Pp2 Tutorial 2

Front 1

Draw a heart and locate the valves. Name all of the structures, including the valves, with every name that is ever used for them. give the flow of the blood in your diagram.

Back 1

Blood flow:
Deoxygenated blood from extremities --> Enters via superior inferior vena cava and goes into the right atrium --> goes through right AV valve (tricuspid) --> goes into the right ventricle --> goes through the pulmonary semilunar valve (pulmonary valve) --> goes into pulmonary trunk --> goes out into lungs via pulmonary arteries --> comes back into heart through pulmonary veins (now oxygenated blood) --> goes into left atrium --> goes through left AV valve (bicuspid or mitral) --> goes into left ventricle --> goes through aortic semilunar valve --> goes into ascending aorta --> goes into aortic arch --> goes into descending aorta --> goes into body (extremities)

Front 2

Consider the heart in relation to the whole circulatory system. In general, what would happen if the left side of the heart slows down when the right continues at the same pace?

Back 2

- A lot more volume of blood coming in from the right side and going out into the lungs
- Blood backs up in the lungs
- In the forward direction there would be a decrease in amount of blood being forced out into extremities and into the brain
- Would cause hypoxia to tissues and productive cough due to lung congestion
- On inside of the heart there would be hypertrophy of the cardiac muscle on the left side which has the potential to cause different types of angina

Front 3

Consider the heart in relation to the whole circulatory system. In general, what would happen if the right side of the heart slows down when the left side of the heart pumps normally?

Back 3

- Not as much blood coming in from the right side of the heart
Not as much deoxygenated blood coming from the extremities and into the heart
If not as much blood coming into the heart it would stay in the extremities causing oedema in the extremities
- Blood will be poorly oxygenated as not much is going through pulmonary circulation for re-oxygenation
- There will be hypertrophy of the left side of the heart as it is trying to pump out as much blood as possible, which makes it work harder

Front 4

PICTURE, and then name the signs and symptoms of right-sided heart failure.

Back 4

- Poorly oxygenated blood; decrease in O2 in respect to blood - hypoxia, cyanosis (bluish discolouration)
- Hypertrophy of the left side of the heart
- Oedema: hepatomegaly, ascites, splenomegaly, angle oedema, jugular venous distention (increase in capillary pressure)
- Dyspnoea and tachycardia

Front 5

PICTURE, and then name the signs and symptoms of left sided heart failure.

Back 5

Forward effects:
- Tissue hypoxia manifesting as pain in the muscles; pain in the back of the calves
- Dizziness and mental confusion (due to the heart trying to work against atherosclerotic plaques and failing/not getting enough force)
- Decreased O2 to the gut: nausea and indigestion
- Males: decreased sex drive
- Decreased exercise tolerance
- Fatigue
- Dyspnoea and tachycardia (these happen in many disorders, therefore are not specific to this)
- Decreased pulse in the extremities

Backward effect:
- Pulmonary oedema; extra pressure on pulmonary circulation and capillaries let seepage of plasma into parenchymal area: dry cough --> gets more moist as more fluid comes into area; cough worst when laying down
- Pulmonary Pleural effusion

Heart:
- Hypertrophy (in most cases)

Front 6

Briefly explain the conduction system of the heart. When the electrical impulse goes from the sino-atrial node to the atrial-ventricular node, what happens to the myocardial cells in the aria? Why is the electrical impulse delayed at the bundle of His? What happens when the electrical impulse continues through the Purkinje's fibres?

Back 6

- The right side of the heart has the SA node, which is called the PACEMAKER - sets the impulse and generates the action potentials
- As we generate that impulse it goes through both atria (left and right) and excites the myocardial cells so contraction occurs. The atria have a bit of fluid in them and with the contraction this fluid is forced into the ventricles.
- The AV node then grabs the impulse and slows it down to 1/10 of its original speed - which delays the impulse at the bundles of His. This allows the atria to contract prior to the ventricles
- The purkinje's fibres then grab the impulse and takes it to both ventricles simultaneously, and within a split second both ventricles are contracting at the same time

Front 7

When listening to a patient's heart through a stethoscope, one can hear sounds described as Lubb - Dubb - - Lubb - Dubb... Relate these sounds to: ventricular systole, ventricular diastole, the mitral valve closing, the aortic valve closing, the tricuspid valve closing, the pulmonary valve closing.

Back 7

The 'Lubb' sounds is the first heart sound. It is heard at the beginning of ventricular systole. It occurs when the AV valves (mitral valve and tricuspid valve) snap shut.

The 'Dubb' sound is the second heart sound. It is heard during ventricular diastole. It occurs when the semilunar valves (aortic valve and pulmonary valve) snap shut.

Front 8

What is a heart murmur?

Back 8

An abnormal sound that is made when we are forcing fluid through a narrowed opening or the fluid is going back the opposite way (the way it should not be going). Will relate to stenosis or regurgitation.

Front 9

Define regurgitation.

Back 9

Regurgitation is where the valve does not close properly and allows the fluid to backflow.

Front 10

Define stenosis.

Back 10

Stenosis is the narrowing of a valve causing the valve leaflets to no open properly.

Front 11

Define incompetence.

Back 11

Valve incompetence is the same as regurgitation. E.g. Mitral valve regurgitation is the same as Bicuspid valve incompetence.

Front 12

Mrs Smith has a left sided heart murmur that you heart during ventricular diastole. Where is it heard in regards to 'lubb dubb'?

Back 12

Lubb - Dubb - - Lubb - Dubb

- Murmur is heart between the Dubb - - Lubb

Front 13

Mrs Smith has left sided heart failure that you hear during ventricular diastole. Name two types of valvular disorders that she may have.

Back 13

1. Aortic semilunar valve incompetence or regurgitation

2. Mitral valve stenosis

Front 14

Mrs Smith has a left sided heart murmur that you ear during ventricular diastole. Name two types of valvular disorders that she may have and the consequences of those disorders.

Back 14

1. Aortic semilunar valve regurgitation or incompetence

2. Mitral valve stenosis

Consequences:
- Blood backs up into the lungs causing pulmonary oedema
- Dry cough in the beginning
- Ischaemia to the tissues and brain (or slight ischaemia) - mental confusion

*Any other stuff that is related to left sided heart failure will be relevant

Front 15

After having an echocardiogram, Mr G. was told that he has mitral valve regurgitation. You place your stethoscope in the intercostal spaces nearest the mitral valve and listen with the diaphragm of the instrument. What do you hear in relation to the Lubb/Dubb of his heartbeat? What are the signs and symptoms and the regurgitation gets worse?

Back 15

- It is a SYSTOLIC murmur as it occurs when the AV valves snap shut
- There will be an abnormal sound between the Lubb - Dubb; Lubb swish Dubb

Signs and symptoms:
- Blood will be flowing back into the ventricle and pooling there therefore less blood coming out into the extremities
- Signs and symptoms to left-sided incompetence relevant

Forward Effects:
- Tissue hypoxia manifesting in the muscles; pain in the back of calves
- Dizziness and mental confusion
- Dyspnoea and tachycardia
- Males: decreased sex drive
- Decreased O2 to gut: nausea and indigestion
- Fatigue
- Decreased pulse in the extremities
- Decreased exercise tolerance

Backward Effects:
- Pulmonary oedema; dry cough --> wet cough; cough worst when laying down
- Pulmonary pleural effusion

In the heart:
- Hypertrophy (in most cases)

Front 16

In respects to the heart sounds "Lubb Dubb", what will you hear in a systolic murmur?

Back 16

Lubb swish Dubb

Front 17

In respects to the heart sounds "Lubb Dubb", what would you hear in a diastolic heart murmur?

Back 17

Lubb - Dubb swish