300 Midterm notes – CardiovascularAnt surface – right ventricle and pulmonary trunk, left side of sternum.Pulm art – 2nd intercostals space.PMI – size of quarter (1-2.5), 7-9cm left of midsternum, fith intercostals space.Right atrium = right border.Left atrium = posterior, though small appendage makes up top of left border.Valvue opens or closes due to pressure being matched and then over-come by heartcontraction.Splitting of S2 into A2 and P2, due to increased compliance of respiratory vasculature.S2 splitting varies with respirations. Not S1.Valve is audible due to: relative pressure of blood, or if stiff leaflet (Opening snap).S1 is broken into two, with mitral being louder to due to pressure increase.Preload – stretch of cardiac ventricular muscles prior to contraction. Right side – up with inspiration, increased return, and pooling in heard due todialtion; down with expriation, decreased left ventricular output, or capillary pooling.Contractility – ability to shorten. ANSAfterload – resistance against which heart muscle must overcome during contraction.Resistance applied by compliance of arterial and arteriolar wall compliance.Old Age – increased anterioposterior dimension of thorax, so harder to hear and feel PMI.Pitch, BP, and hardening of arteries also change.Orthopnea – may suggest left ventricular heart failur or mitral stenosis, or accompanyobstructive lung disease.Paroxysmal nocturnal dyspnea - suggest LVHF or mitral stenosis, mimicked by nocturnalasthma attack.Jugular venous pulse goes up a down x up v down y.a atrial contractionx atrial relaxation, as blood goes into ventricalsv passive venous filling from vena cavaey descent during passive filling.S1 btwn a and xS2 btwn x and v
Carotid - ptnt at 30, assess for amplitutde and contour, (LOOK FIRST forpulsations)index/middle or thumb on lower 1/3, at level of cricoid cartilage. Press downto feel strong pulse, then release till feel good contour. Looking for amplitude = CO, andcontour : brisk upstroke, rounded peak, more gradual down stroke.small thready pulse - cardiogenic shockbouding pulse - aortic insufficiencydelayed upstroke - aortic stinosisPulsus alternans - regular beat, varying force. Check with palpaing radial/femoral pusle,auscultate with cuff, slow release from systolic pressure. -->Left sided heart failur.bigeminal pulseparadoxical pulse -thrill - tremor felt on palpation --> auscultate for bruit!Bell on bruit --> except for carotid!