PD Exam 2: Heart/Lungs/Abdominal/Male Genitalia

what is the largest chamber of the heart?

left ventricle

3 multiple choice options

what are the 4 valves of the heart?

tricuspid, pulmonary, mitral, aortic

tricuspid valve

between the right atrium and the right ventricle

pulmonary valve

between right ventricle and pulmonary artery

aortic valve

between left ventricle and aorta

what does the superior vena cava do?

returns deoxygenated blood from the upper body to the right atria

what does the inferior vena cava do?

returns deoxygenated blood from the lower body to the right atria

what does the pulmonary artery do?

carries deoxygenated blood from the right ventricle to the lungs

what does the pulmonary vein do?

carries oxygenated blood from the lungs to the left atria

what does the aorta do?

carries oxygenated blood from the left ventricle to the body

what is the first structure the heart feeds and through what?

heart itself through coronary arteries

where is the right ventricle located?

anterior, behind and to the left of the sternum

where is the base of the heart located?

right and left 2 nd intercostal spaces

where is the left ventricle located?

posterior (and lateral) and left of the right ventricle

where is the apex of the heart located?

5th intercostal space, midclavicular line

what is the point of maximal impulse?

apical impulse

where is the aortic valve located?

right 2nd intercostal space

where is the pulmonic valve located?

left 2nd intercostal space

where is the tricuspid valve located?

left 4th and 5th intercostal space close to the sternum

where is the mitral valve located?

left 5th intercostal space near the left midclavicular line

cardiac cycle diastole

relaxation

in diastole, whats the pressure in the left atrium and left ventricle?

left atrium: increased

left ventricle: decreased

cardiac cycle systole

contraction

in systole, whats the pressure in the left ventricle and left atrium?

left atrium: decreased

left ventricle: increased

as space decreases, what happens to volume and pressure?

volume decreases, pressure increases

in diastole, pressure in blood filled left atrium slightly exceeds that in the relaxed LV and blood flows from left atrium to left ventricle across the open mitral valve. Just before the onset of systole, atrial contraction produces a slight pressure rise in both chambers which creates what?

atrial kick (S4)

in systole, LV starts to contract and ventricular pressure rapidly exceeds left atrial pressure, closing the mitral valve. Closure of the mitral valve (left) and the tricuspid valve (right) produce what?

first heart sound S1

As the LV pressure continues to rise, it quickly exceeds the pressure in the aorta and forces the ________ ______ open

aortic valve

__________ ____ ________ corresponds to systolic blood pressure. LV ejects most of its blood, ventricular pressure begins to fall. When LV pressure drops below aortic pressure, aortic valve closes. Aortic valve closure, as well as closure of the pulmonic valves, produces the S2 and another diastolic begins

maximal LV pressure

In diastole, LV pressure continues to drop and falls below left atrial pressure. What valve opens and what sound does it make?

mitral valve opens - silent

After mitral valve opens, period of _______ _______ ______ as blood flows early in diastole from LA to LV. What sound can be associated with this?

rapid ventricular filling; S3

preload

load that stretches cardiac muscle before contraction

volume of blood in the right ventricle at the end of diastole is the ________ for the next beat

preload

Increased right ventricular preload occurs with _________ venous return

increased

Decreased right ventricular preload occurs with _______ venous return

decreased

afterload

Load against which the heart has to contract to eject blood or degree of vascular resistance to ventricular contraction

myocardial contractility

ability of muscle to shorten

what increases myocardial contractility?

stimulation from sympathetic nervous system

what decreases myocardial contractility?

blood flow or oxygen delivery to myocardium is impaired

stroke volume

volume of blood ejected from the heart with each heartbeat

cardiac output

volume of blood ejected from the heart each minute

equation for cardiac output

HR x SV = CO

S1 closure from what valves? systole or diastole?

mitral and tricuspid valves; systole

S2 closure from what valves? systole or diastole?

aortic and pulmonic; diastole

ejection sound

heard in some pathologic conditions when the aortic valve opens

opening snap

opening sound created by a calcified mitral valve in mitral stenosis

S3 occurs during what? caused by what?

occurs during rapid ventricular filling; caused by the rapid deceleration of the column of blood against the ventricular wall

what can cause S3?

physiologic or pathologic

what is S4 typically caused by and is it typically heard?

atrial contraction; no

which valves close slightly later? left or right

right

1 multiple choice option

whats a split heart sound?

one of the normal heart S1 or S2 is perceived as two distinct sounds

what are more common S1 or S2 split

S2

1 multiple choice option

physiologic S2 split

normal, closure of aortic and pulmonary valve

physiologic S2 split in expiration and inspiration

one sound during expiration

splitting sound during inspiration

pathologic/fixed S2 split

NOT normal, persistent separation between the closure of the aortic valve and pulmonary valve regardless of breathing

pathologic/fixed S2 split in expiration and inspiration

splitting sound during expiration

splitting sound during inspiration

what could be some causes for a pathologic/fixed S2 split?

valve dysfunction, heart problem

paradoxical S2 split

NOT normal, closure of the aortic valve occurs after the closure of the pulmonary valve

paradoxical S2 split in expiration and inspiration

Splitting sound during expiration

One sound during inspiration

A2 closure of aortic valve

softer or louder

where is it heard?

louder

heard though precordium

P2 closure of pulmonic valve

softer or louder

where is it heard?

softer

heard 2nd and 3rd left interspace, close to sternum

split S1 also varies with inspiration/expiration t/f

false

1 multiple choice option

M1 closure of the mitral valve

softer or louder

where is it heard?

louder

heard throughout the precordium

T1 closure of the tricuspid valve

softer or louder

where is it heard?

softer

heard at the left lower sternal border

what parts of the heart are involved in the conduction system?

sinus node, AV node, bundle of HIS, right and left bundle branches, purkinje fiber

sinus node

right atria, dictates the HR

AV node

junction of atria and ventricles, coordinates timing of heart beats

bundle of HIS

in septum, conducts electrical impulses

right and left bundle branches

transmits impulses from Bundle of HIS to ventricles

purkinje fibers

inner ventricle walls, essential for rapid and coordinated ventricular contraction

what are the steps of the conduction system?

1. SA node fires

2. Excitation spreads through atrial myocardium

3. AV node fires

4. Excitation spreads down AV bundle

5. Purkinje fibers distribute excitation through ventricular myocardium

P wave

atrial depolarization

PR segment

delay at AV node

QRS complex

ventricular depolarization

T wave

ventricular repolarization

isoelectric line

no electrical activity

what part of the heart contracts and sends blood flow to systemic circulation?

left ventricle

the pressure wave that moves throughout the arterial system is the _______

pulse

what is the highest pressure pulse?

carotid

describe the pressure within the arterial system

peak in systole (contracting)

trough in diastole (relaxing)

what is pulse pressure?

difference between systolic and diastolic pressure

what can affect blood pressure?

LV stroke volume

Compliance of aorta and large arteries

Peripheral vascular resistance

Blood volume

what do jugular veins provide information about?

right heart pressures

what vein provides the most information?

right internal jugular

what does an increased JVP indicate?

heart failure, pulmonary hypertension

what does an decreased JVP indicate?

blood loss, dehydration, ↓ blood volume

a wave

peak, right atrial pressure rises due to atrial contraction

x wave

trough, right atrial pressure falls due to relaxation and atrial filling

v wave

second peak, right atrial pressure rises due to inflow from the vena cava during systole

y wave

second trough, right atrial pressure falls as the RA passively empties to RV

Cardiac ROS

Chest pain

Palpitations

Shortness of breath

Edema

History of heart disease

Cardiac testing

Rick factors for CAD

History of a murmur

History of rheumatic fever (more common years ago)

Family history of CAD

what kind of questions do you need to be asking for a patient with chest pain?

Onset

Location

Duration

Pattern

Triggers

Quality

Radiation

Aggravating factors

Alleviating factors

Associated symptoms

Previous occurrence

Pain

what are pain questions you should ask your patients?

Pain scale (0-10)

Quality

Radiation

what kind of questions do you need to be asking for a patient with palpitations?

Onset

Location

Duration

Pattern

Triggers

Aggravating factors

Alleviating factors

Associated symptoms

Previous occurrence

what kind of questions do you need to be asking for a patient with shortness of breath?

Onset

Duration

Pattern

Triggers

Aggravating factors

Alleviating factors

Associated symptoms

Previous occurrence

dyspnea

uncomfortable awareness of breathing inappropriate to the level of exertion

orthopnea

dyspnea with lying down that improves with sitting up

paroxysmal nocturnal dyspnea

sudden dyspnea and orthopnea that awakens a patient from sleep

what kind of questions do you need to be asking for a patient with edema?

Onset

Location

Duration

Triggers

Aggravating factors

Alleviating factors

Associated symptoms

Previous occurrence

what additional characteristics should you consider with a patient that has edema?

pitting or not pitting

associated weight gain

temporal relation