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PA: Exam 2 > 7.7 Cardiovascular & Jugular > Flashcards

7.7 Cardiovascular & Jugular Flashcards

1
Q

Which has a higher systemic pressure? Venous or arterial?

A

ARTERIAL has a higher systemic pressure than venous.

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2
Q

Venous pressure depends on…

A

Left ventricular contraction

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3
Q

Determinants of venous pressure (4)

A

o Left ventricular contraction
o Blood volume
o Capactiy of the right heart to eject blood to the pulmonary arterial system
o Cardiac disease (may alter these variables, produce abnormalities)

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4
Q

What effect does failure of the RIGHT heart have on the venous system?

A

Venous pressure RISES

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5
Q

When left ventricular output or blood volume is reduced, what happens to venous pressure?

A

Venous pressure falls.

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6
Q

Units of CVP measurements in hospitals (2):

A

o cm of H2O when using a manometer

o mmHg when using an electronic device

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7
Q

What is normal CVP?

A

o 0-8 mm Hg or

o 3-8 cm of H20

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8
Q

Venous pressure changes are reflected in…

A

The height of the venous column of blood in the INTERNAL jugular veins.

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9
Q

What is JVP? What does it reflect?

A

o Jugular venous pressure.

o It is a reflection of the pressure of the right atrium or central venous pressure

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10
Q

Where is JVP measured? Why?

A

o The right internal jugular vein

o Because it has a more direct anatomic channel into the right atrium

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11
Q

How do you estimate the level of the JVP?

A

o Find the highest point of oscillation in the internal jugular vein
o JVP is usually measured in vertical distance above the sternal angle (angle of louis – which is 5cm above the right atrium)
o 5cm + distance of highest oscillation above sternal angle = JVP

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12
Q

What is considered to be an elevated or abnormal JVP?

A

o A JVP of more than 8-9cm total

o 3 or possibly 4cm above the sternal angle

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13
Q

How do you position a patient for the JVP measurement? 3 scenarios

A

o Normal/to start: position patient at a 30 degree angle
o A hypovolemic patient may need to lie flat to do measurement
o If JVP is increased, an elevation of up to 60 or 90 degrees may be required

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14
Q

Where should you begin to look for the jugular venous pulsations?

A

In the suprasternal notch of the neck

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15
Q

What is the precordium?

A

Area overlying the heart and great vessels

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16
Q

What area is the heart in, in terms of rib count?

A

2nd to 5th intercostal space

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17
Q

What pulse spot is at the apex? Where is the Apex located?

A

o PMI

o Left 5th intercostal space

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18
Q

Name the five great vessels of the heart

A 
o	Superior vena cava
o	Inferior vena cava
o	Pulmonary artery
o	Pulmonary veins
o	Aorta
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19
Q

Layers of the heart, from innermost to outermost

A 
o	Endocardium (Purkinje fibers connect here)
o	Myocardium
o	Epicardium (Visceral pericardium)
o	Pericardial cavity
o	Parietal pericardium
o	Fibrous pericardium
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20
Q

Which side of the heart is high pressure? Which is low?

A

o Right: Low pressure

o Left: High pressure

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21
Q

What causes valves to open and close?

A

They open and close PASSIVELY due to changes in pressure.

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22
Q

When do AV valves oen / close?

A

o OPEN during diastole

o CLOSE during systole (S1 – lub)

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23
Q

When do semilunar valves open / close

A

o OPEN during systole

o CLOSE during diastole (S2 – dub)

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24
Q

When is S1? When is S2?

A

o S1: Systole. AV valves close. Lub.

o S2: Diastole. Semilunar valves close. Dub.

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25
Q

What happens during Systole? (4, don’t forget to mention valves)

A

o S1: Closing of AV valves
o The ventricles contract
o Right ventricle pumps blood into pulmonary arteries (Pulmonary valve is open.)
o left ventricle pumps blood into Aorta. (Aortic valve is open.)

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26
Q

What happens during diastole? (4, don’t forget to mention valves)

A

o S2: Closing of semilunar valves
o Ventricles relax
o Blood flows from right atrium to right ventricle (Tricuspid valve is open)
o Blood flows from left atrium to left ventricle (Mitral valve is open)

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27
Q

Where is S1 best auscultated?

A

o 5th intercostal space, at apex
o Tricuspid best heard at left sternal border
o Mitral best heard at right midclavicular line

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28
Q

Where is S2 best auscultated?

A

o 2nd intercostal space, at base
o Aortic – best heard on right
o Pulmonic – best heard on left

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29
Q

Where are S1 & S2 heard equally well?

A

o Erb’s point

o 3rd intercostal space

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30
Q

What is a split S2? What causes this? Give a pneumonic.

A

o When you hear the S2 sounds slightly apart during inspiration
o Occurs because pt has more blood sequestered in the heart picking up oxygen, so you have more blood going into the right ventricle. (Therefore, left AV valve closes first)
o “moRe to the Right and Less to the Left”

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31
Q

Cardiac output equation

A

o CO = Stroke volume x heart rate

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32
Q

Define stroke volume, give average

A

o Amount of blood in each systole

o 4-6L per minute

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33
Q

Blood pressure equation

A

BP = COxSVR

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34
Q

Define preload. When does this occur?

A

o Volume overload

o Occurs during exercise to give you a stronger contraction

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35
Q

Define afterload. When does this occur?

A

o Pressure overload

o The ventricle must generate this pressure to open the aortic valve

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36
Q

What is systolic blood pressure? (3)

A

o Pressure generated by the Left Ventricle during systole
o When the LV ejects blood into the aorta and the arterial tree
o Pressure waves in the arteries create pulses

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37
Q

What is diastolic blood pressure?

A

o Pressure generated by blood remaining in the arterial tree during diastole, when the ventricles are relaxed

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38
Q

Four manifestations of myocardial ischemia?

A

o Stable (typical) angina
o Unstable angina
o Variant (Prinzmetal’s) angina
o Myocardial infarction

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39
Q

What is “angina?”

A

A temporary ischemia

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40
Q

What is “myocardial infarction?”

A

Total blockage of heart

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41
Q

Three cardiac causes of chest pain (NOT by ischemia)

A

o Mitral valve prolapse
o Pericarditis
o Dissecting aneurism

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42
Q

What is mitral valve prolapse?

A

When the mitral valve is not closing well – one or both mitral valve leaflets prolapse back into atria during systole

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43
Q

What is pericarditis? Define. Give 5 causes. Treatment.

A

o Inflammation of the pericardium
o May be caused by virus, bacteria, uremia, lupus, neoplasm
o May be treated with advil

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44
Q

What is a dissecting aneurism? What does it feel like?

A

o The tearing of arterial intima. Begins suddenly, tearing quality.
o Sharp pain radiating into back or into neck.

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45
Q

Define “ischemia”

A

o Inadequate blood supply

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46
Q

Five pulmonary causes of chest pain

A 
o	Pulmonary embolism
o	Pleurisy
o	Pulmonary hypertension
o	Pneumothorax
o	Mediastinal emphysema
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47
Q

What is a pulmonary embolism? What are the symptoms?

A

o Blood clot travels to the lung

o Dyspnea more common, may be asymptomatic

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48
Q

What is pleurisy? What are the symptoms?

A

o Pleural inflammation

o Pain worse with breathing, disappears when breath held

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49
Q

Two symptoms of pulmonary hypertension

A

o Dyspnea more common

o Pain is described as discomfort, nonradiating tight constricting band across chest

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50
Q

How does a pneumothorax occur?

A

Air in pleural cavity collapses lung

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51
Q

Mediastinal emphysema. What happens? 2 symptoms, 1 sign.

A

o Free air in the mediastinum produces chest tightness and dyspnea
o Hamman’s sign – crunching sound

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52
Q

Three gastrointestinal causes of chest pain

A

o Esophageal spasm
o Esophageal reflux
o Gallstone colic

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53
Q

What symptoms occur with esophageal spasm? (3)

A

o Substernal pain
o Dyspagia
o May mimic angina

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54
Q

What symptoms occur with esophageal reflux? What might this be mistaken for? What relieves it?

A

o Substernal burning or cramping radiates into arms, neck, jaw
o Can feel like heart attack
o Relieved with antacids

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55
Q

What does gallstone colic feel like?

A

Right upper quadrant pain radiating to back or right shoulder

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56
Q

Four symptoms / traits of dyspnea

A

o Shortness of breath
o Uncomfortable awareness of breathing
o Feels smothering
o Causes urgent need to take another breath

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57
Q

For manifestations of dyspnea

A

o Orthopnea
o Paroxysmal Nocturnal Dyspnea
o Pulmonary edema
o Valvular heart disease

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58
Q

What is orthopnea? What relieves it?

A

o Dyspnea that occurs soon after patient lies down

o Relieved by sitting or standing up

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59
Q

What is paroxystmal nocturnal dyspnea? What relieves it?

A

o Dysnpea after lying down for several minutes, or pt awakes short of breath.
o Not relieved immediately after sitting up. May walk around a bit.

60
Q

Pulmonary edema: What is it, what do symptoms look like?

A

o Pulmonary congestion (left-sided heart failure)

o Patient is anxious, dyspneic, diaphoretic pink frothy sputum and a fear of impending death.

61
Q

Valvular heart disease: What is occurring? What is the principle symptom? When in the cardiac cycle does it occur?

A

o Dyspnea is principal symptom of mitral stenosis

o May occur late in mitral regurgitation or aortic stenosis or regurgitation

62
Q

Six causes of palpations - gradual acceleration

A 
o	Exercise
o	Anemia
o	Sexual activity
o	Postural hypotension
o	Anxiety
o	Use of stimulant drug
63
Q

Four causes of palpations - sudden onset

A

o Paroxysmal atrial tachycardia
o Ectopic beats
o Extra systoles, or premature atrial or ventricular contractions
o Syncope or seizures may mean asystole, bradycardia

64
Q

What is syncope?

A

“Rapid onset, transient loss of consciousness”: blackout, fainting

65
Q

What is the most common cause of syncope?

A

“Vasovagal”: Vasomotor response to the vagus nerve

66
Q

Five cardiovascular causes of syncope

A 
o	Arrhythmia
o	Cardiac outflow tract or obstruction
o	Ischemia
o	Carotid sinus syncope (thyroid cartilage)
o	Decreased blood volume (hypovolemia)
67
Q

What cardiac issue do you usually think of when you see edema?

A

Right sided heart failure

68
Q

______ refers to generalized edema

A

Anasarca

69
Q

What is anasarca? (1 def, 3 causes)

A

Heart failure, liver or nephritic failure

70
Q

What causes central cyanosis (generally, and 1 pathology)

A

o Decreased pulmonary venous saturation

o Tetralogy of fallot – most common cause of cyanosis

71
Q

What causes peripheral cyanosis? (generally, and 2 pathologies

A

o Decreased cardiac output or reduced rate of blood flow thru capillaries and increased local extraction of oxygen
o CHF, Shock

72
Q

_______ refers to coughing up blood

A

Hemoptysis

73
Q

Four causes of hemoptysis

A

o Mitral valve stenosis due to increased pulmonary venous congestion
o Ruptured vessel
o Pulmonary infarction
o Pulmonary emboli with infarction

74
Q

What is the most common cause of hemoptysis? What causes it?

A

o MITRAL VALVE STENOSIS

o due to increased pulmonary venous congestion

75
Q

Four causes of orthostatic hypotension

A

o Vascular volume loss
o Redistribution of blood volume
o Prolonged bed rest (causes simple vasovagal fainting)
o Autonomic nervous system disfunction

76
Q

What might cause vascular volume loss (5) that could result in hypotension?

A 
o	Hemmorrhage
o	Diarrhea
o	Vomiting
o	Dehydration
o	Excessive diuresis
77
Q

What might cause a redistribution of blood volume (4) that could result in hypotension?

A

o Antihypertensives
o Antidepressants
o Alcohol
o Nitrates

78
Q

• What might cause autonomic nervous system dysfunction (3) that could result in hypotension?

A

o Diabetic neuropathy
o Adrenal insufficiency
o Parkinson’s disease

79
Q

When palpating the carotid upstroke, “brisk” is ________

A

NORMAL

80
Q

When palpating the carotid upstroke, a delayed stroke suggests ____________

A

Aortic stenosis

81
Q

When palpating the carotid upstroke, bounding stroke suggests ___________

A

Aortic insufficiency

82
Q

Listen for bruits with the ____ of the stethoscope

A

BELL

83
Q

In order to hear a bruit…

A

The artery must be 70% occluded

84
Q

What three things do you inspect the neck for distention?

A

o Inspect the jugular venous pulse
o Estimate the jugular venous pressure
o Hepatojugular reflux

85
Q

What is the hepatojugular reflex?

A

When you push un the liver and the right jugular juts out in response, this means the heart is not able to accommodate everything coming its way.

86
Q

What is a heathe?

A

Any forceful lifting of the chest wall during systole

87
Q

What is the mean height of the vertical column of blood when measuring the JVP?

A

o 6-10 cm

88
Q

How do you assess the precordium? (4)

A

o Inspect the anterior chest
o Palpate the apical impulse
o Palpate across the precordium
o Percuss to outline the cardiac borders

89
Q

How do you assess the PMI? (2 actions)

A

o Inspect left anterior chest for a visible PMI

o Palpate the apex for the PMI (w fingerpads)

90
Q

How do you find the PMI?

A

o Locate PMI by interspace and distance in m from midsternal line
o One interspace, 5th midclavicular line

91
Q

What two things are you palpating for with PMI?

A 
o	Amplitude (short, gentle tap)
o	Duration (short - first half of systole)
92
Q

If you don’t feel the PMI, what two reasons might be responsible?

A

o Left ventricular dilatation (volume overload)

o Left ventricular hypertrophy (pressure overload)

93
Q

Left Ventricular Dilatation: What does this do to finding the PMI? (2)

A

o Displaces impulse down and to the left

o Increases size more than one space

94
Q

Left Ventricular Hypertrophy: What does this do to finding the PMI? (2)

A

o Increased force & duration

o No change in location

95
Q

What six places do you listen to in cardiac auscultation?

A

1) Aortic area
2) Pulmonic area
3) Tricuspid area
4) Mitral area
5) Erb’s Point
6) PMI

96
Q

Why do you have patient lean forward during cardiac auscultation?

A

To better listen to aortic and pulmonary valves

97
Q

Why do you position the patient in left lateral decubitus during auscultation? What part of the stethoscope do you use?

A

To better listen to the AV valves (listen with bell)

98
Q

What part of the stethoscope do you use when listening to S1 & S2?

A

Diaphragm

99
Q

What part of the stethoscope do you use to listen to the apex of the heart?

A

The bell

100
Q

The diaphragm of the stethoscope is best for detecting… (4)

A

o High pitched sounds like S1, S2

o S4 and most murmurs

101
Q

The bell of the stethoscope is best used for detecting

A

o Low-pitched sounds like S3 and the rumble of mitral stenosis

102
Q

Where is S1 louder than S2?

A

APEX

103
Q

Where is S2 louder than S1?

A

BSE

104
Q

What coincides with S1?

A

o Carotid artery pulse

o R wave on ECG

105
Q

What side would an S3 sound be best auscultated?

A

Left side

106
Q

In what position might an S3 heart sound be normal?

A

Lying down

107
Q

What does S3 sound like?

A

Ventricular gallop

“KEN TUC KY”

108
Q

What does S4 sound like? What is is a reaction to?

A 
Atrial gallop (reaction to the atrial kick)
"TEN NESS EE"
109
Q

What might be responsible for an early systolic ejection click? (2)

A

o Aortic stenosis

o Pulmonic stenosis

110
Q

What might be responsible for a Midsystolic Click?

A

Mitral regurgitatoin

111
Q

What might be responsible for an opening snap?

A

Mitral stenosis

112
Q

What is a summation gallop

A

All four heart sounds

113
Q

How do you communicate normal heart sounds on a chart?

A

ØMRG

No murmurs rubs or gallops

114
Q

What click might be involved with ejection

A

Early systolic ejection

115
Q

Where might you hear extra diastolic sounds?

A

3 or 4 ICS at sternal border

116
Q

How do you grade murmurs?

A

1-6 scale

117
Q

What would a grade 1 murmur be?

A

Barely audible. Only audible in completely silent room.

118
Q

What would a grade 2 murmur be?

A

Clearly audible but faint

119
Q

What would a grade 3 murmur be?

A

Moderately loud. Easy to hear

120
Q

What would a grade 4 murmur be?

A

Loud and with a thrill

121
Q

What would a grade 5 murmur be?

A

Definite thrill, very loud, can even be auscultated if stethoscope is off the chest.

122
Q

What would a grade 6 murmur be?

A

VERY loud. Stethoscope is off chest.

123
Q

What should you document about a murmur? (5)

A 
o	Timing (systolic, diastolic)
o	Location
o	Loudness / intensity
o	Radiation (to neck)
o	Position of patient
124
Q

To detect murmurs, what else should you do while auscultating the heart? What does this tell you?

A

o Palpate the carotid upstroke. Carotid upstroke occurs in systole.
o So, if murmur coincides with the carotid upstroke, it is systolic.

125
Q

What is the “shape” of a murmur? (4)

A

o Crecendos up to a heart sound
o Decrecendos down from a heart sound
o Both - crecendos and decrecendos betweween heart sounds
o Plateau

126
Q

What is responsible for causing a murmur that exhibits BOTH crecendo and decrecendo?

A

AORTIC STENOSIS

127
Q

What is responsible for causing a murmur that exhibits plateau?

A

Holosystolic murmur of mitral regurgitation (between S1 & S2)

128
Q

If a murmur has a thrill, how would you grade it?

A

Between a 4-6

129
Q

How would you describe the sound of mitral regurgitation (5)?

A 
o	Harsh
o	2/6
o	Medium-pitched
o	Holosystolic murmur
o	Best heard at apex
130
Q

How would you describe the sound of aortic regurgitation? (5)

A 
o	Soft
o	Blowing
o	3/6 decrescendo
o	Diastolic murmur
o	Best heard at the lower left sternal border
131
Q

What happens to blood going through a stenotic valve?

A

Only a little blood gets through

132
Q

What happens to blood going through an incompetent valve?

A

It can go backwards through the valve

133
Q

What’s the difference between a bruit and a murmur?

A

o Bruit: Turbulent bloodflow in VESSEL

o Murmur: Turbulent bloodflow in HEART

134
Q

During systole, you might hear: (2)

A

o Tricuspid or mitral regurgitation

o Aortic or pulmonic stenosis

135
Q

What problems are best auscultated at apex? (2)

A

o Tricuspid or mitral regurgitation

o Mitral or tricuspid stenosis

136
Q

What problems are best auscultated at base? (2)

A

o Aortic or pulmonic stenosis

o Aortic or pulmonic regurgitation

137
Q

What are midsystolic ejection murmurs? (2)

What is the shape of the sound?

A

o Aortic stenosis
o Pulmonic stenosis

o Sound crescendoes and decrescendoes between S1&S2

138
Q

What are pansystolic regurgitant murmurs? (2)

What is the shape of the sound?

A

o Mitral regurgitation
o Tricuspid regurgitation

o Plateau

139
Q

Diastolic rumbles of AV valves (2)

A

o Mitral stenosis

o Tricuspid stenosis

140
Q

Early diastolic murmurs

A

o Aortic regurgitation

o Pulmonic regurgitation

141
Q

What is the shape of diastolic rumbles of AV valves

A

o Between S2 & S1: Starts out big, goes in a little, ends huge.

142
Q

What is the shape of early diastolic murmurs

A

o Starts big after S2, decreases slowly til S1

143
Q

Where is a rub auscultated?

A

o Mostly at the apex

144
Q

When is a ventricular systole rub auscultated?

A

Before S2

145
Q

When is a ventricular diastole rub auscultated

A

Briefly between S2 and S1

146
Q

When is an atrial systole auscultated?

A

Leading up to S1

PA: Exam 2 (10 decks)

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