Assessing Heart and Neck Vessels Flashcards
What are the great vessels?
Large veins and arteries leading directly to and away from the heart
The superior and inferior vena cava return the blood to the ___ from the ____
right atrium
from the upper and lower torsos
Blood vessel that returns oxygenated blood to the left atrium
Pulmonary veins
The anterior chest area that overlies the heart and great vessels is called the
Precordium
Layer of endothelial tissue that forms the innermost layer of the heart
Endocardium
T/F the endocardium is continuous with the endothelial lining of the blood vessels
True
Thickest layer of the heart is known as the..
myocardium
The myocardium is made of what kind of cell?
contractile cardiac muscle cells
Serous membrane lining that secretes a small amount of pericardial fluid for friction-free muscle contraction
Parietal pericardium
tough, inextensible, loose-fitting, fibroserous sac that attaches to the great vessels and surrounds the heart
Pericardium
T/F the SA node conducts both atria simultaneously
True
What is the rate of the rhythmicity of the SA node?
60 to 100/min
T/F the AV slightly delays incoming electrical impulses from the atria and then relays the impulse to the AV bundle
True
T/F Purkinje fibers contract asynchronouslu
False
They contract simultaneously
What is known as the pacemaker of the heart?
SA node
What phase of the ECG depicts atrial depolarization?
P wave
What phase of the ECG depicts ventricular depolarization?
QRS complex
What phase of the ECG depicts atrial repolarization?
QRS complex
On the ECG, this phase is the period between ventricular depolarization and the beginning of ventricular repolarization
ST segment
What phase of the ECG depicts ventricular repolarization?
T wave
What phase of the ECG depicts the time beginning atrial depolarization to the beginning of ventricular depolarization?
PR interval
What phase of the ECG depicts total time for ventricular depolarization and repolarization?
QT interval
What phase of the ECG may or may not be present?
U wave
T/F If the U wave is present it follows the QRS complex representing atrial fibrilation
False
U wave follows the T wave and represents the final phase of ventricular repolarization.
Diastole describes what cardiac event?
Relaxation of ventricles (filling)
Systole describes what cardiac event?
Contraction of the ventricles (emptying)
T/F During ventricular diastole, the AV valves are open and the ventricles are relaxed. This causes higher pressure in the atria than in the ventricles.
True
Early, rapid, passive filling is called…
Early or Protodiastolic filling
The final act of filling is called ___ and raises ___ pressure (heart chamber)
This final active filling phase is called presystole, atrial systole, or sometimes the atrial kick. This action raises left ventricular pressure.
T/F During systole, the pressure in the atria are higher than ventricles
False
The pressure in the ventricles are higher than the atria during systole.
Closure of the AV valve produces what sound?
S1, First heart sound ; Lub
Name the process when valve closure prevents blood from backflowing
Regurgitation
What is isometric contraction?
All 4 points are closed and the ventricles contract
How are heart sounds produced?
Valve closure
T/F If the first heart sound is heart as two sounds, the first component represents mitral valve closure (M1) and the second component represents tricuspid closure (T1).
True
Where is the best location to auscultate for S1?
At the apex, left left midclavicular line (MCL), 5th intercostal space (ICS).
What is an accentuated S1
An accentuated S1 sound is louder than an S2. This occurs when the mitral valve is wide open and closes quickly.
What is a diminished S1?
Sometimes the S1 sound is softer than the S2 sound. This occurs when the mitral valve is not fully open at the time of ventricular contraction and valve closing
What is a split S1?
This occurs when the left and right ventricles contract at different times (asynchronous ventricular contraction).
What is a varying S1?
This occurs when the mitral valve is in different positions when contraction occurs.
Why might varying S1 occur?
(1) atria and ventricles beat independently
(2) total irregular rhythm
Why might split S1 occur?
(1) Conduction delaying the cardiac impulse to one of the ventricles, as in bundle branch block
(2) Ventricular ectopy in which the impulse starts in one ventricle, contracting it first, and then spreads to the second ventricle
What is an accentuated S2?
An accentuated S2 means that S2 is louder than S1. This occurs in conditions in which the aortic or pulmonic valve has a higher closing pressure
What is a diminished S2?
A diminished S2 means that S2 is softer than S1. This occurs in conditions in which the aortic or pulmonic valves have decreased mobility.
What is a wide split S2?
This is an increase in the usual splitting that persists throughout the entire respiratory cycle and widens on expiration. It occurs when there is delayed electrical activation of the right ventricle.
What is a fixed split S2?
This is a wide splitting that does not vary with respiration. It occurs when there is delayed closure of one of the valves.
What is a reversed split S2?
This is a split S2 that appears on expiration and disappears on inspiration. It occurs when closure of the aortic valve is abnormally delayed, causing A2 to follow P2 in expiration. Normal inspiratory delay of P2 makes the split disappear during inspiration.
What are extra heart sounds and what do they result from?
S3 and S4 are referred to as diastolic filling sounds, or extra heart sounds, which result from ventricular vibration secondary to rapid ventricular filling
Identify 4 conditions that contribute to turbulent blood flow
(1) increased blood velocity, (2) structural valve defects, (3) valve malfunction, and (4) abnormal chamber openings (e.g., septal defect).
What is cardiac output
amount of blood pumped by the ventricles during a given period of time (usually 1 minute) and is determined by the stroke volume (SV) multiplied by the heart rate (HR): SV × HR = CO.
What is the normal adult CO?
5 to 6 L/min
What is stroke volume?
amount of blood pumped from the heart with each contraction
Which jugular vein is superficial? And which muscle are they next to?
External jugular veins.
Jugular veins lie lateral to the sternocleidomastoid
a wave of jugular venous pulse
reflects rise atrial pressure that occurs with atrial contraction
x descent of jugular venous pulse
reflects RA relaxation and descent of the atrial floor during ventricular systole
v wave of jugular venous pulse
reflects RA filling, increased volume, and increased atrial pressure
y descent of jugular venous pulse
reflects RA emptying into RV and decrease atrial pressure
The pressure the heart must exert to pump blood out of the ventricles.
Afterload
You hear this when auscultating over the second intercostal space, right sternal border
Aortic valve
The volume of blood ejected by the heart with each contraction
Stroke Volume
The amount of cardiac muscle stretch before each contraction
Preload
What is the volume of blood per contraction?
70 mL
If we have increase preload, what does that mean?
It means increased stretch, fluid volume overload, edema
If we have decreased preload, what does that mean?
Fluid volume deficiency (dehydration)
If we have increased afterload, what does that mean?
Vasoconstriction and increased BP
If we have decreased afterload, what does that mean?
Vasodilation and decreased BP
Infarction
A blockage in a coronary artery leading to cell death
SA node intrinstic rate (best rate)
60-100
AV node intrinsic rate (best rate)
40-60
Ventricular intrinsic rate (best rate)
20-40
What happens if the electrical conduction of the heart does not originate from the SA node?
AV node becomes the pacemaker; SLOW rate; concerns of decreased perfusion! Dizziness and LOC
During diastole (filling), what’s happening on the cellular level?
Repolarizing; Resting
During systole (contraction), what’s happening on the cellular level?
Depolarization; Firing
Once tissue ischemia occurs, what happens to the electrical conduction of the heart?
Conduction stops
Stenosis
Valves do not open properly, these are normally open
Regurgitation
Valves do not close properly when they are normally closed, leading to back flow
What are we looking for when inspecting the anterior chest?
Heave/Lift
Coming from hypertrophy (enlarged heart).
What causes visible pulsation of apical impulse?
Hypertrophy
What are some physiological (normal) variations
Split S2
S3 in youth 0 subsides with sitting or standing
Physiological mid-systolic (S3-S4) murmurs-not associated symptoms
T/F S3 and S4 are diastolic sounds
True
T/F S1 and S2 are systolic sounds
True
Rubs
rubbing sounds due to friction and inflammation
