Term
|
Definition
| notch in arterial waveform caused by closure of the aortic valve |
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Term
| Difference between arterial and jugular pulse |
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Definition
- arterial pulse caused by forward propulsion of blood
- jugular pulse caused by backwash; has five components:
- A = atrial contraction (blood flows backward)
- C = ventricular contraction
- X = atrial relaxation (dip in the curve)
- V = passive atrial filling
- Y = passive ventricular filling |
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Term
| Time of first fetal heart beat |
|
Definition
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Term
|
Definition
| Part of fetal circulation; opening in the atrial septum of the fetus; allows oxygenated blood to be shunted to the body without passing through the lungs |
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Term
|
Definition
Part of fetal circulation; duct that shunts blood from from the pulmonary artery to the aorta (in the fetus).
Closes w/in 10-15 hours, but may take 48 hours |
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Term
|
Definition
| Palpable at the fifth intercostal space |
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Term
|
Definition
- Closure of the AV valves;
- corresponds w/ R wave
- @ beginning of systole;
- heard loudest at the apex |
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Term
|
Definition
| Closure of the semilunar valves; end of systole; heard loudest at the base |
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Term
|
Definition
| When aortic valve closes slightly before pulmonic valve; occurs normally during inspiration due to decreased intrathoracic pressure, pushing more blood into the right side of the heart, delaying pulmonic valve closure. |
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Term
|
Definition
| Ventricular filling sound; occurs at beginning of diastole right after S2 |
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Term
|
Definition
| Occurs at end of diastole when ventricles are resistant to filling. |
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Term
|
Definition
| gentle wooshing sound hear on chest wall |
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Term
| Conditions resulting in a murmur |
|
Definition
1) Increased velocity of blood (e.g. thyrotoxicosis)
2) Viscosity of blood decreased (e.g. anemia)
3) Structural defects in the valves |
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Term
| How are heart sounds described? |
|
Definition
1) Frequency (pitch)
2) Intensity (loudness)
3) Duration
4) Timing (systole or diastole) |
|
|
Term
| Blood pressure - Aging adult |
|
Definition
Increase in SBP due to stiffening of large arteries due to arteriosclerosis.
There are no significant changes to DBP w/ aging. |
|
|
Term
| Heart Structure - Aging adult |
|
Definition
| Overall size of heart stays the same, but left ventricular wall thickness increases (adaptive mechanism to accommodate increased afterload) |
|
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Term
|
Definition
| No changes in HR w/ aging |
|
|
Term
| Cardiac output -- Aging adult |
|
Definition
| No changes in CO at rest, but decreased ability to increase CO w/ exercise |
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Term
|
Definition
- Prolonged P-R interval
- Prolonged Q-T interval
- Bundle branch block
- Left axis deviation (due to LV hypertrophy) |
|
|
Term
| What is the prevalence of heart disease in the U.S.? |
|
Definition
|
|
Term
| What are the 9 modifiable risk factors for CVD identified by the INTERHEART study? |
|
Definition
1) abnormal lipids
2) smoking
3) hypertension
4) diabetes
5) abdominal obesity
6) psychosocial factors
7) consumption of fruits/veggies
8) alcohol
9) regular physical activity |
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|
Term
| Hypertension (definition) |
|
Definition
SBP >= 140 mmHg
DBP >= 90 mmHg
or, currently taking antihypertensive medicine |
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|
Term
| Hypertension -- gender differences |
|
Definition
* age <45 --> F* age 45-64 --> F=M
* age >64 --> F>M
F=female
M=male |
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|
Term
| Cholesterol levels -- risk for CVD |
|
Definition
>= 240 mg/dL = high risk
200-239 = borderline high risk |
|
|
Term
| Prevalence of high cholesterol (ethnic differences) |
|
Definition
Mexican > white > black
(men > women) |
|
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Term
|
Definition
overweight --> >=25
obese --> >= 30 |
|
|
Term
|
Definition
black > Mexican > white
- abdominal obesity is greatest predictor
- also genetic |
|
|
Term
| Carotid artery -- assessment |
|
Definition
1) palpate gently, one at a time; normal is 2+
2) auscultate using bell; ask pt to hold breath; bruit indicates atherosclerosis |
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|
Term
| Jugular veins -- assessment |
|
Definition
1) used to assess central venous pressure (CVP)
2) measure either internal or external jugular veins
3) w/ pt supine at 30-45 degree angle; normal is flattened
4) full, distended veins indicate increased CVP |
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Term
|
Definition
1) hold a vertical ruler on the sternal angle
2) hold another ruler horizontal at the highest level of pulsations of jugular vein
3) read the level of intersection on the vertical ruler
4) >3cm is abnormal, indicating heart failure |
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|
Term
|
Definition
1) instruct pt to breath through mouth
2) watch level of JVD as you push on the pt's RUQ below the ribs w/ your right hand; hold pressure for 30 seconds
3) if HF present, jugular veins will elevate and stay elevated
4) normal pt's, vein will momentarily rise, then go back down |
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Term
|
Definition
Pulsation created as left ventricle rotates against chest wall during systole at 4th or 5th intercostal space, at or inside midclavicular line.
Should be a short, gentle tap.
May not be palpable w/ pulmonary emphysema. |
|
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Term
|
Definition
a sustained forceful thrusting of the ventricule during systole that occurs w/ ventricular hypertrophy;
- RV heave --> @ sternal border
- LV heave --> @ apex |
|
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Term
|
Definition
| a palpable vibration signifying turbulent blood flow as w/ loud murmurs (palpated on the precordium) |
|
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Term
|
Definition
| Used to outline the heart borders; enlarged w/ increased ventricular volume or wall thickness |
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|
Term
| Auscultation of heart sounds |
|
Definition
1) aortic area --> second right interspace
2) pulmonic area --> second left interspace
3) Erb's point --> third left interspace
4) Tricuspid area --> left lower sternal border
5) Mitral area --> fifth interspace at left midclavicular line |
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Term
|
Definition
| Unaffected by respiration; seen in atrial septal defect |
|
|
Term
| Split S2 -- paradoxical split |
|
Definition
| Opposite of physiologic split; occurs on expiration; |
|
|
Term
|
Definition
| Associated w/ mitral valve prolapse |
|
|
Term
|
Definition
Grade i --> barely audible
Grade ii --> faint, but clearly audible
Grade iii --> moderately loud, easy to hear
Grade iv --> loud, associated w/ thrill
Grade v --> very loud, may hear w/ corner of stethoscope lifted
Grade vi --> loudest; may hear w/ entire stethoscope lifted from chest wall |
|
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Term
|
Definition
| Describe as "high," "medium," or "low;" depends on pressure and rate of blood flow |
|
|
Term
|
Definition
- Crescendo --> getting louder
- Decrescendo --> tapers off
- Crescendo-decrescendo |
|
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Term
|
Definition
| "musical," "blowing," "harsh," or "rumbling" |
|
|
Term
|
Definition
1) timing
2) loudness (grade)
3) pitch
4) pattern
5) quality
6) location (where is it heard best?)
7) radiation (can you hear it somewhere else?)
8) posture (does it change depending on pt position?) |
|
|
Term
|
Definition
| no valvular or other pathologic cause; usually soft, midsystolic, short, crescendo-decrescendo, and musical |
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Term
|
Definition
| due to increased blood flow in the heart (e.g. w/ fever, pregnancy, hyperthyroidism, anemia) |
|
|
Term
| Displacement of the apex in infants |
|
Definition
- cardiac enlargement
- pneumothorax
- diaphragmatic hernia
- dextrocardia |
|
|
Term
|
Definition
- 120-140 bpm (100-180 bpm immediately after birth)
- tachycardia is >150bpm (>200 in newborns)
- bradycardia is < 60bpm (<90 in newborns)
- Sinus arrhythmia is normal |
|
|
Term
|
Definition
- a continuous, low-pitched hum heard throughout the cardiace cycle w/ bell over supraclavicular fossa
- due to turbulence of blood flow in the jugular venous system; common in healthy children
- can be distinguished from other murmurs by occluding the jugular veins w/ the fingers momentarily |
|
|
Term
| Heart assessment -- pregnancy |
|
Definition
- increased resting pulse (10-15 bpm)
- drop in BP (lowest at 2nd trimester, then rises during 3rd)
- Splitting of S1
- increased loudness of S1
- presence of S3
- systolic murmur (in 90%)
- mammary souffle -- murmur from breast vasculature, easily obliterated w/ pressure from stethoscope |
|
|
Term
| Pregnancy-induced hypertension |
|
Definition
- Rise in SBP > 30mmHg
- Rise in DBP > 15mmHg |
|
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Term
|
Definition
| sudden drop in BP when rising to sit or stand |
|
|
Term
| Heart assessment -- aging adult |
|
Definition
- widened pulse pressure
- increased chest anterioposterior diameter
- S4 may be heard w/ no cardiac disease
- systolic murmurs are common (>50%)
- occasional ectopic beats are common |
|
|
Term
| Clinical portrait of heart failure |
|
Definition
- dilated pupils
- pale, gray, or cyanotic skin
- Dyspnea
- Orthopnea
- Crackles, wheezes in lungs
- Cough w/ frothy pink sputum
- Hypotension
- N/V
- Ascites
- Dependent, pitting edema
- anxiety
- decreased O2 saturation
- confusion, ALOC
- JVD
- Fatigue
- S3, gallop, tachycardia
- hepatosplenomegaly
- decrease UOP
- weak pulse
- cool, moist skin |
|
|
Term
|
Definition
- Loud S1 --> mitral stenosis, hyperkinetic states
- Faint S1 --> mitral insufficiency, severe hypertension
- Varying S1 --> A-fib, complete heart block
- Split S1 --> normal, but uncommon |
|
|
Term
|
Definition
- Accentuated S2 --> Systemic HTN, mitral stenosis, HF, aortic or pulmonic stenosis
- Diminished S2 --> shock, aortic or pulmonic stenosis
- Fixed split S2 --> atrial septal defect; RV HF
- Paradoxical split S2 --> aortic stenosis, LBBB, patent ductus
- Wide split S2 --> RBBB |
|
|
Term
|
Definition
- occurs when semilunar valves open
- w/ aortic or pulmonic stenosis |
|
|
Term
|
Definition
| mechanical aortic prosthesis -- early systolic sound |
|
|
Term
|
Definition
- associated w/ mitral valve prolapse
- short and high pitched
- heard w/ the diaphragm at the apex
- usually followed w/ systolic murmur |
|
|
Term
|
Definition
- occurs in early diastole after S2
- associated w/ mitral stenosis
- usually followed w/ low-pitched diastolic rumbling |
|
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Term
|
Definition
| - early diastolic click heard over the whole precordium |
|
|
Term
|
Definition
- ventricular filling sound
- occurs during early diastole
- dull, soft, low-pitched
- heard at apex
- may be confused w/ split S2 (different location, pitch, and no respiratory variation)
- pathologic S3 = "ventricular gallop"; indicates decreased compliance of ventricles, early sign of heart failure |
|
|
Term
|
Definition
= ventricular filling sound
- occurs in late diastole when atria contract
- immediately before S1
- "physiologic S4" --> may occur in older adults
- "pathological S4" --> "atrial gallop"; associated w/ decreased compliance and systolic overload (e.g. outflow obstruction or systemic HTN); heard best at apex in left lateral position |
|
|
Term
|
Definition
| when both pathologic S3 and S4 are present during tachycardia and S3 and S4 are superimposed |
|
|
Term
|
Definition
| High-pitched, scratchy sound heard best w/ diaphragm while sitting up and leaning forward, holding breath in expiration. |
|
|
Term
| Patent ductus arteriosus -- clinical data |
|
Definition
S: Usually no symptoms
O: "Machinery murmur"; wide pulse pressure, bounding pulses, thrill at left upper sternal border |
|
|
Term
| Atrial septal defect -- clinical data |
|
Definition
S: Well tolerated; normal growth; children may have mild fatigue and DOE
O:
- sternal lift
- fixed split S2
- murmur due to increased pulmonic blood flow; systolic, ejection, medium pitch, heard at base |
|
|
Term
| Ventricular septal defect -- clinical data |
|
Definition
S:
- small defects are asymptomatic
- w/ large defect, poor growth, appear pale, thin, and delicate; problems feeding; DOE; freq respiratory infections; heart failure in severe cases
O:
- Loud, harsh, holosystolic murmur
- heard at left lower sternal border, w/ thrill |
|
|
Term
| Tetralogy of Fallot -- clinical data |
|
Definition
S:
- severe cyanosis as infant grows
- cyanosis w/ crying and exertion, later at rest
- squatting posture
- slowed development
O:
- Systolic, loud, crescendo-decrescendo murmur
- Thrill at left lower sternal border |
|
|
Term
| Coarctation of the Aorta -- clinical data |
|
Definition
S:
- heart failure in first few months
- some children asymptomatic
- adolescents --> vague lower extremity cramping, worse w/ exercise
O:
- upper extremity hypertension (20mmHg greater than lower extremity)
- absent or diminished femoral pulses
- systolic murmur at left sternal border, radiating to back |
|
|
Term
| Aortic stenosis -- clinical data |
|
Definition
S:
- fatigue, DOE, palpitation, dizziness, faintness, angina
O:
- Pallor, diminished radial pulse, low BP, auscultatory gap
- apical impulse displaced to left
- ejection click
- paradoxical split S2
- S4 w/ LV hypertrophy |
|
|
Term
| Pulmonic stenosis -- clinical data |
|
Definition
O:
- systolic, medium pitch, coarse, crescendo-decrescendo murmur; radiates to left and neck
- ejection click
- diminished S2
- wide split S2
- S4 w/ RV hypertrophy |
|
|
Term
| Mitral regurgitation -- clinical data |
|
Definition
S:
- fatigue, palpitation, orthopnea, PND
O:
- pansystolic, loud, blowing murmur heard at apex; radiates to left axilla
- thrill in systole at apex
- left at apex
- apical impulse displaced down and to left
- S1 diminished
- S2 accentuated |
|
|
Term
| Tricuspid regurgitation -- clinical data |
|
Definition
O:
- soft, blowing, pansystolic murmur heard best at left lower sternal border, increases w/ inspiration
- engorged pulsating neck veins
- enlarged liver
- lift at sternum
- thrill at left lower sternal border |
|
|
Term
| Aortic regurgitation -- clinical data |
|
Definition
S:
- minor symptoms, then rapid deterioration
- DOE, PND, angina, dizziness
O:
- high pitched, blowing, diastolic, decrescendo murmur; heard best at third left interspace at base, as person leans forward
- bounding "water hammer" pulses
- widened pulse pressure
- displaced apical impulse |
|
|
Term
| Pulmonic regurgitation -- clinical data |
|
Definition
| Murmur has same timing and characteristics as aortic regurge (hard to distinguish) |
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|
