1. 300 Midterm notes – Cardiovascular
Ant 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 heart
contraction.
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 to
dialtion; down with expriation, decreased left ventricular output, or capillary pooling.
Contractility – ability to shorten. ANS
Afterload – 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 accompany
obstructive lung disease.
Paroxysmal nocturnal dyspnea - suggest LVHF or mitral stenosis, mimicked by nocturnal
asthma attack.
Jugular venous pulse goes up a down x up v down y.
a atrial contraction
x atrial relaxation, as blood goes into ventricals
v passive venous filling from vena cavae
y descent during passive filling.
S1 btwn a and x
S2 btwn x and v

2. Carotid - ptnt at 30, assess for amplitutde and contour, (LOOK FIRST for
pulsations)index/middle or thumb on lower 1/3, at level of cricoid cartilage. Press down
to feel strong pulse, then release till feel good contour. Looking for amplitude = CO, and
contour : brisk upstroke, rounded peak, more gradual down stroke.
small thready pulse - cardiogenic shock
bouding pulse - aortic insufficiency
delayed upstroke - aortic stinosis
Pulsus alternans - regular beat, varying force. Check with palpaing radial/femoral pusle,
auscultate with cuff, slow release from systolic pressure. -->Left sided heart failur.
bigeminal pulse
paradoxical pulse -
thrill - tremor felt on palpation --> auscultate for bruit!
Bell on bruit --> except for carotid!