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what is represented by the point of maximal impulse?
the furthermost point at which the cardiac impulse can be felt; heart apex rotates forward with systole
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where is the PMI located?
left 5th intercostal space
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PMI shifting indicates?
lateral displacement indicates left ventricular enlargment (cardiomegaly). localization of the PMI to the subxiphoid area is indicative of hyperinflation of the lungs, right ventricular prominence, or both. latter is typically seen in pts with pulmonary hypertension and may also have a prominent pulsation over the left second or third intercostal space and a loud P2 sound. If P2 can be heard at the apex it should be considered evidence of pulmonary hypertension
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what effect will COPD have on the PMI?
displaced inferiorly
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what are the valves of the heart?
pulmonic, aortic, mitral, tricuspid
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what valves are called the semilunar valves?
pulmonic and aortic
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what makes the 1st sound of the heart
the closing of the tricuspid and mitral valves
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what makes the 2nd sound of the heart
the closing of the semilunar valves
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what makes the 2nd sound of the heart?
the closing of the pulmonic and aortic valves
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describe a murmur
rumbling swishing sound btwn or after S1 & S2
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what can cause a murmur?
stenotic valve, incompetent valve, increase perfusion across valves, vibrations of loose cardiac structures, continuous flow through an AV shunt (hole in heart)
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what is meant by an incompentent valve?
backward regurgitation through leaking valve
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what is represented by a loud P2 sound?
pulmonic valve is closing too loudly > pulmonary hypertension > chronic hypoxemia
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what are the basic principles of a chest radiogram?
cassette placed on one side of the pt and radiographic waves are passed through the pt on the other side. the waves that pass through will reach the film in the cassette and cause a shadow to be cast on it, resulting in a darker area. If the waves are absorbed (like in areas of lower density tissue) there will be a lighter spot.
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what are the 4 different tissue densities on a chest x-ray?
air, fat, soft tissue, bone
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translucent
allows permeance of light
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radiolucency
partly or wholly permeable to x-rays, also describes darker areas on film
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radiopaque
dense areas that appear white on the xray
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consolidation
solid white area
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