Quizlet ast Heart Sound ($1) and Heart Sound ($2) 3rd Heart Sound (83) 4th Heart Sound ($4) Afterload AllHeart Sounds are described by what? Angina Angina angina pectoris Aorta aortic Aortic Regurgitation, Aortic Stenosis Combo with Health Assessment Jarvis Chapter 19 - Heart Study online at quizlet.com/_n25vt Occurs with closure ofthe AV Valves and thus signals the beginning of systole. Loudest atthe Apex ofthe Heart Oceurs with the closure of the SL valves and signals the end of systole, Loudest atthe Base ofthe Heart Occurs when the ventricles are resistant to filling during the early rapid filling phase ‘When the AV valves open and atrial blood 1st pours into the ventricles. Occurs atthe end of diastole when the ventricle is resistant to filling. The atria contract and push blood into a noncompliant ventricle, ‘The opposing pressure the ventricle must ‘generate to open the aortie valve against the higher aortic pressure. Its the resistance against whieh the ventricle must pump its blood 1. Frequency (piteh) 2. Intensity (loudness) 3. Duration 4. Timing Chest pain signs: “clenching fist’ symptoms: diaphoresis, cold sweats, pallor, ‘grayness, Palpitations, dyspnea, nausea, tachyeardia, fatigue Oceurs when the heart's own blood supply cannot keep up with metabolic demand. ‘Clenched Fist isa key sign acute chest pain that oceurs when myocardial demand exceeds its oxygen supply carvies it out to the body- ascends from the left ventricle aches ack at the level ofthe sternal angle, and descends behind the heart. ‘major artery that carries blood from the heart tothe body left semilunar valve Stream of blood regurgitates back through incompetent aortic valve that allows backward flow of blood into LV during diastole, LV dilation and hypertrophy due to inereased LV SV into poorly filled aorta, then rapid runoffin diastole as part of blood pushed back into LV Caleification of aortic valve cusps restricts forward flow of blood during systole; LV hypertrophy develops Aortie Valve Apex of the Heart Apical Impulse Arterioselerosis Atrial Septal Defect (ASD) ‘The Atrioventricular (AV) Valves atrioventricular (AY) valves atrium Base base of the heart bell (ofthe stethoscope) bieuspid (mitra) Blood Vessels Bradyeardia Bruit cardiac eyele cardiac output Carotid Artery and Neck: Subjective Data and 7 others ‘Theleft semilunar valve separating the left ventricle and the aorta tip ofthe heatt pointing down toward the sth let intereostal space (point of maximal impulse, PMI) pulsation ereated as the left ventricle rotates against the chest wall during systole, normally atthe sth let intercostal spacein the midelavicular line Calcification of vessel walls, Abnormal opening in the atrial septum, resulting usually in left-to-right shunt and causing large inerease in pulmonary blood flow Mitral Valve and Tricuspid Value RIGHT AV = tricuspid, LEFTAV = bicuspid or mitral separate the atria and the ventricles; they open during diastole ‘and and close during systole thi alled reservoir for holding blood top ofthe heart broader area ofthe heat’s outline located atthe grd right and left intercostal space ceup-shaped endpiece used for soft, low- pitched heat sounds left AV valve separating the left atria and ventricle Pulmonary circulation and Systemic circulation slow heart rate, <50 beats per minute in theadult Blowing, swishing sound indicating blood ow turbulence the rhythmie movement of blood through the heart; has 2 phases, systole and diastole volume of blood pumped each minute; equal to volume of blood pumped during systole x beats/minute isa central artery. is located inthe groove between the trachea and the sternomastoid muscle, medial to and alongside that musclechordae tendineae Clubbing Coaretation of the Aorta Conditions that Cor Pulmonale Cyanosis/Pallor diaphragm (of the stethoscope) Diastole Diastolic Rumbles of AV Valves ductus arteriosus Dyspnea Early Diastolic Murmurs Edema endocardium Exb's Point collagenous fibers that anchor the AV valves’ thin leaflets to papillary museles embedded in the ventricular oor bulbous enlargement of distal phalanges of fingers and toes that oceurs with ehronie cyanotic heart and lung conditions Severe narrowing of descending aorta, usually atthe junetion ofthe ductus arteriosus and theaortie arch, just distal to the origin ofthe left subelavian artery Results in increased workload of LV, congenital heart defect ‘Velocity of blood inereases, viscosity of blood deereases, structural defects in the valves, unusual openings in the chambers Right ventricular hypertrophy and heart failure due to pulmonary hypertension dusky blue motling of the skin and mucous membranes due to excessive amount of reduced hemoglobin in the blood, oceurs with myocardial infarction or low eardiae ‘output states as a result of decreased tissue perfusion fat endpiece ofthe stethoscope used for hearing relatively high-pitehed heart sounds Phase one ofthe cardiac eyele, The AV valves open during the heart's filling phase ‘The ventricles relax and fill will with blood Filling murmurs at low pressures, best heard with bell lightly touching the skin site where the pulmonary artery joins with the aorta such that the remaining 1/3 of ‘oxygenated blood is rerouted Shortness of breath difficult, labored breathing- quantify exactly Paroxysmal, constant or intermittent, recumbent, paroxysmal nocturnal dyspnea (PND) --> heart failure Due to SL valve incompetence swelling of the legs or dependent body part due to inereased interstitial uid dependent when caused by heart failure thin layer of endothelial tissue that lines the inner surface ofthe heart chambers and valves ‘Traditional auscultatory area in the grdleft intercostal space First Heart Sound (S1) firstheart sound (S1) ‘The Flow of Blood Beginning with the Right Atrium foramen ovale fourth heart sound ($4) (Sa gallop, atrial gallop) Frank Starling Law Gallop Rhythm great vessels Heave ain) Herb's point inching ‘The Intensity of St depends on what factors? isometric isovolumic relaxation Caused by the closure of the atriventricular (AV) valves; signals the beginning of systole ‘occurs with closure ofthe atrioventricular (AV) valves signaling the beginning of systole Right Atium --> Through Tricuspid Valve Right Ventricle > Through Pulmonary Valve > Pulmonary Artery > Lungs ~> Pulmonary Veins -> Left Atrium ~> Through Mitral Valve~ -> Left Ventriele~-> Through Aortie Valve --> Aorta ~> To the Body ~> The Superiorand Inferior Vena Cava ‘opening in the atrial septum (wall between the atria) through which about 2/3 of oxygenated. blood is rerouted in fetal circulation very soft, low-pitched ventricular filling sound thatoceurs in late diastole ‘The greater the stretch, the strongeris the heats contraction, This increased contractility results inn inereased volume of blood ejected (lnereased SV) ‘The addition ofa grdor 4b heart sound makes the rhythm sound like the cadence ofa galloping horse superior and inferior vena eavas; they lie ‘bunched above the base of the heart and return ‘unoxygenated venous blood tothe right side of theheart A sustained foreful thrusting ofthe ventricle during systole. occurs with ventricular hypertrophy asa result of inereased workload, traditional oseulatory area inthe gr left intercostal space technique of moving the stethoscope Jncrementallyaross the precordium through the auscultatory areas while listening tothe heart sounds 1. Postion of AV vale atthe start of systole 2. Structure ofthe valve leaflets 3. How quikly pressure rises in the ventricles ventricular relaxation while ll four valves are closed shorty after the closure ofthe semilunar valves and the end of systoleJugular veins ‘The Layers if the Heart Wall Lett Ventricular Hypertrophy Lift/Heave Location of the Apical Impulse LVH eft ventricular hypertrophy) Mammary Souffle MCL (midelavieular line) mediastinum Midelavicular Line Midsystolie Ejection Murmurs Mitral Regurgitation Mitral Stenosis Mitral Valve Murmurs empty unoxygenated blood directly into the superior vena cava. Interior jugular lies deep and medial to the sternomastoid rmusele, not visible, Extemal jugular - more superficial and lis lateral to the sternomastoid muscle above the elaviele, Pericardium, Myocardium, Endocardium Increase in thickness of myocardial wall that occurs when the heart pumps against chronie outflow obstruction Oceurs with right ventricular hypertrophy; found in pulmonic valve disease, pulmonic hypertension, and chronic disease Located atthe 5th left intercostal space in the midelavieular line inerease in thickness of myocardial wall that occurs when the heart pumps against chronie outflow obstruction (e.g. aortic stenosis) Oceurs near term or when mother is lactating; i's due to inereased blood flow through the internal mammary artery imaginary vertical line biseeting the middle ‘of the clavicle in each hemithorax riddle third ofthe thoracie cage Imaginary vertical line bisecting the middle of the clavicle in each hemithorax Due to forward flow through SL valves Stream of blood regurgitates back into LA during systole through ineompetent mitral valve, In diastole, blood passes back into LV again along with new flow; results in LV dilation and hypertrophy Caleified mitral valve wll not open properly, impedes forward flow of blood into LV during diastole, Results in LA enlarged and LA pressureinereased Left atrioventricular valve separating the left atria and ventricle A gentle, blowing, swooshing, sound that can be heard on the chest wall ‘Velocity of blood inereases, viscosity of blood deereases, structural defects in the valves or unusual openings aceur in the chambers. myocardium Noeturia Orthopnea P Wave Palpitation Pansystolie Regurgitant, Murmurs Paradoxical Splitting Patent Duetus Arteriosus (pay pericardial fluid Pericardial Friction Rub Pericardium pericardium, myocardium, endocardium Physiologie Splitting PRInterval PRinterval Precordium. Preload presystole or atrial systole ‘muscular wall of the heat that does the pumping Recumbeney at night promotes fluid reabsorption and exeretion this occurs with, heart failure inthe person who is ambulatory during the day the need to assume a more upright position to breathe (note exact numberof pillows used) Depolarization ofthe atria ‘Uncomfortable awareness of rapid or invegular heart rate Due to backward flow of blood from area of higher pressure to one of lower pressure Opposite ofa normal split 2 so that the split is heard in expiration, andin inspiration the sounds fase to one sound Persistence of the channel joining left pulmonary artery to aorta. This is normal in the fetus and usually closes spontaneously within hours of bith uid contained within the two layers of the pericardium, itensures smooth, frition-free movement ofthe heart muscle High-pitehed, seratchy extracardiae sound heard when the precordium is inflamed ‘Tough, fibrous, double-walled sae that surrounds and proteets the heart. Ithas two layers that contain a few mm of serous pericardial fuid layers ofthe heatt wall Normal variation in S2 heard as two separate components during inspiration ‘The time necessary for atrial depolarization plus time for the impulse to travel through the AV node to the ventricles; from the beginning ‘of the P wave tothe beginning of the QRS. complex from the beginning ofthe P wave to the beginning of the QRS complex. Area on the anterior chest direetly overlying. the heart and great vessels ‘The venous return that builds during diastole. It's the length to which the ventricular muscle is stretehed at the end of diastole just before contraction, toward the end of diastole the atria contract to actively push the remaining blood into the ventriclesPulmonary artery pulmonary veins pulmonic pulmonic regurgitation (pulmonic insufficiency) pulmonic stenosis Pulmonie Valve Pulse Deficit QRS complex Risk Factors for caD St coincides with the pulseand the_ Stis louder at the Sais louder atthe Second Heart Sound (S2) semilunar (SL) valves ‘The Semilunar Valves leaves the right ventricle, bifureates, ‘and carries the venus blood to the lungs vein that return the freshly ‘oxygenated blood tothe lft side of the heart right semilunar valve separating the right ventricle and pulmonary artery backflow of blood through incompetent pulmonie valve into the Fight ventricle caleification of pulmonic valve that restrietsforwau flow of blood during systole Right semilunar valve separating the right ventricle and pulmonary artery Signals a weak contraction of the ventricles; occurs with atrial fibrillation, premature beats and heart failure depolarization of the ventricles 1. Elevated cholesterol 2. Elevated B/P 43, Blood sugar levels above 130 mg/dL or known DM 4, Obesity 5, Cigarette smoking 6, Low activity level 7. Length of any hormone replacement therapy for postmenopausal women Carotid Amtery; R Wave Apex Base ‘Caused by the closure of the semilunar valves, aortic and ppulmonie, and signals the end of systole valves set between the ventricles and the arteries; each has three eusps that look like half moons Aortic valveand Pulmonic valve Sinus Arrhythmia Summation Gallop Superior & Inferior vena ‘Syncope systole TWave Tachycardia Tetralogy of Fallot ‘Third Heart Sound ($3) Thrill tricuspid ‘Tricuspid Regurgitation ‘Tricuspid Stenosis ‘Tricuspid Valve Use of the Bell of the Stethoscope Use of the Diaphragm ofthe Stethoscope Rhythm varies with the person's breathing, increasing at the peak of inspiration and slowing with expiration Abnormal mid-diastolie heart sound heard when both the pathologie $3 and S4 are present retum unoxygenated venous blood to the right side of the heart, temporary loss of consciousness due to decreased cerebral blood flow (fainting) caused by ventricularsystole, pronounced bradyeardia, or ventricular fibrillation Phase two ofthe cardiac eyele, The heart's contraction, Blood is pumped from the ventricles and fills the pulmonary and systemie arteries Repolarization of the ventricles rapid heart rate, >90 beats per minutein the adult 4 components: 1. RV outflow stenosis 2.VsD ‘3: RV hypertrophy 4. Oversiding aorta Result: Shunts alot of venous blood direetly into aorta away from pulmonary system, $0 blood never gets oxygenated Soft, low-pitehed venticular filling sound that occurs in early diastole; may be an eatly sign of heart failure ‘A Palpable vibration on the chest wall. It feels like the throat of a purring eat. Signifies turbulent blood flow and accompanies loud right AV valve separating rightatria and ventricle Backflow of blood through incompetent twieuspid valve into RA Caleification of wieuspid valve impedes forward flow into RV during diastole Right atrioventricular valve separating the right atria and ventricle Used for hearing sof, low-pitehed heart sounds Used for hearing relatively high-pitehed heart soundsValves prevent backflow of blood, can open only one way, open and elose passively. Ventricle thick walled muscular pumping chamber Ventricular Septal Defect Abnormal opening in the septum between the ventricles, usually in the subaortic area. The size and exact «vsp) position vary considerably