Cardiac Flashcards
Pericardium
Double walled lining covering the heart
R/L Ventricles
Lower chambers of the heart. R pumps blood into the pulmonary artery. L pumps blood into the aorta
R/L Atrium
Upper chambers of the heart Pumps blood into the ventricles. R receives blood from the SVC/IVC. L receives blood from the Pulmonary vein.
Aortic Valve
Separates the L ventricle from the aorta.
Pulmonic valve
Separates the R ventricle from the pulmonic valve
Great vessels
IVC, SVC, Aorta, pulmonary veins and arteries
Apex
The point or tip of the heart. Located around the left 5th intercostal, midclavicular line
Base
Broad upper border of the heart
Precordium
Area of chest overlying the heart
Tricuspid valve
Valve that separates the R atrium and ventricle
Mitral vavle
valve that separates the L atrium and ventricle
Systole
Ventricles are at maximum contraction
Diastole
Ventricles are max relaxation, refilling
PMI
Point of maximal pulse at apex. Represents ventricular contraction.
Thrill
Palpable murmur, signifies turbulent blood flow. Can be felt with ulnar surface of the hand.
Heave/lift
Sustained palpable movements of localized areas of the precordium. Usually due to increased intensity of systolic contraction or hypertrophy
Situs inversus/dextrocardia
Condition in which the heart and the liver are flipped. Heart is to the right, liver is the to left
SA Node
Start of heart contraction signal
Electrical signal pathway for heart contraction
SA node - AV Node (small pause) - Bundle of his - R/L Bundles - Purkinje Fibers
P wave
depolarization of the atria
PR interval
Stimulation of Atria
QRS complex
Ventricular depolarization
ST interval
Ventricle repolarization
What do you look for during inspection of the heart
- Look for signs of acute cardiac distress
- Cyanosis of the skin, pallor, cool temp
- Respiratory difficulty
- Chest pain, levines sign, clutching chest
- Anxiety
What external signs do you look for with chronic heart conditions
- Skin - clubbing, xanthelasma - cyanotic heart disease
- Body habitus
- Inspection of the PMI
Where is the PMI located (ribs)
4th or 5th ICS, midclavicular line
Where do you palpate for a thrill
Over each area that corresponds with a valve
What do you hear in the 2nd right ICS
Aortic valve
What do you hear in the 2nd and 3rd left ICS
Pulmonic valve
Erbs point
3rd left ICS, tricuspid valve
S2
Dub, closing of the pulmonic and aortic valves. Means blood as been ejected and the ventricles are relaxing. Marks the end of systole
S1
Lub, closing of the mitral and tricuspid valves.
Marks the beginning of systole
Where is the tricuspid valve best heard
4th left ICS or erbs point
Where is the mitral valve best heard
4th or 5th left ICS
What are you assessing for during palpation of the chest
- PMI
2. Abnormal cardiac impulses, lifts, heaves, thrills
What are you listening for during auscultation
- Normal heart sounds
- Rate and rhythm
- Abnormal heart sounds
When does splitting occur
During deep inspiration
What happens during splitting (physiological)
Deep inspiration, causes an increase in the chest pressure. Causes an increase in venous blood return. Because of this there is more blood to eject from R ventricle during systole which takes longer. This causes a delay in the s2 sound
2 types of pathologic splitting
- Fixed splitting
2. Paradoxic splitting
Fixed splitting
Splitting sound is always there regardless of breathing. septal defect
Paradoxic splitting
Aortic valve closure is delayed. Pulmonic valve closes first Reverse of physiologic splitting
Which valve closes first during splitting
Aortic
Fatigue
Tired, lethargic, suggests angina, MI, acute endocartitis
Dyspea
Difficult and labored breathing, chest pain, angina, MI
Diaphoresis
Excessive sweating, acute cardiac disease
Claudication
limping due to pain in butt or calf. Suggest muscle ischemia
xanthelasma
yellow deposits of fat underneath the skin on eyelids, mitral insufficiency
cough
dry cough with sharp stabbing chest pain may suggest pericarditis
orthopnea
SOB when lying down, suggest CHF, left side
Paroxysmal noctural dyspnea
SOB which wakes you in the night, mitral insufficiency
What could you do if someone has an irregular rhythm
Compare apical and radial pulses. Note the pulse deficit
syncope
temporary loss of consciousness caused by a drop in blood pressure. May indicate Cor Pulmonale (enlargement of the R ventricle)
postural or orthostatic hypotension
Decrease in BP when you go from lying to standing. Must be a drop of at least 20mm Hg in systolic pressure
Murmur
An abnormal turbulent blood flow that occurs because of valve stenosis or damaged (regurgitation) valve
Systolic murmurs
- Aortic/pulmonic stenosis
2. Mitral/tricuspid regurgitation
Diastolic murmurs
- Aortic/pulmonic regurgitation
2. Mitral/tricuspid stenosis
7 dimensions of a murmur
- timing/duration
- pitch
- intensity
- pattern
- location
- radtiation
- respiratory phase variations
Timing/duration
Is murmur systolic or diastolic and is it mid late
Intensity of murmur
Measure on a scale of 1-6. Most people would be in the 3 range. Anything 4 and above has a palpable thrill
pattern
crescendo, decrescendo of a murmur
What would you have the patient do to accentuate an aortic murmur
Have them sit upright, lean forward and listen the the right 2nd ICS wile exhaling
Preload
Stretch of ventricular muscle fibers at end of diastole. CO increases with preload
Afterload
The load or resistance against which the left ventricle must eject its volume of blood during contraction
What is the resistance in after load produced by
Volume of blood already in the vascular system and by constriction of vessel walls
S3
Beginning of diastole, first phase of ventricular filling
S4
Kick of the atria to get all of the blood into the ventricles
Gallop
General name for hearing s3 or s4
Rub
Cardiac tissue touching pericardial sac, pericarditis
Click
Clicking sound made by a mitral valve regurgitation or prolapse
Snap
Sound of abnormal blood flow through the valve during opening (Mitral stenosis)
Ejection sounds
High frequency sound that results from abrupt halting of a valve opening
When would you hear an ejection sound
Aortic valve stenosis, aortic insufficiency
