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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.
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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
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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.
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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.
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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.
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Murmur grades?
- 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.
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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.
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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.
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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.
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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)
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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.
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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.
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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.
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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.
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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.
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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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