Discussion: Heart Issues

1. Label the following on this diagram of the heart.
· Sternum
· Axilla
· Base
· Apex
· Aortic valve
· Pulmonic valve
· Erbs Point
· Tricuspid valve
· Mitral valve
· Normal PMI location
2. Draw a line on your diagram indicating the normal blood flow circulation through the heart.
3. Describe PMI. What does it represent?
4. Where is the normal PMI location ___________________?
5. Describe the Frank Starling law.
6. Review target end organ damage as a result of HTN. Go system by system head to toe.
· Brain
· HEENT
· Cardiovascular
· What changes do you see in the heart? Why?
· What changes do you see in the vessels? Why?
7. Renal
8. Any other systems impacted by HTN?
9. Review target end organ damage from DM. Go system by system head to toe.
10. Describe left ventricular hypertrophy.
11. List some causes of LVH.
12. Go back to your diagram. Make the left ventricle larger. How does this displace the PMI?
13. What is the clinical significance of PMI found in the normally anticipated area?
14. Go back to your diagram. Which valves are open and closed during
· S1
· S2
15. Review normal heart sounds. Which sounds do you expect to hear in a normal patient?
16. When does an S3 occur?
17. When does an S4 occur?
18. EKG foundation content
· How does LVH manifest on an EKG?
· How does afib manifest on an EKG?
19. How does smoking influence HTN and cardiovascular risk?
20. Review normal lipid profile numbers. Are the desired target numbers different if your patient has CAD or DM?
· LDL
· HDL
· Triglycerides
21. Review pharmacologic options to treat HTN.

· How does a patients race influence your choice?
· Which agents are renal protective?
· Which agents would be considered first line for patients who have DM? Why?
· Which agents require caution for patients with increased lipids?
· Which agents impact uric acid?
· Which agents impact glucose?

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