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N507 Exam 1 > (9) Cardio > Flashcards

(9) Cardio Flashcards

1
Q

Systole

A

ventricles contract

  • right ventricle pumps blood into pulmonary arteries (pulmonic valve open)
  • left ventricle pumps blood into aorta (aortic valve open)
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2
Q

Diastole

A

ventricles relax

  • blood flows from right atrium to right ventricle (tricuspid valve open)
  • blood flows from left atrium to left ventricle (mitral valve open)
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3
Q

blood flow through heart

A

superior and inferior vena cavas - right atrium and right ventricle - pulmonary arteries - left atrium and left ventricle - aorta and aortic arch

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4
Q

preload

A

volume overload

load that stretches the cardiac muscle before contraction

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5
Q

contractility

A

ventricles contract during systole

ability of cardiac muscle to shorten when given. load

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6
Q

afterload

A

pressure overload

degrees of vascular resistance to ventricular contraction

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7
Q

cardiac output

A

stroke volume x heart rate

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8
Q

blood pressure

A

cardiac output x systemic vascular resistance

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9
Q

systolic blood pressure

A

pressure generated by left ventricle during systole when the LV ejects blood into the aorta and the arterial tree
(pressure waves in the arteries create pulses)

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10
Q

diastolic blood pressure

A

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

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11
Q

carotid pulse: brisk upstroke

A

normal

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12
Q

carotid pulse: delayed upstroke

A

suggests aortic stenosis

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13
Q

carotid pulse: bounding upstroke

A

suggests aortic insufficiency

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14
Q

Apex (PMI) pulse: tapping

A

normal

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15
Q

Apex (PMI) pulse: sustained

A

suggests LV hypertrophy from HTN or aortic stenosis

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16
Q

Apex (PMI) pulse: diffuse

A

suggests a dilated ventricle from CHF or cardiomyopathy

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17
Q

what to assess at apical pulse?

A

location, amplitude, duration, diameter

rhythm least important

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18
Q

heart auscultation: diaphragm

A

best for high-pitched sounds like S1,S2,S4, most murmurs

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19
Q

heart auscultation: bell

A

best for low-pitched sounds like S3 and rumble of mitral stenosis

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20
Q

how to ID if murmur is systolic or diastolic

A

murmur coincides w/ carotid upstroke = systolic

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21
Q

PMI

A

may not be palpable even in healthy pt

left border of heart normally 5th intercostal space at or just medial to left midclavicular line

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22
Q

PMI > 2.5 cm - abnormal dx?

A

left ventricular hypertrophy from HTN, aortic stenosis

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23
Q

PMI displacement lateral to midclavicular line of >10cm lateral to mistrial line - abnormal dx?

A

LVH

ventricular dilation from MI or heart failure

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24
Q

hear S3 or S4 - abnormal dx?

A

heart failure
acute myocardial ischemia

S3 abrupt deceleration of inflow across the mitral valve
s4 increased L ventricular end diastolic stiffness which decreases compliance

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25
S1
closure of mitral valve
26
S2
closure of aortic valve
27
chest wall location & typical rising of sound/murmur
R 2nd interspace to apex: aortic valve L 2nd/3rd interspaces close to sternum but also higher/lower levels: pulmonic valve @/near lower left sternal border: tricuspid valve @/near cardiac apex: mitral valve
28
P wave
atrial depolarization
29
QRS
ventricular depolarization
30
T wave
ventricular depolarization or recovery
31
factors affecting BP
L ventricular stroke volume distensibility of the aorta and large arteries peripheral vascular resistance, particularly @ arteriolar level volume of blood in arterial sysem
32
JVP (jugular venous pressure)
reflects right atrial pressure (which equals CVP and R ventricular end-diastolic pressure) best estimated from RIJ which has most direct channel into the R atrium
33
Cardiac: common/concerning symptoms
``` chest pain palpitations shortness of breath swelling fainting ```
34
anterior chest pain "tearing, ripping" radiating to back - abnormal dx?
acute aortic dissection
35
sudden dyspnea - abnormal dx?
pulmonary embolism spontaneous pneumothorax anxiety
36
PND
episodes of sudden dyspnea and orthopnea that awaken pt from sleep 1-2 hrs after going to bed, prompting pt to get up, may have wheezing coughing
37
orthopnea and PND - abnormal dx?
L ventricular heart failure mitral stenosis obstructive lung disease
38
edema - abnormal dx?
cardiac nutritional positional can be dependent or anasarca (whole body) periorbital - nephrotic syndrome waist - liver ascites
39
healthy fats
high monounsaturated fats: nuts high in polyunsaturated fat: corn, cottonseed, soybean oils, walnuts, pumpkin/sunflower seeds, soft margarine, mayo, salad dressings high in omega-3s: flaxseed, walnuts, tuna, anchovies, herring, mackerel, rainbow trout, salmon, sardines, shrimp
40
unhealthy fats
high in saturated fats: high fat dairy, bacon, chocolate, coconut oil, lard, meat gravy, ground meat, bologna, hot dogs, sausage high in trans fats: hydrogenated oil, stick margin, fried food
41
JVP
pg 375 if have time
42
elevated JVP
#1 heart failure ``` tricuspid stenos chronic pulmonary HTN superior vena cave obstruction cardiac tampondae constrictive perocarditis ```
43
IJ vs carotid pulsations
IJ - rarely palpable - biphasic - eliminated by light pressure - height changes w/ position - height falls w/ inspiration Carotid - palpable - single outward thrust component - not eliminated by pressure - height unchanged by position or inspiration
44
assessment characteristics of carotid pulse
- amplitude - contour of pulse wave - variations in amplitude - timing of upstroke in relation to S1 and S2
45
unilateral carotid pulsatile bulge -abnormal dx?
torturous or kinked carotid artery
46
decreased carotid pulsations - abnormal dx?
decreased stroke volume from shock or MI and atherosclerotic narrowing or occlusion
47
carotid pulse small, thready weak vs bounding - abnormal dx?
small - cardiogenic shock | bounding - aortic regurgitation
48
pulses alternans
rhythms of pulse remains regular but the force of the arterial pulse alternates b/c of alternating strong and weak ventricular contractions almost always indicates severe L ventricular dysfunction
49
Paradoxical pulse
greater than normal drop in SBP during inspiration signaled by alternately loud and soft Korotkoff sounds of sudden doubling of apparent HR as cuff pressure declines (upright position may accentuate this finding) ``` seen in: acute asthma COPD pericardial tamponade constrictive pericarditis acute pulmonary embolism ```
50
carotid thrill - abnormal dx?
aortic stenosis
51
carotid bruit - abnormal dx?
``` torturous carotid artery external carotid artery disease aortic stenosis hypervascularity of hyperthyroid external compression from thoracic outlet syndrome ```
52
thrill vs bruit
thrill - vibration | bruit - murmur like sound, stop breathing 15 sec to listen
53
sequence of cardiac exam by pt position
supine, HOB 30: JVP, carotid, inspect/palpate precordium, 2nd R&L interspaces, RV, LV, apical impulse left lateral decubitus: palpate apical impulse for diameter, listen supine, HOB 30: listen 2nd R&L interspace, down L sternal border to 4th/5th interspaces, across to apex the 6 listening areas w/ both sides of stethoscope sitting, leaning forward after full exhalation: listen L sternal border and apex w/ diaphragm
54
diminished S1 or S2 - abnormal dx?
S1 - 1st degree heart block S2 - aortic stenosis
55
S1 vs S2 intensity
S1 louder at apex | S2 louder at base
56
palpation of carotid artery during auscultation is valuable for?
coming of sounds and murmurs b/c carotid upstroke always occurs in systole immediately after S1 sounds or murmurs coinciding w. upstroke are systolic, sounds/murmurs following carotid upstroke are diastolic
57
heaves and lifts
sustained impulses that rhythmically lift your fingers produced by an enlarged R or L ventricle or atrium and occasionally by ventricular aneurysms (use palm or finger pads firmly on chest)
58
apical pulse shifted upward and to left - abnormal dx?
pregnancy | high left diaphragm
59
apical pulse lateral displacement from axillary line - abnormal dx?
``` heart failure cardiomyopathy ischemic heart disease thoracic deformities mediastinal shift ```
60
apical pulse lateral displacement from midclavicular line - abnormal dx?
increased L ventricular volume and low left ventricular EF more likely
61
hyperkinetic apical pulse - abnormal dx?
hyperthyroid severe anemia pressure overload of L ventricle from HTN or aortic stenosis volume overload of L ventricle from aortic regurgitation
62
sustained high-amplitude apical impulse - abnormal dx?
significantly increases LVH from pressure overload seen in HTN - if displaced laterally consider value overload
63
diffuse sustained low amplitude apical impulse - abnormal dx?
heart failure | dilated cardiomyopathy
64
pulmonic area (L 2nd interspace) prominent pulsation or palpable S2 - abnormals?
prominent pulsation: dilation or increased flow in pulmonary artery palpable S2: pulmonary HTN
65
aortic area (R 2nd interspace) pulsation - abnormal?
systemic HTN | dilated of aneurysmal aorta
66
stethoscope: diaphragm v bell
diaphragm: high pitched sounds of S1 S2, murmurs of aortic and mitral regurgitation, pericardial friction rubs bell: low pitched sounds of S3 S4 and murmur of mitral stenosis
67
important maneuver to enhance mitral stenosis detection
pt on left lateral decubitus position (brings L ventricle closer to chest wall) use bell on apical impulse hear mitral murmur
68
importnat maneuver to enhance aortic regurgitation detection
pt sits up, leans forward, exhales completely, briefly stop breathing after expiration diaphragm on chest along L sternal border at apex - have pt periodically breath hear soft diastolic decrescendo murmur
69
Systolic Murmurs
coincide w/ carotid upstrike begins S1 often heard in healthy pts and not pathologic
70
Diastolic Murmurs
usually represent valvular heart disease begins S2 early = regurgitant flow across incompetent semilunar valves
71
Continuous Murmurs
begin in systole and extends in all or part of diastole congenital: PDA, AV fistulas
72
Mitral Stenosis type of murmur?
pre systolic murmur | -cresendo
73
Aortic Regurgitation type of murmur?
early diastolic | - descrendo
74
Aortic Stenosis type of murmur?
mid systolic murmur -crescendo-decrescendo often radiates to neck in direction of arterial flow especially on R
75
Mitral Regurgitation type of murmur?
Pansystolic murmur - plateau radiates to axilla (bone conduction)
76
Murmur Grades
1: faint, not heard all positions 2. quite but heard immediately after placing stethoscope 3: moderately loud 4: loud w/ thrill 5: very loud w/ thrill, maybe heard w/ stethoscope partly off chest 6: very loud w/ thrill, maybe heard w/ stethoscope entirely off chest
77
squatting and assessing murmurs
help to ID prolapsed mitral valve and distinguish hypertrophic cardiomyopathy from aortic stenosis

N507 Exam 1 (10 decks)

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