Cardiac Flashcards
heart size
5in long, 3.5in diameter, 2.5in thick
female heart
smaller and less in weight compared to male
precordium
area of the chest where you listen to heart sounds and do assessments of the heart
pericardium
double layered sac that encloses the heart
- fluid between the layers to prevent friction when the heart is contracting and relaxing
when cardiac valves are pathologic…
forward blood flow is restricted, resulting in regurgitation or murmurs
S1
(lub)
first heartbeat heard due to the closure of AV (tricuspi and mitral) valves
- when ventricles are filled
- loudest at apex
S2
(dub)
second heartbeat heard, due to the closure of semilunar (aortic and pulmonic) valves
- when ventricles empty blood to the pulmonic artery and arota
- loudest at base of heart (top of chest)
pulse grading
0: no pulse
+1: faint/weak/thready
+2: normal
+3: brisk
+4: bounding
aortic area
- 2nd ICS
- RSB (right sternal border)
- S2 > S1
pulmonic area
- 2nd ICS
- LSB
- S2 > S1
erb’s point
- 3rd ICS
- LSB
- S2 = S1
tricuspid area
- 4th ICS
- LSB
- S1 > S2
mitral area
- 5th ICS
- left midclavicular
- S1 > S2
cardiac murmurs are associated with…
- tricuspid regurgitaion
- tricuspid stenosis
- mitral regurgitation
- mitral stenosis
- aortic regurgitaion
cardiac murmur grading
graded 1-6
- 1/6 barely audible
- 6/6 loudest
major risk factors of heart diseases
- HTN
- smoking
- DM
- obesity
- high cholesterol
heart sounds are interpreted according to…
pitch, duration, intensity, and phase
sympathetic cardiac nerve
stimulation of heart, increase HR, increase dilation of coronary arterties
parasympathetic cardiac nerve
decrease in stimulation, decrease in HR, constriction of coronary artery
PMI
(point of maximal impulse)
heard loudest at the 5th ICS, left midclavicular line (mitral or apical pulse)
PMI in infants
heard at the 4th ICS, left midclavicular line
- b/c the heart is horizontally positioned
newborn heart rate
160-180 bpm
sound on percussion of the heart
dullness
normal BP
below 120/80
prehypertension
120/80-139/89
hypertension
140/90+
who has high incidence of HTN?
african americans
pedal pulse location
lateral to and parallel with the big toe
popliteal pulse location
medial behind the knees
femoral pulse location
inguinal area
posterior tibialis pulse location
groove behind the medial malleolus and achilles tendon
what is ECG
electrical representation of the cardiac cycles that are documented by the deflection on recording paper
electrical initation of the heart occurs in…
the SA node, known as the pacemaker of the heart
- fires 60-100 joules/min
av node fires…
60 joules/min
bundle branches fires…
40-60 joules/min
cardiac depolarization
when current from SA node spreads across the atria causing cardiac contraction
- cardiac cells are positively charges
repolarization
cardiac cells are relaxed
- negatively charged
imbalance in Na, K, and Ca
dysregulation of cardiac conduction system
p wave
atrial depolarization
atrial repolarization is…
hidden behind the qrs wave
qrs wave
ventricular depolarization
t wave
ventricular repolarization
v-fib
total absence of regular heart rhythm
v-tach
rhythm is rapid, regular heartbeat
- up to 200 bpm
heart block
slow heart rate; conduction between atria and ventricles are disrupted
- as low as 20-40 bpm
S/S of heart failure
- JV pulsation over 3cm at 45 degree elevation
- low BP
- HR >120 bpm
- angle edema
- SOB
- S3 is present
severe aortic regurgitation cause
synchronous head bobbing and heartbeat
infective endocarditis
thin red lines or splinter hemorrhages on the nail beds
arterial insufficieny
legs are cold, with no hair
venous insufficieny
legs are warm, with pain from prolonged sitting or standing
raynauds syndrome
fingers and handshave intermittent skin pallor, blueish discoloration, and rubor
allen’s test
determines the patency of the radial or ulnar arteries
expected finding of percussion of the heart
dullness
varicosities do not…
disappear when legs are elevated
JVD > 3cm causes:
- increased central venous pressure
- fluid overload (CHF)
- pressure at the superior vena cava
who has high incidence of CVD
caucasian females 65-74 years old
who has 2x incidence of cardiovascular mortality
native americans < 35 years old
use of cocaine is attributed to…
- HTN
- MI
- ruptured aorta
S3 and S4 are more common in…
patients in cardiac anomaly:
- MI
- CHF
- angina
- ventricular hypertrophy
S3
(ventricular gallop)
when there is vibration when AV valves open and blood goes to the ventricles
- can also be heard in healthy children, healthy adults, and 3rd trimester pregnancy
- S3 follows S2
S4
(atrial gallop)
when atrial contraction and ejection of blood to the ventricles in the late diastole
- heard before S1
- can be heard in healthy children, well-fit adults, and healthy elderly
tetralogy of fallot
(4 cardiac defects)
- dextroposition of the aorta
- pulmonary stenosis
- right ventricular hypertrophy
- ventricular septal defect
patent ductus areteriosus
opening between pulmonary artery and descending aorta
- should close 24-48 hrs after brith
- if does not close=murmur; manage with SX
foramen ovale
passageway of bloodbetween right and left atria
- should close shortly after birth
- if does not close=murmur; manage with SX
70% of children will have…
innocent cardiac murmur
innocent cardiac murmurs arise from…
high blood flow across normal heart structures
- usually when the individual has a fever and anemia
how many hearbeats in 24 hours?
100,000x
when all blood vessels are connected end to end, how many miles will it be?
60,000 miles; 2x around the world
difference between S/S of MI and GERD
both have indigestion, N/V
MI:
- SOB/dyspnea
GERD:
- hoarseness/eructation
S/S, nursing care, and monitoring of pericarditis
S/S:
- sharp chest pain on inhalation, pulsus paradoxus, SOB
Actions:
- manage pain/anxiety, bed rest w/ HOB 45, anti-inflam for pain
Monitor:
- signs of tamponade, prepare for pericardiocentesis
pulsus paradoxus
abnormally large decrease in BP during inspiration
- as much as 10 mmHg
- present with pericarditis
- cause: heart attack, immune system, or cardiac SX
