clinical skills-cardiovascular

R ventricle

what is the most anterior structure of the heart?

when there is a noticeable difference between right and left sided events

when does splitting of heart sounds occur?

right

___ sided events occur slightly later

junction of the sternum and xiphoid process

where does the inferior border of the RB lie?

base of heart

what surface of the heart is where the RV joins the pulmonary artery?

sternal angle

at what level is the base of the heart?

behind

where is the left ventricle located in relation to right ventricle?

apex

what part of the heart produces the point of maximal impulse?

R 2nd ICS

where can the aortic valve be best auscultated?

L 2nd ICS

where can the pulmonic valve be best auscultated?

lower L sternal border

where can the tricuspid valve be best auscultated?

apex/5th ICS, midclavicular line

where can the mitral valve be best auscultated?

cardiac cycle

what is the process of valvular function and heart muscle contraction that allows blood to flow in the right direction?

distal vasculature

what aids in blood flow?

AV

systole involves closure of the ____ valves (S1)

semilunar

diastole involves closure of the ___ valves (S2)

EKG

what is the electrical system of the heart best evaluated by?

depolarization occurs during S2 and atria contract

what happens when SA node fires electrical conduction through atria?

depolarization occurs during S1 and ventricles contract

what happens after the electrical impulse travels through the bundle of his and bundle branches and purkinje fibers?

ventricle heart pressure

clinically, what do we care about most in regard to heart pressure gradients since it dictates pulse?

ejection fraction

what is the percentage of ventricular volume ejected at each heart beat?

60%

what is the normal ejection fraction?

Exertional pain, pressure of discomfort in the chest, shoulder, back, neck, arm

what is the typical MI and associated symptoms common with CAD?

cramping or grinding pain, tooth or jaw pain, SOB, fatigue, nausea or vomiting without pain

what are atypical sx of CAD?

retrosternal, knife-like pain, worse when lying down and with deep inspiration

describe pericarditis

tearing or ripping sensation, radiates to the back between the shoulder blades, pts rapidly lose consciousness and decline

describe dissecting aortic aneurysm

often sharp and worse on inspiration, more likely to have SOB, hemoptysis, LOC

describe pulmonary embolism

palpitations

what might be described as skipping, racing, fluttering, extra beat, pounding, or stopping?

uncomfortable awareness to breathing that is inappropriate to level of exertion

what is dyspnea?

dyspnea when supine and improves with elevation

what is orthopnea?

by number of pillows they need in bed or sleeping in a recliner

how do you quantify orthopnea?

episodes of dyspnea that wakes pt from sleep

what is paroxysmal nocturnal dyspnea (PND)?

5L

interstitial fluid can accumulate up to ___ of fluid before pitting edema occurs

neurologic, CV, or other source

what can fainting/syncope be from?

that it is cardiac in nature

if syncope is abrupt onset/offset, what should you think?