Cardiovascular System and Heart Function

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• The heart is a four-chambered organ with two auricles and two ventricles, surrounded by the pericardium, which is fixed to the diaphragm by the pericardiac-phrenic ligament.

• The cardiac cycle involves the contraction of the auricles and then the ventricles, producing the first and second heart sounds, respectively, due to the closure of the mitral and tricuspid valves.

• The pulse is a result of the ventricular contraction, and its evaluation includes the anatomy of the vessel, frequency, regularity, amplitude, and tension.

• The frequency of the pulse is not the same as the heart rate, and the oximeter only provides a parameter of oxygenation, but not information about the rhythm or possible arrhythmias.

• The palpation of the pulse cannot be replaced by the oximeter, as it provides valuable information about the heart rhythm and possible abnormalities.

• The cardiac cycle involves the contraction of the auricles, which forces the opening of the auriculoventricular valves, and then the ventricles contract, closing the auriculoventricular valves and opening the semilunar valves.

• The valves can produce murmurs or sounds during two moments: when they open (e.g., stenosis) or when they close (e.g., insufficiency).

• The mitral valve opens in diastole and closes in systole, producing the first heart sound, while the aortic valve opens in systole and closes in diastole, producing the second heart sound.

• The tricuspid valve opens in diastole and closes in systole, producing a diastolic murmur if it doesn't open properly, and a systolic murmur if it doesn't close properly.

• The pulmonary valve opens in systole and closes in diastole, producing a systolic murmur if it doesn't open properly, and a diastolic murmur if it doesn't close properly.

• The heart has preload (the amount of blood that reaches the ventricle) and afterload (the amount of blood that is pumped out), which affect its contractility.

• An increase in preload or afterload can produce cardiac insufficiency, and a decrease in preload can produce cardiac failure.

• The symptoms of cardiac disease include chest pain, palpitations, difficulty breathing, edema, and loss of consciousness.

• The identification of a cardiac murmur involves the location, timing, and characteristics of the sound.

• The examination of the cardiovascular system includes inspecting the patient's general appearance, palpating the pulse, inspecting the neck veins, and auscultating the heart sounds.

• The measurement of the jugular venous pressure (JVP) is done by placing a ruler on the sternum and measuring the height of the jugular vein.

• The decubitus position is important in cardiac patients, as it can affect their tolerance to exercise and breathing.

• The evaluation of the pulse includes its amplitude, contour, and variation in amplitude, which can indicate cardiac problems such as aortic insufficiency.

• The palpation of the carotid artery can help identify murmurs or thrills.

• The examination of the heart involves placing the patient in different positions, such as cubitus supino, cubitus lateral, and sitting, to better auscultate and palpate the heart sounds and murmurs.

• Stólico los pulsos hepáticos are associated with right-sided cardiac insufficiencies, such as tricuspid insufficiency and pulmonary insufficiency, which increase pressure in the right ventricle.
• The Rivero-Carvallo maneuver helps differentiate between tricuspid and mitral murmurs, where the patient is asked to hold their breath and the intensity of the murmur is observed.
• During the Rivero-Carvallo maneuver, if the murmur intensity increases during sustained inspiration, it suggests a tricuspid murmur, and if it doesn't, it suggests a mitral murmur.
• In cardiac inspection, palpation, and percussion, matidez is found in the third to fifth intercostal space, and the cardiac apex is located in the fourth intercostal space.
• The pulmonary component of Chávez's complex is characterized by universal latidos and vibraciones fritos that transmit to the thoracic cage.
• The diaphragm is used to listen to R1 and R2, and the bell is used to listen to R3 and R4, with the bell always placed firmly against the thorax.
• When identifying a murmur, it is important to determine the moment it occurs, its location, and its characteristics, such as whether it is decreasing or increasing in intensity.
• The intensity of the murmur is graded from 1 to 4, with 4 being the highest intensity, and associated characteristics such as frémito are observed.
• A silent room and specific patient positions, such as decubitus lateral for mitral diseases or sitting leaning forward for aortic insufficiency, are used to facilitate auscultation.
• The characteristics of systolic murmurs are divided into mesos systolic, pans systolic, and teles systolic, depending on when they occur during the systole.
• Diastolic murmurs are classified into protodiastolic, mesodiastolic, and telediastolic, depending on when they occur during the diastole.