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Terms Definitions
caridac murmurs -timing(systole or diastole)
-location (mitral or aortic)
- radiation (does it move)
-quality (blowing, grating, harsh)
-pitch (high or low bellow)
-intensity (very loud VI, very faint I)

longer duration than heart sounds, aortic murmur, sit up lean forward, swooshing
Afterload reflects end systolic volume (end systolic pressure)
S1 heard best at apex (mitral area)
what would an opneing snap mean? mitral/tricuspid stenosis
Does the Aorta carry oxygenated or unoxygenated blood out to the body? Oxygenated
Which carries “unoxygenated blood”- Pulmonary Arteries or Pulmonary Veins? Pulmonary “ARTERIES” carry unoxygenated blood. The pulmonary system is the only place that arteries carry unoxygenated blood and veins carry oxygenated blood
physical exam -persistant cough, changes in skin color(shiny, pigment), decreased pulses, symmetrical? palpitations( conscious awareness of heart beating in precordial area or neck, reg or irreg, some insignificant)
-general appearance, vitals, orthostatics,(obese, alert, apical, clubbed nails(cyanotic heart disease ad well as lung disorders), skin temp turgor texture, anxious, pulse symmetrical)
-skin extremities, large veins of neck (JVD)
- capillary refill(<3 secs)
-aging changes
-chest and abd- abd aort, pulse in precordial area, chest retractions
-apical- bell and diaphragm
-auscultate-femoral, carotids, bruits, thrill(abnormal swishing from occlusions) AV fistula
-inspection and palpation of thorax, epigastric areas, and mitral valve areas
-extra heart sounds (s3 and s4) use bell
preload volume of blood in ventricles at the end of diastole (usually expressed as a pressure)
the closure of the aortic and pulmonic valves begins what? diastole
what might be present in older clients? ausculatory gap.
S3 is it an atrial or ventricular gallop? Venticular
Systolic murmur is heard after which valves close? AV valves
PAst history -chest pain, SOB(esp on exertion or lying down), anemia
-ETOH, tobacco
-rheumatic fever, DM
- CVA, congential heart disease
-syncope, HTN, thrombophlebitis
-intermittent claudication(DVT, pain, arterial occlusion)
- varicosities, edema(CHF)
- current and past meds
-family cardiovascular hx(heart disease CAD)
- HTN, lipids, diabetes
- weight, diet
-exercise and effects(how much)
-stress
-83% die heart disease 85+
-women more likely to die than men from MI, women increased risk after menopause, men increased risk earlier in life
-heredity, af amer, asian, hispanic-increased risk
-most MI occur in early morning
edema 1+ = trace 2mm(1/4 inch)
2+ = mild 4mm(1/4-1/2 inch)
3+ = moderate 6mm ( 1/2 - 1 inch)
4+ = severe 8mm(>1inch)
for edema to be visible patient has retained 5L (10lb) of fluid
what sympotms spell heart trouble? dyspnea, cough, snycope, fatigue, changes in extremities, edema, palpatations, chest pain.
Does Isovolumetric relaxation happen during Systole or Diastole? At the beginning of Diastole
what does a normal s4 indicate? hypertention,...may be normal in athletes
S4 is heard with what disease processes? CAD, Hypertension, Aortic Stenosis
What is Compliance? The amount a vessel will stretch due to a change in pressure.
S1 is it heard in Systole or Diastole? Beginning of Systole
How do heart problems affect asians? they have lower incidence of hypertension and hyperlipidemia
how do you measure pulse pressure? the difference between systole and diastole should be no more than 1/3 of the systolic pressure
Is the Aorta on the right or left side of the heart? Left side
S4 is it heard in Systole or Diastole? Late diastole before S1
Where do you listen to hear the Pulmonic valve sound? 2nd left intercostal space
S3 is it heard in systole or diastole? Early Diastole after S2
S1 which valves closing make this sound? AV valves Mitral and Tricuspid
Where do you listen to hear the Tricuspid valve sound? 4th left intercostal space
a "normal" s3 indicates what? it is normal in children and some young adults, but it is abnormal in adults and means heart failure
What is a mnemonic for remembering where to listen to the valve sounds? APE To Man=Aortic, Pulmonic, Erb's point, Tricuspid, Mitral, starting from 2nd right intercostal space across to 2nd left and then down
What is Isovolumetric relaxation? The point at which all 4 heart valves are closed for an instant just after the atrium have filled
What causes the sound of S3? Rapid filling of the ventricles which causes turbulence and vibrations.
what is teh ankle brachial index? it assesses circulation at the feet. Use a doppler to measure blood pressure at the poteriaor tibialis or dorsalis pedias. Then compaire that pressure that one one obtained at the brachial artery. Devide the systolic pressure at the ankel, by the one at the brachial site. Normal would be 1 or greater. .8-.9 is minimal disease, .8-.4 is moderate disease, .4-0 is severe disease. *so obviously you want thsi number to be HIGH.
what does a pericardial friction rub indicate acute MI!!!! occurs in both systole and diastole
what is the atrial kick? it is 25% of cardiac output, it happens near the end of diastole.
What patient position is best to hear a pericardial friction rub? Supine taking a deep breath in? or Sitting up, leaning forward, with breath held in expiration? Sitting up, leaning forward, with breath held in expiration.
What could be a cause of the heart sounding muffled or distant? Fluid around the heart-Cardiac Tamponade
bruits and venus hums,..can you acclude them? you can occlude a venous hum, but not a bruit
True or False? Abnormally high volume in the right side of the heart would show up in JVD, enlarged liver and spleen, dependant edema-(swollen hands and feet) and fatigue? True. These are signs of right sided heart failure. Just think of where the veinous blood would back up to on the right side of the body and how gravity would take it back down to the liver and the hands and feet
S2 is it heard best at the base or the apex? loudest at the base
What is the best patient position to hear S3 and S4? Supine? Semi Fowlers? Left lateral position? Lying in the left lateral position shifts the heart closest to the chest wall
what is patency, and what test could you use to assess this? patency is normal refil, you could use the allen test to assess it on the radial and ulnar arteries before you go and puncter them.
If the heart is enlarged how could this be veiwed? (EKG-ECG)-Electrocardiogram? Echocardiogram? Xray? Angiogram? An enlarged heart with a shifted PMI (at the 6th intercostal space or greater) could be seen on Xray.
where is ventricular diastole heard best? at the base of the heart (so up at the top)
If the right side of the heart fails to pump well and blood backs up how might this be seen? In the carotid arteries or In the Jugular veins? Blood would back up and cause (JVD) Jugular vein distension.
Are there valves in the veins of your head? The veins in our head have no valves they drain into our jugular veins that drain directly into the superior vena cava and into the right atrium.
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