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what are important landmarks in the Heart?
- PMI: point of maximal impulse - apical impulse - apex of the heart. It is located in the 5th intercostal space, lateral to the midclavicular line.
- BASE: Near the right ventricle and the edge of the sturnum. At the top near the pulmonary artery and aorta.
- Midclavicular line: middle of the clavile.
- Anterior axillary line: Almost at the end of the clavicle.
What is preload? When do ventricules contract? what is afterload? What is CO? what is BP?
- Preload: Stretch of the muscle before contraction - Volume overload.
- Ventricles contract in systole.
- Afterload: Degree of vascular resistance to ventricle contraction - pressure overload.
- CO: The amt ejected to maintain tissue perfusion. Can be calculated: stroke volume x HR.
- BP: CO x Systemic vascular resistance
What is systolic BP? What is Dyastolic BP? What is pulse pressure?
- SBP: Pressure generated by the LV during sytole, when the ventricle ejects blood into the aorta.
- DBP: Pressure generated by blood remaining in the arterial tree during dystole, when the ventricles are relaxed.
- Pulse pressure: Systole - dystole.
What are the sounds of the heart? Which one are pathologic? Describe each sound?
- Common sound in the heart are S1 (lop) S2 (dub).
- Pathologic are S3 in adults, and S4 in everyone.
- S1: produce when the mitral valve closes and corresponds to the carotid artery pulsation.
- S2: produced by the aortic valve. Marks the end of systole.
- S3: It is caused by rapid deceleration of the blood agains the ventricular wall as the blood moves from atrium to ventricle.
- Pathologic in older adults, no children and younger adults.
- S4: Always pathologic. Marks atrial contraction. it immediately precedes the S1 sound. It symbolizes decrease ventricular compliance.
What is a murmur?
- A longer in duration heart sound (lob shish dub).
- They can be benign, or pathologic (valvular disease)
- The most common murmur is the Mitral valve regurgutation, due to the high pressure in the Lt ventricle.
- I: barely audible if listen carefully.
- II: faint
- III: loud with no palpable thrill.
- IV: Loud murmur with palpable thrill.
- V: Loud with palpable thrill and barely need the stethoscope on the chest.
- VI: Loud with palpable thrill, stethoscope not on chest.
What is the normal impulse conduction in the heart? What does the p wave stand for? QRS? T?
- AS node --> through atrium --> AV node --> blundle of his --> perkenji fibers.
- P-wave: atrial depolarization/spreading of the impulse through the atria.
- QRS: ventricular depolarization/ impulse through the ventricles.
- T-wave: Ventricular re-polarization.
What are common changes in finding in older adults?
- Extra sound may develop: S3 linked with CHF, S4 decreased ventricle compliance.
- Murmurs: Mitral regurgatition common bc of the high pressure in the Lf ventricule.
- HTN: Stiffnen of the arteries bc of increase in systolic BP, orthostatic hypotension.
- Rythm distrubances: Atrial and ventriculas ectopy.
what are common changes in findings in childbearing women?
- PMI could moved to the 4th IC space.
- Venous hum. (vein walls vibrating)
- increase in blood volume.
- Vasodilation resulting decreased BP.
What is JVP? How do u know where the venous pulsation is?
- Index the Rt heart pressure and CO.
- JVP low: loss of blood
- JVP high: Rt or Lt Heart failure, pulmonary HTN, Tricuspid stenosis, and tamponade.
- This is not used in children <12.
- Venous pulsation can be seen, but if palpable, they get obliterated (disappear)
Carotid pulse? how to describe it?
- The carotid pulse is the best way to identify the S1 sound.
- Brisk: normal.
- Delayed: suggests aortic stenosis.
- Bounding: Suggests aortic insufficiency.
Areas of the heart? What sound sound more in each area? Do u use the bell or diaphram?
- Base: S2
- Apex: S1
- Use the diaphram.
- Use bell for murmurs, so come back to the last 3 spots and re-listen.
Where should u use the diaphram? and where the bell?
- Diaphram: high-pitches sound, press firmly ( S1,S2, aortic and mitral murmurs).
- Bell: Use for low-pitched sounds, press lightly (S3, S4, mitral stenosis) although murmurs are heard better w the bell most of the time.
when do systolic murmurs occur? diastolic? How are they described?
- systolic murmurs: B/t the S1 and S2, they usually coincide with the carotid pulse.
- Diastolic: B/t S2 and S1. It is a red flag!
- Description: Crescendor, decrescendo, plateu, or both.
what are some techniques to heard the heart better?
- supine to sitting.
- Valsalva maneuver (bear down): systolic murmur of hypertrophic cardiomyopathy increases.
- Pulsus alterans: Alternating loud and soft korotkoff sounds, force of arterail pulse alternates strong and weak, usually it means Lt sided heart failure.
- Paradoxical pulse: Greater than normal drop in systolic pressure during inspiration as you decrease the cuff. It indicates tamponade or pericardial restriction.
1) normal sinus rythm
2) Sinus arrhythmia.
3) Sinus tachycardia.
4) Sinus Bradycardia.
- 5) atrial fibrilation (cannot see the real p, irregular)
- 6) Atrial flutter
7) ventricular fibrulation
8) Vetricular Tachycardia.
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