Maryville 612 Exam 2 Advanced Health Assessment test

What is S4 indicative of? - In the 2nd phase of ventricular filling, vibration in the valves, papillae, and ventricular walls produce S4. When there is increased resistance to filling because ventricular walls have lost compliance. HTN, CAD or increased stroke volume high output, anemia, pregnancy, and thyrotoxicosis. A loud S4 suggest pathology and deserves additional evaluation. What is the apical PMI? - Point of maximal impulse (PMI), the point at which the apical impulses are most readily seen or felt. Usually at the 5th ICS, midclavicular line in adults. 4th ICS medial to nipple in children. What is normal or abnormal in relation to PMI? - Normal- 1cm diameter, gentle, brief, not lasting as long as systole. Abnormal- Heave or lift (vigorous apical pulse outside above normal parameters), most often left sternal border, displacement. Thrill- (palpable murmur, vibration) most often at base of heart right or left 2nd ICS. When assessing family history what questions do you ask for CV history? - Long QT syndrome. Marfan syndrome-genetic, connective tissue disease MVR/MVP, AR, AD. DM, heart disease, HLD, HTN, obesity, congenital heart disease, morbidity, mortality r/t heart, age at time of illness or death, especially young and middle age relatives. What questions do you ask for patient history in MI? - Heart surgery/hospitalization for cardiac evaluation, congenital heart disease, rhythm, acute rheumatic fever, Kawasaki disease.