NUR 505 Module 4:
Advanced Health
Assessment Heart and
Blood Vessels Study Guide
Chapter 15 Heart
1. Complete the following table
Valve Anatomic Function/Blood Auscultation Expected Unexpected findings
Location Flow Location findings
Tricuspid Between Separates the 4th Left ICS S1 Holosystolic murmur:
the right right atrium along lower • Tricuspid
atrium and from the right left SB. S1>S2 regurgitation.
the right ventricle & • Ventricular septal
ventricle allows defect.
deoxygenated Diastolic murmur:
blood to flow • Tricuspid stenosis
between.
Pulmonic Between Separates the 2nd left ICS at S2 Systolic ejection murmur:
the right right ventricle left SB. • Pulmonic stenosis.
ventricle & from the S1<S2 • Atrial Septal Defect.
pulmonary pulmonary • Flow murmur.
artery artery. Opens
to allow blood
to be pumped
from the right
ventricle to the
lungs through
the pulmonary
artery where it
will receive
oxygen.
Prevents
backflow of
blood from the
pulmonary
artery to the
right ventricle.
, 2nd Right ICS Systolic murmur:
Opens to allow at Right S2 • Aortic Stenosis.
Between blood to leave Sternal • Flow
Aortic the left the heart from Border. S1<S2 murmur(physiologic).
Ventricle the left • Aortic valve stenosis.
and the ventricle
Aorta through the
aorta and the
body.
Prevents the
backflow of
blood from the
aorta to the left
ventricle
Mitral/Apical Between Regulates blood 5th ICS, S1 Holosystolic murmur:
the left flow from the Midclavicular • Mitral valve
atrium and left atrium into line. S1>S2 regurgitation.
left the left Systolic murmur:
ventricle ventricle. The apex of • Mitral valve
the heart. prolapse.
**The left Diastolic murmur:
ventricle is the • Mitral stenosis.
hearts main
pumping
chamber**
2. Review the anatomy and physiology of the heart in your textbook.
a. What are some differences in specialty populations (infants, children, pregnancy,
elderly) when compared to a normal adult heart?
Infants & Children
Fetal circulation compensates for the nonfunctional fetal lungs.
Blood Flow:
• RA foramen ovale LA
• RV patent ductus arteriosus (instead of lungs)
• Birth closure of ductus arteriosus in 24 to 48 hours
• By age 1, the ventricles are size ratio of 2:1 when compared to adult size
• Heart lies more horizontal in chest in infants and young children
• Age 7, adult heart position is reached.
What happens in an infant’s heart after birth? Closure of ductus arteriosus in 24 to 48 hours
, How does pregnancy affect the cardiac system?
• Blood volume increases
• Workload of heart increases due to increased HR and Stroke Volume
• Returns to normal 3-4 weeks after delivery.
What changes occur in our elderly population?
• Heart size may decrease (if HTN or HD is not present)
• LV wall thickens, valves fibrose
• SV decreases
3. What is the apical impulse? What position is it best seen? What is the PMI? Where is
the PMI located? If the PMI is more vigorous than expected, how would you
characterize this? Displacement of the PMI is an indication of what?
Apical impulse:
The apical impulse corresponds to the rhythmic contraction of the left ventricle of the heart.
also known as the point of maximum impulse (PMI), is a term used in clinical medicine to
describe the pulsation at the apex (tip) of the heart. It is the palpable heartbeat that can be felt
on the chest wall.
Where is the PMI located?
• Apical impulse is seen at the MCL, 5th ICS
• Should be seen in only 1 ICS
What position is it best seen in?
• May only become visible with sitting up and leaning forward.
• palpate the PMI to assess the heart's size, position, and overall cardiac function.
• Changes in the location, size, or strength of the PMI can provide important
diagnostic information about the heart to diagnose various cardiac conditions.
• If PMI is more vigorous than expected- characterized as a “heave” or “lift”.
This can indicate:
▪ increased cardiac output
▪ Ventricular hypertrophy
▪ Use proximal halves of 4 fingers
▪ Apex LSB base RSB axillae
▪ Feel for apical impulse
▪ PMI is the point of maximal impulse
o 5th ICS, MCL in adults
o 4th ICS, medial to nipple in children
o If more vigorous than expected heave or lift
o If displace laterally or downward, Might indicate LVH or increased CO
▪ Feel for thrill, heaves, lifts
▪ Palpate carotid pulse at the same time, should be at same time as S1
Advanced Health
Assessment Heart and
Blood Vessels Study Guide
Chapter 15 Heart
1. Complete the following table
Valve Anatomic Function/Blood Auscultation Expected Unexpected findings
Location Flow Location findings
Tricuspid Between Separates the 4th Left ICS S1 Holosystolic murmur:
the right right atrium along lower • Tricuspid
atrium and from the right left SB. S1>S2 regurgitation.
the right ventricle & • Ventricular septal
ventricle allows defect.
deoxygenated Diastolic murmur:
blood to flow • Tricuspid stenosis
between.
Pulmonic Between Separates the 2nd left ICS at S2 Systolic ejection murmur:
the right right ventricle left SB. • Pulmonic stenosis.
ventricle & from the S1<S2 • Atrial Septal Defect.
pulmonary pulmonary • Flow murmur.
artery artery. Opens
to allow blood
to be pumped
from the right
ventricle to the
lungs through
the pulmonary
artery where it
will receive
oxygen.
Prevents
backflow of
blood from the
pulmonary
artery to the
right ventricle.
, 2nd Right ICS Systolic murmur:
Opens to allow at Right S2 • Aortic Stenosis.
Between blood to leave Sternal • Flow
Aortic the left the heart from Border. S1<S2 murmur(physiologic).
Ventricle the left • Aortic valve stenosis.
and the ventricle
Aorta through the
aorta and the
body.
Prevents the
backflow of
blood from the
aorta to the left
ventricle
Mitral/Apical Between Regulates blood 5th ICS, S1 Holosystolic murmur:
the left flow from the Midclavicular • Mitral valve
atrium and left atrium into line. S1>S2 regurgitation.
left the left Systolic murmur:
ventricle ventricle. The apex of • Mitral valve
the heart. prolapse.
**The left Diastolic murmur:
ventricle is the • Mitral stenosis.
hearts main
pumping
chamber**
2. Review the anatomy and physiology of the heart in your textbook.
a. What are some differences in specialty populations (infants, children, pregnancy,
elderly) when compared to a normal adult heart?
Infants & Children
Fetal circulation compensates for the nonfunctional fetal lungs.
Blood Flow:
• RA foramen ovale LA
• RV patent ductus arteriosus (instead of lungs)
• Birth closure of ductus arteriosus in 24 to 48 hours
• By age 1, the ventricles are size ratio of 2:1 when compared to adult size
• Heart lies more horizontal in chest in infants and young children
• Age 7, adult heart position is reached.
What happens in an infant’s heart after birth? Closure of ductus arteriosus in 24 to 48 hours
, How does pregnancy affect the cardiac system?
• Blood volume increases
• Workload of heart increases due to increased HR and Stroke Volume
• Returns to normal 3-4 weeks after delivery.
What changes occur in our elderly population?
• Heart size may decrease (if HTN or HD is not present)
• LV wall thickens, valves fibrose
• SV decreases
3. What is the apical impulse? What position is it best seen? What is the PMI? Where is
the PMI located? If the PMI is more vigorous than expected, how would you
characterize this? Displacement of the PMI is an indication of what?
Apical impulse:
The apical impulse corresponds to the rhythmic contraction of the left ventricle of the heart.
also known as the point of maximum impulse (PMI), is a term used in clinical medicine to
describe the pulsation at the apex (tip) of the heart. It is the palpable heartbeat that can be felt
on the chest wall.
Where is the PMI located?
• Apical impulse is seen at the MCL, 5th ICS
• Should be seen in only 1 ICS
What position is it best seen in?
• May only become visible with sitting up and leaning forward.
• palpate the PMI to assess the heart's size, position, and overall cardiac function.
• Changes in the location, size, or strength of the PMI can provide important
diagnostic information about the heart to diagnose various cardiac conditions.
• If PMI is more vigorous than expected- characterized as a “heave” or “lift”.
This can indicate:
▪ increased cardiac output
▪ Ventricular hypertrophy
▪ Use proximal halves of 4 fingers
▪ Apex LSB base RSB axillae
▪ Feel for apical impulse
▪ PMI is the point of maximal impulse
o 5th ICS, MCL in adults
o 4th ICS, medial to nipple in children
o If more vigorous than expected heave or lift
o If displace laterally or downward, Might indicate LVH or increased CO
▪ Feel for thrill, heaves, lifts
▪ Palpate carotid pulse at the same time, should be at same time as S1
