmonic , S2

Front 24

A2 is produced by ___ closure

Back 24

aortic valve

Front 25

P2 is produced by ___ closure

Back 25

pulmonic valve

Front 26

What makes the S3 heart sound?

Back 26

Diastole is a relatively passive interval until ventricular filling is almost complete. This filling sometimes produces a third heart sound (S3).

Front 27

What makes the S4 heart sound?

Back 27

Then the atria contract to ensure the ejection of any remaining blood. This can sometimes be heard as a fourth heart sound (S4).

Front 28

What is split S2 heart sound?

Back 28

aortic valve closes slightly before the pulmonic, so that S2 is often heard as two distinct components

Front 29

In ECG, ___ the spread of a stimulus through the atria (atrial depolarization)

Back 29

P wave

Front 30

In ECG, ___ -the time from initial stimulation of the atria to initial stimulation of the ventricles,

Back 30

PR interval

Front 31

In ECG, ___ and ___ are return of stimulated ventricular muscle to a resting state (ventricular repolarization).

Back 31

ST segment and T wave

Front 32

In ECG,___ a small deflection sometimes seen just after the T wave

Back 32

U wave

Front 33

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.

Back 33

Q-T interval

Front 34

PR interval is usually __ seconds

Back 34

usually 0.12 to 0.20 second.

Front 35

QRS is usually __ seconds

Back 35

less than 0.10 second

Front 36

When the heart is beating at a rate of ___ beats per minute, ventricular systole is shorter than diastole

Back 36

68 to 72

Front 37

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.

Back 37

120beats/min

Front 38

The fetal circulation, the right ventricle pumps blood through the ___ rather than into the lungs

Back 38

patent ductus arteriosus

Front 39

The fetal circulation, The right and left ventricles are equal in weight and muscle mass because__________

Back 39

they both pump blood into the systemic circulation

Front 40

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 ____

Back 40

horizontally,fourth left intercostal space

Front 41

In most cases, the adult heart position is reached by the age of ___years.

Back 41

7

Front 42

The maternal blood volume increases ___ to __ over the pre-pregnancy level.

Back 42

40% to 50%

Front 43

On the average, plasma volume increases __ with a single pregnancy and as much as __ with a twin pregnancy

Back 43

50%, 70%

Front 44

When is cardiac output highest in pregnancy?

Back 44

25 to 32 weeks of gestation

Front 45

In pregnancy, The cardiac output increases approximately __ over that of the nonpregnant state

Back 45

30% to 40%

Front 46

In older adults, The left ventricular wall ___ and the valves tend to ___

Back 46

thickens, fibrose and calcify

Front 47

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___

Back 47

slows,decreases, 30% to 40%

Front 48

In Older Adults, The endocardium ___ The myocardium becomes ___

Back 48

thickens,less elastic and more rigid

Front 49

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.

Back 49

fibrosis and sclerosis, increased vagal, baroreceptor

Front 50

____ is traditionally described as a pressure or choking sensation substernally or into the neck

Back 50

Angina pectoris

Front 51

Angina pectoris, may radiate to the __ and down the ___

Back 51

jaw, left (and sometimes the right) arm

Front 52

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.

Back 52

precordial catch

Front 53

What are common causes of cardiac pain in kids?

Back 53

trauma, exercise-induced asthma, cocaine

Front 54

sudden turning of neck

Back 54

carotid sinus effect

Front 55

looking upward could be a sign of ___

Back 55

vertebral artery occlusion

Front 56

Type of Chest Pain: Substernal, provoked by effort, emotion, eating; relieved by rest and/or nitroglycerin; often accompanied by diaphoresis, occasionally by nausea

Back 56

Anginal

Front 57

Type of Chest Pain:Precipitated by breathing or coughing- usually described as sharp- present during respiration- absent when breath held

Back 57

Pleural

Front 58

Type of Chest Pain: Burning, substernal, occasional radiation to the shoulder- nocturnal occurrence, usually when lying flat- relief with food, antacids, sometimes nitroglycerin

Back 58

Esophageal

Front 59

Type of Chest Pain:Almost always infradiaphragmatic and epigastric- nocturnal occurrence and daytime attacks relieved by food- unrelated to activity

Back 59

From a peptic ulcer

Front 60

Type of Chest Pain: Usually under right scapula, prolonged in duration- often occurring after eating- will trigger angina more often than mimic it

Back 60

Biliary

Front 61

Type of Chest Pain: Usually lasts for hours- local tenderness and/or pain with movement

Back 61

Arthritis/bursitis

Front 62

Type of Chest Pain: Associated with injury- provoked by activity, persists after activity- painful on palpation and/or movement

Back 62

Cervical

Front 63

Type of Chest Pain:Intensified or provoked by movement, particularly twisting or costochondral bending- long lasting- often associated with focal tenderness

Back 63

Musculoskeletal (chest)

Front 64

Type of Chest Pain: Associated with/after anxiety- poorly described- located in intra-mammary region

Back 64

Psychoneurotic

Front 65

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

Back 65

Light

Front 66

Exercise Intensity: Making the bed, dusting and sweeping, walking a level short block, office filing

Back 66

Moderate

Front 67

Exercise Intensity: Climbing one or two flights of stairs, lifting full cartons, long walks, sexual intercourse

Back 67

Moderately heavy

Front 68

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

Back 68

Heavy

Front 69

St. Vitus dance aka

Back 69

Sydenham chorea

Front 70

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

Back 70

1 in 100, three to five, left

Front 71

How do you calculate pack-years?

Back 71

number of years smoking times number of packs per day

Front 72

What is the illegal drug known as poppers?

Back 72

amyl nitrate

Front 73

What is this personality, characterized by negative emotions, pessimistic attitude, and failure to share emotions

Back 73

type D personality

Front 74

What is this personality, characterized by hostile attitudes, inability to relax, and compulsive behavior

Back 74

type A personality

Front 75

potassium ___ (weakness, bradycardia, hypotension, confusion)

Back 75

excess

Front 76

potassium ___ (weakness, fatigue, muscle cramps, dysrhythmias)

Back 76

depletion

Front 77

which drug has these side effects: anorexia, nausea, vomiting, diarrhea, headache, confusion, dysrhythmias, halo, yellow vision

Back 77

digitalis toxicity

Front 78

What are these signs of crackles in the lungs, engorgement of the liver, and peripheral edema?

Back 78

signs of heart failure

Front 79

Osler nodes or Janeway lesions of ___

Back 79

bacterial endocarditis

Front 80

Proper order for assessing cardiac function

Back 80

inspection and proceeding to palpation, percussion, and then auscultation

Front 81

apical impulse should be visible at about the ___ line in the ___ intercostal space

Back 81

midclavicular, fifth left

Front 82

A readily visible and palpable impulse when the patient is ___suggests an intensity that may be the result of a problem.

Back 82

supine

Front 83

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 ___

Back 83

intervening extracardiac problem, such as pleural or pericardial fluid

Front 84

The size of a apical impulse is about

Back 84

1cm

Front 85

If the apical impulse is more vigorous than expected, lasting as long as systole, characterize it as a __

Back 85

heave or lift

Front 86

An apical impulse that is more forceful and widely distributed, fills systole, or is displaced laterally and downward may indicate ___ or ___

Back 86

increased cardiac output or left ventricular hypertrophy.

Front 87

A lift along the left sternal border may be caused by_____.

Back 87

right ventricular hypertrophy

Front 88

A loss of thrust may be related to ___ or ___

Back 88

overlying fluid or air or to displacement beneath the sternum

Front 89

Displacement to the right without a loss or gain in thrust suggests ___, ___, ___, or ___

Back 89

dextrocardia, diaphragmatic hernia, distended stomach, or a pulmonary abnormality

Front 90

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

Back 90

thrill

Front 91

Thrills, generally indicates a disruption of the expected blood flow related to some defect in the closure of one of the ___ , ___, or ___

Back 91

semilunar valves (generally aortic or pulmonic stenosis), pulmonary hypertension, or atrial septal defect

Front 92

The carotid pulse and ___ are practically synchronous

Back 92

S1

Front 93

The carotid pulse is located just medial to and below the___

Back 93

angle of the jaw

Front 94

Thrill during Systole: Suprasternal notch and/or second and third right intercostal spaces

Back 94

Aortic stenosis

Front 95

Thrill during Systole: Suprasternal notch and/or second and third left intercostal spaces

Back 95

Pulmonic stenosis

Front 96

Thrill during Systole: Fourth left intercostal space

Back 96

Ventricular septal defect

Front 97

Thrill during Systole: Apex

Back 97

Mitral regurgitation

Front 98

Thrill during Systole: Left lower sternal border

Back 98

Tetralogy of Fallot

Front 99

Thrill during Systole: Left upper sternal border, often with extensive radiation

Back 99

Patent ductus arteriosus

Front 100

Thrill during Diastole: Right sternal border

Back 100

Aortic regurgitation, Aneurysm of ascending aorta

Front 101

Thrill during Diastole: Apex

Back 101

Mitral stenosis

Front 102

The right ventricle tends to enlarge in the ___diameter rather than___

Back 102

anteroposterior , laterally

Front 103

best position to hear relatively high-pitched murmurs with the stethoscope diaphragm

Back 103

Patient sitting up and leaning slightly forward and, preferably, in expiration

Front 104

best position to hear the low-pitched filling sounds in diastole with the stethoscope bell

Back 104

Patient left lateral recumbent

Front 105

best position for evaluating right rotated heart of dextrocardia

Back 105

Patient right lateral recumbent

Front 106

auscultatory area: second right intercostal space at the right sternal border

Back 106

Aortic valve area

Front 107

auscultatory area:second left intercostal space at the left sternal border

Back 107

Pulmonic valve area

Front 108

auscultatory area:third left intercostal space at the left sternal border

Back 108

Second pulmonic area

Front 109

auscultatory area:fourth left intercostal space along the lower left sternal border

Back 109

Tricuspid area

Front 110

auscultatory area:at the apex of the heart in the fifth left intercostal space at the midclavicular line

Back 110

Mitral (or apical) area

Front 111

Which heart sounds marks the beginning of systole

Back 111

S1

Front 112

What heart sound coincides with the rise (upswing) of the carotid pulse?

Back 112

S1

Front 113

What heart sound marks the initiation of diastole

Back 113

S2

Front 114

Split S2 is best heard in the____ area.

Back 114

pulmonic auscultatory

Front 115

Where is S1 BEST heard louder then S2?

Back 115

toward the apex

Front 116

Which heart sound is louder at the base of the heart, S1 or S2?

Back 116

S2

Front 117

How does the S1 compare to S2?

Back 117

lower in pitch and a bit longer than S2, and it occurs immediately after diastole

Front 118

What conditions can cause blood velocity to be increased in the heart?

Back 118

anemia, fever, hyperthyroidism, anxiety, and during exercise.

Front 119

What can produce a louder S1? 2 things

Back 119

Blood velocity increased, mitral valve stenotic

Front 120

How does S2 intensity change:Systemic hypertension, syphilis of the aortic valve, exercise, or excitement

Back 120

Increases

Front 121

How does S2 intensity change:Pulmonary hypertension, mitral stenosis, and congestive heart failure

Back 121

Increases

Front 122

How does S2 intensity change:The valves are diseased but still fully mobile; the component of S2 affected depends on which valve is compromised.

Back 122

Increases

Front 123

How does S2 intensity change:A shocklike state with arterial hypotension causes loss of valvular vigor.

Back 123

Decreases

Front 124

How does S2 intensity change:The valves are immobile, thickened, or calcified

Back 124

Decreases

Front 125

How does S2 intensity change:Aortic stenosis affects A2

Back 125

Decreases

Front 126

How does S2 intensity change:Pulmonic stenosis affects P2

Back 126

Decreases

Front 127

How does S2 intensity change:Overlying tissue, fat, or fluid

Back 127

Decreases

Front 128

Where is a split of S1 beat heard?

Back 128

tricuspid area

Front 129

Which heart sound result of closure of the semilunar valves, indicates the end of systole

Back 129

S2

Front 130

Where is S2 best heard?

Back 130

aortic and pulmonic areas

Front 131

How does S2 compare to S1 at the base of the heart?

Back 131

It is of higher pitch and shorter duration than S1. S2 is louder than S1 at the base of the heart

Front 132

How does S2 compare to S1 at the apex of the heart?

Back 132

softer than S1 at the apex

Front 133

failure of the mitral and tricuspid valves or the pulmonic and aortic vales to close simultaneously

Back 133

Splitting

Front 134

When is splitting of S1 best heard?

Back 134

may be audible in the tricuspid area, particularly on deep inspiration.

Front 135

S2 is actually two sounds that merge during ___

Back 135

expiration

Front 136

The closure of the ___ contributes most of the sound of S2

Back 136

aortic valve (A2)

Front 137

Where is S2 heard?

Back 137

aortic or pulmonic areas

Front 138

During ___, P2 occurs slightly later, giving S2 two distinct components; this is a split S2

Back 138

inspiration

Front 139

If P2 is heard outside the ___ area, it is most often unusually loud or delayed.

Back 139

pulmonary

Front 140

Splitting of S2 is greatest at the peak of ___

Back 140

inspiration

Front 141

Ejection times tend to equalize when the breath is held in ___, so this maneuver also tends to eliminate the split

Back 141

expiration

Front 142

The degree of S2 splitting is most evident during ___

Back 142

inspiration

Front 143

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.

Back 143

S3

Front 144

Which heart sound, In the second phase of ventricular filling, vibration in the valves, papillae, and ventricular walls

Back 144

S4

Front 145

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

Back 145

S2

Front 146

The split becomes ___ when there is delayed activation of contraction or emptying of the right ventricle resulting in delay in pulmonic closure

Back 146

wider

Front 147

The split becomes narrower and is even eliminated or paradoxic when closure of the aortic valve is delayed, such as in ___.

Back 147

left bundle branch block

Front 148

A RBBB which make a S1 S2 split _

Back 148

Wider

Front 149

Splitting is said to be ___ when it is unaffected by respiration

Back 149

fixed

Front 150

This occurs with delayed closure of the pulmonic valve when output of the right ventricle is greater than that of the left

Back 150

Fixed splitting

Front 151

What type of split is caused by large atrial septal defects?

Back 151

Fixed splitting

Front 152

What type of split is caused by septal defect with left to right shunting?

Back 152

Fixed splitting

Front 153

What type of split is caused by right ventricular failure?

Back 153

Fixed splitting

Front 154

____ occurs when closure of the aortic valve is delayed (such as in left bundle branch block) so that P2 occurs first, followed by A2

Back 154

Paradoxic splitting

Front 155

Paradoxic (Reversed) Splitting, In this case, the interval between P2 and A1 is heard during ___ and disappears during ___.

Back 155

expiration,inspiration.

Front 156

asking the patient to raise a leg

Back 156

Increase Venous return

Front 157

asking the patient to grip your hand vigorously and repeatedly

Back 157

Increase Arterial Pressure

Front 158

When S3 becomes intense and easy to hear, the resultant sequence of sounds simulates a ____

Back 158

gallop; this is the protodiastolic gallop rhythm

Front 159

S3 may be ___ if filling pressure is increased or if ventricular compliance is reduced

Back 159

louder

Front 160

Best position to hear S3

Back 160

left lateral decubitus (recumbent) position

Front 161

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)

Back 161

increased S4

Front 162

Heart sound change with the increased stroke volume of high-output states (e.g., in profound anemia, pregnancy, and thyrotoxicosis)

Back 162

increased S4

Front 163

The rhythm of the heart sound when an ___ is heard resembles the rhythm of pronouncing the word Ken-TUCK-y

Back 163

S3

Front 164

When an__ is heard, it resembles the rhythm of pronouncing the word TEN-nes-see

Back 164

S4

Front 165

___ may produce an opening snap (mitral valve), ejection clicks (semilunar valves), or mid-to-late nonejection systolic clicks (mitral prolapse).

Back 165

Valvular stenosis

Front 166

The pulmonary ejection click is best heard on __ and is seldom heard on ___

Back 166

expiration, inspiration

Front 167

___ are less sharp, are less involved with S1, and may be heard as distant as the anterior axillary line

Back 167

aortic ejection clicks

Front 168

Extra heart sounds often accompany __ and should always be considered indicative of a pathologic process.

Back 168

murmurs

Front 169

Pericardial friction rub may have three components that are associated in sequence with the__, __, __

Back 169

atrial component of systole, ventricular systole, and ventricular diastole

Front 170

A ___ is a grating sound that may be intense enough to obscure the heart sounds.

Back 170

three-component friction rub

Front 171

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 ___

Back 171

intracardiac murmur

Front 172

prosthetic mitral valve, listen for a distinct click early in __ loudest at the ___ and transmitted precordially

Back 172

diastole, apex

Front 173

A prosthetic aortic valve causes a sound in ___

Back 173

early systole

Front 174

Extra Heart Sounds: Bell at apex; patient left lateral recumbent Early diastole, low pitch

Back 174

Increased S3

Front 175

Extra Heart Sounds: Bell at apex, patient supine or in the left lateral recumbent position Late diastole or early systole, low pitch

Back 175

Increased S4

Front 176

Extra Heart Sounds: Bell at apex; patient supine or left lateral recumbent position Presystole, intense, easily heard

Back 176

Gallops

Front 177

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

Back 177

Mitral valve opening snap

Front 178

Extra Heart Sounds:Diaphragm; patient sitting or supine

Back 178

Ejection clicks

Front 179

Extra Heart Sounds:Apex, base in second right intercostal space Early systole, intense, high pitch; radiates; not affected by respirations

Back 179

Aortic valve Ejection clicks

Front 180

Extra Heart Sounds:Second left intercostal space at sternal border Early systole, less intense than aortic click. intensifies on expiration, decreased on inspiration

Back 180

Pulmonary valve Ejection clicks

Front 181

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

Back 181

Pericardial friction rub

Front 182

___ are caused by some disruption in the flow of blood into, through, or out of the heart

Back 182

Murmurs

Front 183

____ are relatively prolonged extra sounds heard during systole or diastole; they often indicate a problem

Back 183

Heart murmurs

Front 184

When the leaflets are thickened and the passage narrowed, forward blood flow is ____

Back 184

restricted (stenosis)

Front 185

When valve leaflets, which are intended to fit together snugly, lose competency, the slack openings allow____

Back 185

backward flow of blood (regurgitation).