The document summarizes different types of heart sounds, their causes and characteristics. It discusses the first, second, third and fourth heart sounds, their typical locations, and what abnormalities they may indicate. It also covers heart rate regulation factors like the cardioinhibitory and cardioacceleratory centers, as well as other influences like hormones, oxygen levels, and physical activity. Cardiac output factors are explained, including how venous return, heart rate, blood pressure, and myocardial strength can impact cardiac output.

1. Heart sounds

2. First heart sounds Causes: 1.Valvular 2.Vascular 3.Muscular Occur in Character: soft low pitched

3. Second heart sound Occur at the end and beginning Cause valvular character

4. 3 rd heart sound Occur in maximum filling Not heared except Cause vascular

5. 4 th heart sound Occur inAS Not heared Cause mascular

6. Radial pulse significanse

7. Heart rate Innervation of the heart 1.Cardioinhibitory centre 2.Cardioacceleratory centre

8. Factors regulating the heart rate 1.Afferent impulses Intrinsic Extrinsic 2.Effect of other centres a.CC b.RC c.hypothalamus

9. 3.change in chemical composition a.O2 lack,CO2 excess,H+excess b.Hormones 4.Physical regulation

10. COP Stroke volume Minute volume COP=SV /\ HR Cardiac index

11. Factors affecting COP 1.Venous return: influenced by a.Pressure gradient b.Respiratory movement c.Sk ms contraction d.Diameter of 1.arteriole 2.cap 3.veins e.Cont of blood reservoir f.Arterial pulsation

12. 2.Heart rate a.Moderate changes b.Sever changes

13. ABP Increase result in decrease SV only for few beats Sudden decrease result in increase SV only for few beats

14. Strenght of myocardium