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Clinical assesment
heart/chapter 9
150
Medical
11/09/2009

Additional Medical Flashcards

 


 

Cards

Term

1- the right ventricle occupies most of the

2-This chamber and the pulmonary artery form a wedgelike structure behind and to the left of the 

Definition

1. anterior cardiac surface. 

2-sternum, 

Term
The inferior border of the right ventricle lies below the junction of the 
Definition
sternum and the xiphoid process
Term
“base of the heart”
Definition

a clinical term that refers to the superior aspect of the heart at the right and left 2nd interspaces next to the sternum.

 



Term
cardiac “apex.”
Definition

-tapered inferior tip of the left ventricle

- it produces the apical impulse=point of maximal impulse, or PMI. 

-found in the 5th interspace 7 cm to 9 cm lateral to the midsternal line

Term

-In supine patients the normal diameter of the PMI may be as large as?

-left ventricular hypertrophy (LVH), or enlargement has a PMI diameter 

Definition

1-as a quarter, approximately 1 to 2.5 cm

2-  greater than 2.5 cm is evidence of 

Term
Similarly, displacement of the PMI lateral to the midclavicular line or greater than 10 cm lateral to the midsternal line also suggests
Definition
 LVH, or enlargement.
Term

(in some patients the most prominent precordial impulse (PMI) may not be at the apex of the left ventricle)

 

-in chronic obstructive pulmonary disease (COPD), the most prominent palpable impulse or PMI may be in the ____________ or __________ as a result of?


Definition
xiphoid or epigastric area as a result of right ventricular hypertrophy.
Term
As the heart valves close, the heart sounds arise from 
Definition
vibrations emanating from the leaflets, the adjacent cardiac structures, and the flow of blood
Term

1-Systole is the period of 

2-pressure in the left ventricle rises from less than

Definition

1-ventricular contraction

 

2- 5 mm Hg in its resting state to a normal peak of 120 mm Hg

Term

1- Diastole is the period of  

2-Ventricular pressure falls further to 

Definition

1-ventricular relaxation.

2-below 5 mm Hg, and blood flows from atrium to ventricle. Late in diastole, ventricular pressure rises slightly during inflow of blood from atrial contraction.

Term

1- during systole what valves are open and closed  

2-during diastole what valves are open and closed  

Definition

1-the aortic and pulmonic valves are open and The mitral valve and tricuspidare closed, preventing blood from regurgitating back into the left atrium.

2- the aortic and pulmonic valves are closed, preventing regurgitation of blood from the aorta back into the left ventricle. The mitral and tricuspid valves are open, 

Term
What produces the first heart sound, S1.
Definition

Closure of the mitral valve, During systole,

 

 

During systole, the left ventricle starts to contract and ventricular pressure rapidly exceeds left atrial pressure, shutting the mitral valve. 

Term
In some pathologic conditions, an early systolic ejection sound (Ej) accompanies 
Definition

the opening of the aortic valve.

-after S1

Term
  What produces the second heart sound, S2
Definition

Aortic valve closure

 

As the left ventricle ejects most of its blood, ventricular pressure begins to fall. When left ventricular pressure drops below aortic pressure, the aortic valve shuts.

Term
In diastole, left ventricular pressure continues to drop and falls below left atrial pressure. The mitral valve opens. This event is usually silent, but may be audible as a pathologic?
Definition

opening snap (OS) if valve leaflet motion is restricted, as in mitral stenosis.

-right after S2

Term

(After the mitral valve opens, there is a period of rapid ventricular filling as blood flows early in diastole from left atrium to left ventricle.)

 

In children and young adults, what sound may arise from rapid slapping of the column of blood against the ventricular wall.

Definition

a third heart sound, S3,

 In older adults, an S3, sometimes termed “an S3 gallop,” usually indicates a pathologic change in ventricular compliance.

Term

Finally, although not often heard in normal adults, a fourth heart sound, S4, marks ?

-when is it heard

-whats the pathology

 

Definition

-atrial contraction.

-It immediately precedes S1 of the next beat

-also reflects a pathologic change in ventricular compliance.

Term
THE SPLITTING OF HEART SOUNDS (S2)
Definition
right-sided events usually occur slightly later than those on the left. Instead of a single heart sound, you may hear two discernible components, the first from left-sided aortic valve closure, or A2, and the second from right-sided closure of the pulmonic valve, or P2.
Term

1-Of the two components of the S2, which is louder and softer

2-where are A2 and P2 heard

 

3- where do you search for splitting of the S2.

 

Definition

1)-A2 is normally louder, reflecting the high pressure in the aorta. 

-P2, is relatively soft, reflecting the lower pressure in the pulmonary artery. 

 

2)- A2 is heard throughout the precordium.

-Pis heard best in its own area—the (LSB) 2nd and 3rd left interspaces close to the sternum. It is here that you should search for splitting of the S2.

3)-LSB

Term

1- Physiological Splitting

 

2- Pathological Splitting

Definition

1- S2 splits on inspiration, and A2 and P2 fuse on expiration

 

2- S2 splitting occurs on inspiration and expiration

Term

Splitting of S1

1-S1 also has two components (what order do they occur)

2-which is louder and softer

3-where do you listen for each sound

4- where do you listen for the split of S1

Definition

1)-an earlier mitral and a later tricuspid sound.

2)- mitral sound is much louder, 

-The tricuspid component is much softer

3)-mitral sound is heard throughout the precordium and is loudest at the cardiac apex.

-The tricuspid component is heard best at the lower left sternal border

 

4)- you hear Splitting of S1 at the lower left sternal border and it does not vary with respiration.

Term
HEART MURMURS sounds  and explanation in general
Definition
Heart murmurs are distinguishable from heart sounds by their longer duration. They are attributed to turbulent blood flow 
Term
 flow murmur  
Definition
 “innocent,” benign murmur of young adults,
Term
 A stenotic valve murmur
Definition
stenotic valve has an abnormally narrowed valvular orifice that obstructs blood flow, as in aortic stenosis, and causes a characteristic murmur. 
Term
 regurgitant murmur.
Definition

 

 produced by blood leaking backward when a valve fails to fully close, as in aortic regurgitation or insufficiency.

 

Term

Angle of Louis

(Sternal Angle)

Definition
-where the 2nd rib meets the sternum
Term

Cardiac Base

2

Definition

1)-2nd ICS, RSB

2)-2nd ICS, LSB

Term

Listen to what anatomy here?

 

1)- 2nd intercostal space right sternal border(2nd, ICS, RSB)

2)- 2nd intercostal space left sternal border(2nd, ICS, LSB)

Definition

1)-(2nd, ICS, RSB)- sounds from the aortic valve

 

2)- (2nd, ICS, LSB)- sounds from the pulmonic valve

Term

listen to what anatomy?

 

3rd intercostal space left sternal border (3rd ICS LSB)

 

also called?

Definition

(3rd ICS LSB)- aortic sounds transmission

 

-also called Erbs point

Term

listen to what anatomy?

 

4th intercostal space left sternal border (4th ICS LSB)


Definition
(4th ICS LSB)- tricuspid sounds
Term

 

listen to what anatomy?

 

5th intercostal space Midclavicular line (5th ICS MCL)

3

 

Definition

(5th ICS MCL)- Mitral sounds, Cardiac Apex, PMI, Ventricular Impulses


Term
Heart conduction sequence and location in heart
Definition
1. SA node (right atrium)
2. AV node (inferior atrial septum.)
3. Bundle of his (interventricular septum)
4. splits into the right and left bundle branches (interventricular septum)
4 perkinge fibers (inervate the ventricle myocardium)
Term
Each normal electrical impulse starts in the sinus node or Sinoatrial node or SA node- (a group of specialized cardiac cells located in the right atrium near the junction of the vena cava.) The sinus node acts as the cardiac pacemaker and automatically discharges an impulse about 60 to 100 times a minute. This impulse travels through both atria to the atrioventricular node, a specialized group of cells located low in the atrial septum. Here the impulse is delayed before passing down the bundle of His and its branches to the ventricular myocardium. Muscular contraction follows: first the atria, then the ventricles.
Definition
Term

Murmur

ASS

Aortic stenosis systolic

Definition
Term

what does the letter represent

P

QRS

Q

R

S

T

Definition

-The small P wave of atrial depolarization

-The larger QRS complex of ventricular depolarization (S1)

-Q wave- a downward deflection from septal depolarization

-the R wave- an upward deflection from ventricular depolarization

-the S wave- a downward deflection following an R wave

 T wave of ventricular repolarization (S2)

Term
 1-Cardiac output
2- Stroke volume
Definition

Cardiac output-the volume of blood ejected from each ventricle during 1 minute, is the product of heart rate and stroke volume.

 

Stroke volume (the volume of blood ejected with each heartbeat) depends in turn on preload, myocardial contractility, and afterload.
Term
Preload
Definition

refers to the load that stretches the cardiac muscle before contraction. The volume of blood in the right ventricle at the end of diastole,

 

-Right ventricular preload is increased by increasing venous return to the right heart.

-Physiologic causes include inspiration and the increased volume of blood flow from exercising muscles.

-The increased blood volume in a dilated right ventricle of congestive heart failure also increases preload.

-Causes of decreased right ventricular preload include exhalation, decreased left ventricular output, and pooling of blood in the capillary bed or the venous system.

Term
Myocardial contractility
Definition

-refers to the ability of the cardiac muscle, when given a load, to shorten.

-Contractility increases when stimulated by action of the sympathetic nervous system and decreases when blood flow or oxygen delivery to the myocardium is impaired

Term
  • Afterload refers to the degree of vascular resistance to ventricular contraction. Sources of resistance to left ventricular contraction include the tone in the walls of the aorta, the large arteries, and the peripheral vascular tree (primarily the small arteries and arterioles), as well as the volume of blood already in the aorta.
  • Definition

    -refers to the degree of vascular resistance to ventricular contraction.

    -Sources of resistance to left ventricular contraction include the tone in the walls of the aorta, the large arteries, and the peripheral vascular tree (primarily the small arteries and arterioles), as well as the volume of blood already in the aorta.

    Term
    Pathologic increases in 1.preload and 2.afterload, 
     3.produce changes in ventricular function that may be clinically detectable. These changes include?
    Definition

    1-preload-volume overload

    2-afterload-pressure overload

     

    3-alterations in ventricular impulses, detectable by palpation, and in normal heart sounds. Pathologic heart sounds and murmurs may also develop.

    Term
    The term heart failure is now preferred over “congestive heart failure” because?
    Definition
    not all patients have volume overload on initial presentation
    Term
    pulse pressure.
    Definition
    The difference between systolic and diastolic pressures
    Term
    FACTORS INFLUENCING ARTERIAL PRESSURE
    4
    Definition
  • Left ventricular stroke volume
  • Distensibility of the aorta and the large arteries
  • Peripheral vascular resistance, particularly at the arteriolar level
  • Volume of blood in the arterial system
  •  

    (*Changes in any of these four factors alter systolic pressure, diastolic pressure)

    Term
    The oscillations that you see in the internal jugular veins reflect?
    Definition
    changing pressures within the right atrium
    Term
     Jugular venous pressure (JVP) reflects 3
    Definition
    right atrial pressure, which in turn equals central venous pressure (CVP) and right ventricular end-diastolic pressure
    Term
    JVP falls with loss of blood and increases with? 5
    Definition
    right or left heart failure, pulmonary hypertension, tricuspid stenosis, and pericardial compression or tamponade.
    Term

    When measuring JUGULAR VENOUS PRESSURE (JVP)

    1. what is normal and abnormal hight

    2. what positions do u measure in

    Definition

    1-JVP measured at more than 4 cm above the sternal angle, or more than 9 cm above the right atrium, is considered elevated or abnormal

     

    2-30 degrees 60 and 90

    Term
    The jugular venous hum
    Definition

    which is common in children, may still be heard through young adulthood

    A second, more important example is the cervical systolic murmur or bruit, which may be innocent in children but suspicious for arterial obstruction in adults

    Term
    Classic exertional pain, pressure, or discomfort in the chest, shoulder, back, neck, or arm in angina pectoris , seen in 50% of patients with
    Definition
     acute myocardial infarction; atypical descriptors also are common, such as cramping, grinding, pricking; rarely, tooth or jaw pain.Annual incidence of exertional angina is 1 per 1000 in the population 30 years or older.
    Term
    Acute coronary syndrome is used to refer to
    Definition
    any of the clinical syndromes caused by acute myocardial ischemia, including unstable angina, non-ST elevation myocardial infarction, and ST elevation infarction
    Term
    Anterior chest pain, often tearing or ripping, often radiating into the back or neck seen in
    Definition
    in acute aortic dissection
    Term
    Palpitations involve
    Definition

    -an unpleasant awareness of the heartbeat

    -irregular heart beats

    Term

    Symptoms or signs of irregular heart action warrant an ECG. Only atrial fibrillation, which is “irregularly irregular,” can be reliably identified at the bedside

     

    Definition
    no pattern at all
    Term
    -transient skips and flip-flops
    -rapid regular beating of sudden onset and offset
    -a rapid regular rate of less than 120 beats per minute, especially if starting and stopping more gradually
    Definition
    transient skips and flip-flops (possible premature contractions)
    rapid regular beating of sudden onset and offset (possible paroxysmal supraventricular tachycardia)
    a rapid regular rate of less than 120 beats per minute, especially if starting and stopping more gradually (possible sinus tachycardia)
    Term
    Sudden dyspnea is seen in? 3 
    Definition
    pulmonary embolus, spontaneous pneumothorax, anxiety.
    Term
    Orthopnea is
    Definition

    -dyspnea that occurs when the patient is lying down and improves when the patient sits up.

     

    (Classically, it is quantified according to the number of pillows the patient uses for sleeping, or by the fact that the patient needs to sleep sitting up)

    Term
    Orthopnea seen in? 3
    Definition
    left ventricular heart failure or mitral stenosis; also in obstructive lung disease
    Term
    Paroxysmal nocturnal dyspnea, or PND,
    Definition
    describes episodes of sudden dyspnea and orthopnea that awaken the patient from sleep, usually 1 or 2 hours after going to bed, prompting the patient to sit up, stand up, or go to a window for air.
    Term
    PND seen in? 3
    Definition
    left ventricular heart failure or mitral stenosis; may be mimicked by nocturnal asthma attacks.
    Term
    Edema
    Definition
    Edema refers to the accumulation of excessive fluid in the extravascular interstitial space. Interstitial tissue can absorb several liters of fluid, accommodating up to a 10% weight gain before pitting edema appears.
    Term
    Dependent edema appears in
    Definition
    the lowest body parts: the feet and lower legs when sitting, or the sacrum when bedridden. Causes may be cardiac (congestive heart failure), nutritional (hypoalbuminemia), or positional
    Term
    Edema occurs in
    Definition
    renal and liver disease: periorbital puffiness, tight rings in nephrotic syndrome; enlarged waistline from ascites and liver failure.
    Term

    JVP test

    1-When inspecting a hypovolemic patient

     

    2-in volume-overloaded or hypervolemic patients

    Definition

    1- may have to lie flat before you see the neck veins.

    2- raise the head of the bed an elevation up to 60° or even 90° may be required. (In all these positions, the sternal angle usually remains about 5 cm above the right atrium)

    Term
    STEPS FOR ASSESSING THE JVP
    Definition
    •  Raise the head slightly on a pillow to relax the sternomastoid muscles.
    • Raise the head of the bed or examining table to about 30°. Turn the patient's head slightly away from the side you are inspecting.
    • Use tangential lighting and find the internal jugular venous pulsations.
    • If necessary, raise or lower the head of the bed until you can see the oscillation point or meniscus of the internal jugular venous pulsations in the lower half of the neck.
    • Focus on the right internal jugular vein. Look for pulsations in the suprasternal notch, between the attachments of the SCM on the sternum and clavicle, or just posterior to the SCM.
    • Identify the highest point of pulsation in the right internal jugular vein. Extend a long rectangular object or card horizontally from this point and a centimeter ruler vertically from the sternal angle, making an exact right angle. Measure the vertical distance in centimeters above the sternal angle where the horizontal object crosses the ruler. This distance, measured in centimeters above the sternal angle or the right atrium, is the JVP.
    Term

    Internal Jugular Pulsations

    VS

    Carotid Pulsations

    Definition

    Internal Jugular Pulsations

    Carotid Pulsations

    -Rarely palpable

    -Palpable

    -Soft, biphasic, undulating quality, usually with two elevations and two troughs per heart beat

    A more vigorous thrust with a single outward component

    -Pulsations eliminated by light pressure on the vein(s) just above the sternal end of the clavicle

    Pulsations not eliminated by this pressure

    -Height of pulsations changes with position, dropping as the patient becomes more upright

    Height of pulsations unchanged by position

    -Height of pulsations usually falls with inspiration

    Height of pulsations not affected by inspiration

    Term
    Increased JVP  suggests? 4
    Definition
    right-sided congestive heart failure or, less commonly, constrictive pericarditis, tricuspid stenosis, or superior vena cava obstruction
    Term
    (JVP) venous pressure may appear elevated on expiration only and the internal jugular veins collapse on inspiration, this suggests?
    Definition

    In patients with obstructive lung disease,

     

    (This finding does not indicate congestive heart failure)

    Term
    An elevated JVP is 98% specific for an
    Definition
    increased left ventricular end diastolic pressure and low left ventricular ejection fraction, and it increases risk of death from heart failure
    Term
    What is the usual cause of unilateral distention of the external jugular vein.
    Definition
    Local kinking or obstruction
    Term
    A tortuous and kinked carotid artery may produce
    Definition
    a unilateral pulsatile bulge.
    Term
    Causes of decreased pulsations include
    Definition
    decreased stroke volume and local factors in the artery such as atherosclerotic narrowing or occlusion.
    Term

    Pressure on the carotid sinus may cause a

     

    where is the carotid sinus located?

    Definition

    reflex drop in pulse rate or blood pressure

     

    Avoid pressing on the carotid sinus, which lies at the level of the top of the thyroid cartilage.

    Term

    1- Small, thready, or weak pulse seen in 

    2- bounding pulse seen in 

    Definition

    1-cardiogenic shock

    2- aortic insufficiency

     

    Term
    Delayed carotid upstroke in
    Definition

    aortic stenosis

     

    The normal upstroke is brisk. It is smooth, rapid, and follows S1 almost immediately. The summit is smooth, rounded, and roughly midsystolic. The downstroke is less abrupt than the upstroke.

    Term
    1- Pulsus alternans and bigeminal pulse
    2- paradoxical pulse
    Definition

    1- (beat-to-beat variation)

     

    2- (respiratory variation)

    Term
    During palpation of the carotid artery, you may detect humming vibrations, or thrills, that feel like the throat of a purring cat. Routinely, but especially in the presence of a thrill, listen over both carotid arteries with the diaphragm of your stethoscope for a bruit, a murmur-like sound of vascular rather than cardiac origin.
    Definition
    Term
    Note that an aortic valve murmur may radiate to the neck and sound like a?
    Definition

    carotid bruit

     

    Listen to the carotids at the neck w/ the bell, low pitch sounds

    Term
     Presence of a carotid bruit suggests
    Definition
    underlying stenosis
    Term
    (1) while supine turning to the left side and (2) sitting and leaning forward. does what?
    Definition
    These positions bring the ventricular apex and left ventricular outflow tract closer to the chest wall, enhancing detection of the PMI and aortic insufficiency. The examiner should stand at the patient's right side.
    Term

    -with pt in Left lateral decubitus position

    1- Palpate and listen to

    2- what pathology is heard here

    Definition

    1-Palpate the apical impulse and Listen at the apex with the bell of the stethoscope.

     

    2-Low-pitched extra sounds such as an S3, opening snap, diastolic rumble of mitral stenosis

    Term

    Sitting, leaning forward, after full exhalation

    where do you listen?

    What pathology?

    Definition

    Listen along the left sternal border and at the apex with the diaphragm.

    Soft decrescendo diastolic murmur of aortic regurgitation

    Term
     S1 is usually louder than S2 at? 
    S2 is usually louder than S1 at?
    Definition

    1-the apex

    2-the base

    Term

     both the carotid upstroke and the apical impulse occur in?

     

    Definition

    systole, right after S1,

     

    sounds or murmurs coinciding with them are systolic; sounds or murmurs occurring after the carotid upstroke or apical impulse are diastolic.

    Term

    1- S1 is decreased in 

    2- S2 is decreased in

    Definition

    1- first-degree heart block

    2- aortic stenosis.

    Term
    Thrills may accompany loud, harsh, or rumbling murmurs as in? 4
    Definition
    aortic stenosis, patent ductus arteriosus, ventricular septal defect, and, less commonly, mitral stenosis
    Term
    1 What is dextrocardia?
    2- where will the apical pulse be found with 1
    3- In situs inversus
     
    Definition

    1-a heart situated on the right side (rare)

    2-The apical impulse will then be found on the right.

    3-heart, liver and stomach all are on opposite sides from normal

    Term
    A right-sided heart with a normally placed liver and stomach is usually associated with
    Definition
    congenital heart disease.
    Term
     what may displace the apical impulse upward and to the left? 2
    Definition
    Pregnancy or a high left diaphragm
    Term
    Lateral displacement of the apical impulse from
    Definition
    cardiac enlargement in congestive heart failure, cardiomyopathy, ischemic heart disease. Displacement in deformities of the thorax and mediastinal shift.
    Term
    In the left lateral decubitus position, a diffuse PMI with a diameter greater than 3 cm indicates
    Definition
    left ventricular enlargement
    Term
    Increased amplitude of the apical pulse or (hyperkinetic impulse) may also reflect
    Definition
    hyperthyroidism, severe anemia, pressure overload of the left ventricle (as in aortic stenosis), or volume overload of the left ventricle (as in mitral regurgitation).
    Term
    1- A sustained, high-amplitude apical impulse that is normally located suggests

    2- If such an impulse is displaced laterally, consider

    Definition

    1-left ventricular hypertrophy from pressure

    overload (as in hypertension).

     

    2-volume overload.

     

    Term
    A sustained low-amplitude (hypokinetic) apical impulse may result from
    Definition
    dilated cardiomyopathy.
    Term
    1-A brief middiastolic apical impulse indicates an  2-an impulse just before the systolic apical beat itself indicates an
    Definition

    1- S3

    2-S4.

    Term
    A marked increase in amplitude in the The Left Sternal Border in the 3rd, 4th, and 5th Interspaces areas with little or no change in duration occurs in
     
    Definition
    chronic volume overload of the right ventricle, as from an atrial septal defect.
    Term
    An impulse in the The Left Sternal Border in the 3rd, 4th, and 5th Interspaces with increased amplitude and duration occurs with
    Definition
    pressure overload of the right ventricle, as in pulmonic stenosis or pulmonary hypertension
    Term
    In obstructive pulmonary disease, hyperinflated lung may prevent palpation of an enlarged right ventricle in the left parasternal area. The impulse is felt easily, however,
    Definition
    high in the epigastrium where heart sounds are also often heard best.
    Term
    A prominent pulsation in the Left 2nd Interspace often accompanies
    Definition
    dilatation or increased flow in the pulmonary artery. A palpable S2 suggests increased pressure in the pulmonary artery (pulmonary hypertension).
    Term
    1-A palpable S2 at the Right 2nd Interspace suggests
    2-A pulsation here
    Definition

    1-systemic hypertension.

     

    2-suggests a dilated or aneurysmal aorta.

    Term
    1-A markedly dilated failing heart may have a
    Definition

    1-hypokinetic apical impulse that is displaced far to the left.

     

    A large pericardial effusion may make the impulse undetectable.
    Term

    Pt. on left side into the left lateral decubitus position

    This position accentuates or brings out what pathology? 4
    Definition
    left-sided S3 and S4 and mitral murmurs, especially mitral stenosis.
    Term

    Ask the patient to sit up, lean forward, exhale completely, and stop breathing

     

    This position accentuates or brings out what pathology? 1
    Definition
    aortic murmurs. You may easily miss the soft diastolic murmur of aortic regurgitation unless you listen at this position.
    Term
    Extra Sounds in Systole
    Definition
    Such as ejection sounds or systolic clicks
    Term
    Extra Sounds in Diastole
    Definition
    Such as S3, S4, or an opening snap
    Term
    Persistent splitting results from
    Definition
    delayed closure of the pulmonic valve or early closure of the aortic valve.
    Term
    A loud P2 suggests .
    Definition
    pulmonary hypertension
    Term
    1-Diastolic murmurs usually indicate
    2-Systolic murmurs may indicate
    Definition

    1-valvular heart disease.

     

    2-valvular disease but often occur when the heart valves are normal.

    Term
    Midsystolic murmurs typically arise from
    Definition
    blood flow across the semilunar (aortic and pulmonic) valves
    Term
    Pansystolic murmurs often occur with
    Definition
    regurgitant (backward) flow across the atrioventricular valves
    Term
    A late systolic murmur is the murmur of
    Definition
    mitral valve prolapse and is often, but not always, preceded by a systolic click
    Term
    Early diastolic murmurs typically accompany
    Definition
    regurgitant flow across incompetent semilunar valves.
    Term
    Middiastolic and presystolic murmurs reflect
    Definition
    turbulent flow across the atrioventricular valves
    Term

    A crescendo murmur grows louder

     

    eg?

    Definition

    the presystolic murmur of mitral stenosis in normal sinus rhythm

     

    Term
    A decrescendo murmur grows softer
    eg?

     

    Definition
    The early diastolic murmur of aortic regurgitation
    Term

    A crescendo-decrescendo murmur first rises in intensity, then falls.

     

    eg

    Definition
    The midsystolic murmur of aortic stenosis and innocent flow murmurs
    Term

    A plateau murmur has the same intensity throughout.

     

    eg?

    Definition
    The pansystolic murmur of mitral regurgitation
    Term
    A loud murmur of aortic stenosis often radiates into .
    Definition
    the neck (in the direction of arterial flow), especially on the right side
    Term
    An identical degree of turbulence would cause a louder murmur in a thin person than in a very muscular or obese person. Emphysematous lungs may diminish the intensity of murmurs.
    Definition
    Term
    • Gradations of Murmurs
    Definition

    Grade 1

    Very faint, heard only after listener has “tuned in”; may not be heard in all positions

    Grade 2

    Quiet, but heard immediately after placing the stethoscope on the chest

    Grade 3

    Moderately loud

    Grade 4

    Loud, with palpable thrill

    Grade 5

    Very loud, with thrill. May be heard when the stethoscope is partly off the chest

    Grade 6

    Very loud, with thrill. May be heard with stethoscope entirely off the chest

    Term
    A fully described murmur might be: a “medium-pitched, grade 2/6, blowing decrescendo diastolic murmur, heard best in the 4th left interspace, with radiation to the apex”
    Definition
    Term
    Murmurs originating in the right side of the heart tend to vary with respiration more than left-sided murmurs.
    Definition
    Term
    In a 60-year-old person with angina, you might hear a harsh 3/6 midsystolic crescendo-decrescendo murmur in the right 2nd interspace radiating to the neck. These findings suggest
    Definition
    aortic stenosis but could arise from aortic sclerosis (leaflets sclerotic but not stenotic), a dilated aorta, or increased flow across a normal valve. Assess any delay in the carotid upstroke and the intensity of A2 for evidence of aortic stenosis. Check the apical impulse for left ventricular hypertrophy. Listen for aortic regurgitation as the patient leans forward and exhales.
    Term
    (1) Standing and Squatting
    Definition
    (1) to identify a prolapsed mitral valve and (2) to distinguish hypertrophic cardiomyopathy from aortic stenosis.
    Term
    Valsalva Maneuver
    Definition
     help to distinguish prolapse of the mitral valve and hypertrophic cardiomyopathy from aortic stenosis.
    Term
    The murmur of hypertrophic cardiomyopathy is the only systolic murmur that increases in intensity during the Valsalva maneuver (strain phase).
    Definition
    Term
    Alternately loud and soft Korotkoff sounds or a sudden doubling of the apparent heart rate as the cuff pressure declines indicates
    Definition

    a pulsus alternans

     

    The upright position may accentuate the alternation

    Term
    The level identified by first hearing Korotkoff sounds is the highest systolic pressure during the respiratory cycle. The level identified by hearing sounds throughout the cycle is the lowest systolic pressure. A difference between these levels of more than 10 mm Hg indicates a paradoxical pulse and suggests pericardial tamponade, possible constrictive pericarditis, but most commonly obstructive airway disease
    Definition
    Term
    Atrial or Nodal Premature Contractions (Supraventricular)
    Definition
    Rhythm. A beat of atrial or nodal origin comes earlier than the next expected normal beat. A pause follows, and then the rhythm resumes.
    Heart Sounds. S1 may differ in intensity from the S1 of normal beats, and S2 may be decreased.
    Term
    Ventricular Premature Contractions
    Definition
    Rhythm. A beat of ventricular origin comes earlier than the next expected normal beat. A pause follows, and the rhythm resumes.
    Heart Sounds. S1 may differ in intensity from the S1 of the normal beats, and S2 may be decreased. Both sounds are likely to be split.
    Term
    Sinus Arrhythmia
    Definition
    Rhythm. The heart varies cyclically, usually speeding up with inspiration and slowing down with expiration.
    Heart Sounds. Normal, although S1 may vary with the heart rate.
    Term
    Atrial Fibrillation and Atrial Flutter With Varying AV Block
    Definition
    Rhythm. The ventricular rhythm is totally irregular, although short runs of the irregular ventricular rhythm may seem regular.
    Heart Sounds. S1 varies in intensity.
    Term

    Small, Weak Pulses

    -whats it feel like

    -causes

    Definition
    The upstroke may feel slowed, the peak prolonged. Causes include (1) decreased stroke volume, as in heart failure, hypovolemia, and severe aortic stenosis, and (2) increased peripheral resistance, as in exposure to cold and severe congestive heart failure.
    Term
    Large, Bounding Pulses
    Definition

    -the peak is brief.

    Causes include (1) increased stroke volume, decreased peripheral resistance, or both, as in fever, anemia, hyperthyroidism, aortic regurgitation, arteriovenous fistulas, and patent ductus arteriosus; (2) increased stroke volume because of slow heart rates, as in bradycardia and complete heart block; and (3) decreased compliance (increased stiffness) of the aortic walls, as in aging or atherosclerosis.

    Term
    Bisferiens Pulse
    Definition

    -A bisferiens pulse is an increased arterial pulse with a double systolic peak.

     

    -Causes include pure aortic regurgitation, combined aortic stenosis and regurgitation, and, though less commonly palpable, hypertrophic cardiomyopathy.

    Term
    Pulsus Alternans
    Definition

    -The pulse alternates in amplitude from beat to beat even though the rhythm is basically regular

     

     -Pulsus alternans indicates left ventricular failure and is usually accompanied by a left-sided S3.

    Term
    Bigeminal Pulse
    Definition

     -A bigeminal pulse is caused by a normal beat alternating with a premature contraction.

     

    -The stroke volume of the premature beat is diminished in relation to that of the normal beats, and the pulse varies in amplitude accordingly.

    Term
    Paradoxical Pulse
    Definition

    -A paradoxical pulse may be detected by a palpable decrease in the pulse's amplitude on quiet inspiration. If the sign is less pronounced, a blood pressure cuff is needed. Systolic pressure decreases by more than 10 mm Hg during inspiration.

    -A paradoxical pulse is found in pericardial tamponade, constrictive pericarditis (though less commonly), and obstructive lung disease.

    Term

    Left Ventricular Impulse

    Hyperkinetic

    Examples of Causes

     Diameter

    Amplitude

    Duration

    Location

    Definition

    Examples of Causes-Anxiety, hyperthyroidism, severe anemia

    Location-Normal (5th ICS MCL)

    Diameter- about 2cm

    Amplitude-More forceful tapping

    Duration-2/3 systole

    Term

    Left Ventricular Impulse

    Pressure Overload

     

    Examples of Causes

     Diameter

    Amplitude

    Duration

     Location

    Definition

     

    Examples of Causes-Aortic stenosis, hypertension

    Location-Normal (5th ICS MCL)

    Diameter- >2cm

    Amplitude-More forceful tapping

    Duration-Sustained (up to S2)

    Term

     

     

    Left Ventricular Impulse

     

    Volume Overload

     

     

    Examples of Causes

     Diameter

    Amplitude

    Duration

     Location

    Definition

    Examples of Causes- Aortic or mitral regurgitation

    Location-Displaced to the left and possibly downward

    Diameter- >2cm

    Amplitude-Diffuse

    Duration-slightly Sustained

    Term

    Right  Ventricular Impulse

    Hyperkinetic

    Examples of Causes

    Diameter

    Amplitude

    Duration

    Location

    Definition

    Examples of Causes-Anxiety, hyperthyroidism, severe anemia

    Location-3rd, 4th, or 5th left interspaces

    Diameter- not useful

    Amplitude-More forceful

    Duration-normal

    Term

    Right  Ventricular Impulse

    Pressure Overload

    Examples of Causes

    Diameter

    Amplitude

    Duration

    Location

    Definition

    Examples of Causes-Pulmonic stenosis, pulmonary hypertension

    Location-3rd, 4th, or 5th left interspaces also subxiphoid

    Diameter- not useful

    Amplitude-More forceful

    Duration-sustained

    Term

    Right  Ventricular Impulse

    Volume Overload

     

    Examples of Causes

    Diameter

    Amplitude

    Duration

    Location

    Definition

    Examples of Causes-Atrial septal defect

    Location-Left sternal border,

    Diameter- not useful

    Amplitude-More forceful

     

    Term
    Definition
    Term
    Accentuated S1
    Definition
    S1 is accentuated in (1) tachycardia, rhythms with a short PR interval, and high cardiac output states (e.g., exercise, anemia, hyperthyroidism) and (2) mitral stenosis. In these conditions, the mitral valve is still open wide at the onset of ventricular systole and then closes quickly.
    Term
    Diminished S1
    Definition
    S1 is diminished in first-degree heart block  (1) when the mitral valve is calcified and relatively immobile, as in mitral regurgitation and (2) when left ventricular contractility is markedly reduced, as in congestive heart failure or coronary heart disease.
    Term
    Varying S1
    Definition
    S1 varies in intensity (1) in complete heart block, when atria and ventricles are beating independently of each other and (2) in any totally irregular rhythm (e.g., atrial fibrillation). .
    Term
    Early Systolic Ejection Sounds
    Definition
    Early systolic ejection sounds occur shortly after S1, coincident with opening of the aortic and pulmonic valves. They are relatively high in pitch, have a sharp, clicking quality, and are heard better with the diaphragm of the stethoscope. An ejection sound indicates cardiovascular disease
    Term
    Systolic Clicks
    Definition
    Systolic clicks are usually caused by mitral valve prolapse—an abnormal systolic ballooning of part of the mitral valve into the left atrium. The clicks are usually mid- or late systolic. Prolapse of the mitral valve is a common cardiac condition, affecting about 5% of the general population. There is equal prevalence in men and women.
    Term
    Definition