cardiac Flashcards
left side of the heart associated with what?
the arteries
right side the heart is associated with what?
the veins
flow of blood through the heart
blood comes through inferior and superior vena cava to RIGHT atrium- tricuspid valve- RIGHT ventricle- pulmonic valve- pulmonary artery- none 02 blood exchanged for 02 blood-pulmonary veins- LEFT atrium- mitral valve- LEFT ventricle- aortic valve- Aorta- distributed through out body
PMI
point of maximum impulse (the apex beat)
located 7cm-9cm left lateral to midsternal line
S1
closure of AV valves (mitral and tricuspid) heard during systole LUB-dub. occurs when ventricular pressure builds to the point of forcing AV valves closed and forcing open semilunar valves
S2
closure of semi-lunar valves (pulmonary and aortic) heard during end of systole lub-DUB. occurs after ventricular ejection of blood dropping pressure in ventricles forcing semi-lunar valves to close
preload
blood building up in ventricles
afterload
blood being ejected from ventricles
SA node
in right atrium 60-100bpm
AV node
in atrium in septum 40-60bpm
bundle of his
found in end of septum wrapping around both ventricles; forming the left bundle branch and right bundle branch and purkinje fibers
P in (P-QRS-T)
when the atrium depolarizes, blood flowing from atria to ventricles
QRS in (P-QRS-T)
ventricular depolarization; ventricle reaching maximum pressure forcing open semilunar valves and ejecting blood.
T in (P-QRS-T)
repolarization of ventricles,
ausculatory area: Aortic
right sternal border second intercostal space s2 louder than s1
ausculatory area: Pulmonic
left sternal border second intercostal space; s2 louder than s1
ausculatory area: Erb’s point
left sternal border 3rd intercostal space; s2 louder than s1
ausculatory area: Tricuspid
left midsternal 4th intercostal space; s1 louder than s2
ausculatory area: Mitral
left 4th-5th interspace midclavicular line
s3
ken-tuc-KEY happens right after filling of ventricles. (after s2) results from changes in blood flow in diastole, when rapid filling ends and slow filling begins
s4
TEN-nes-see happens right before atrias are ready to contract again (before s1) occurs late in diastolic filling due to atrial contraction
Systolic murmurs
After s1 before s2 Aortic stenosis pulmonic stenosis Mitral valve prolapse Mitral regurgitation Tricuspid regurgitation cardiomyopathies Innocent
Diastolic murmurs
(worse outcomes) after s2 before s1 Aortic regurgitation Pulmonic regurgitation Mitral stenosis Tricuspid stenosis
Aortic stenosis;
Timing, location, intensity, pitch, radiation, quailty
timing: systolic
location: right 2nd interspace
intensity: soft or loud with thrill
pitch: medium, higher at apex
radiation: carotids
quality: harsh
MVP;
Timing, location, intensity, pitch, radiation, quailty
timing: late systolic
location: apex
intensity: midsystolic click
pitch: medium
radiation: none
quality: honking
Mitral regurgitation;
Timing, location, intensity, pitch, radiation, quailty
timing: systolic
location: apex
intensity: soft to loud
pitch: medium to high
quality: harsh
radiation: to left axilla
cardiomyopathies; Timing, location, intensity, pitch, radiation, quailty
timing: systolic
location: 3rd to 4th interspace
intensity: variable
pitch: medium
quality: harsh
radiation: down left sternal border to apex, maybe to base
innocent murmer; Timing, location, intensity, pitch, radiation, quailty
timing: systolic
location: 2nd-4th interspace
intensity: grade 1,2,3
pitch: soft to medium
quality: variable
radiation: little, usually disappears when sitting
aortic regurgitation; Timing, location, intensity, pitch, radiation, quailty
timing: diastolic
location: 2nd-4th interspace
intensity: grade 1-3
pitch: high
quality: blowing decrescendo
radiation: if loud to apex or right sternal border
* have pt hold breath after exhaling while leaning forward
mitral stenosis; Timing, location, intensity, pitch, radiation, quailty
timing: diastolic
location: apex
intensity: grade 1-4
pitch: low pitched
radiation: none
quality: rumble
* turn to left lateral
grading murmurs
I-very little sound
II-quiet but heard
III-moderate sound as loud as s1 or s2
IV-loud with palpable thrill
V-very loud with thrill, may hear with stethoscope partially off chest
VI-very loud with thrill heard with stethoscope off chest wall
unstable angina
chest pain with little to no activity
stable angina
chest pain with activity or physical exertion
variant angina
coronary artery spasm leading to chest pain. can be due to physical stress or cold
atypical angina
chest pain that present as vague chest discomfort
major bacteria that cause valve disease
streptococcus
cardiac history to get from pt
past cardiac event cardiac risk factors medications family hx review of systoms
physical exam for cardiac complaints
General appearance; A+Ox3, levines sign, tripod, facial grimicing, color, edema
Inspection, Palpation; pulses, PMI, ribs
Ausculatory exam- 3 positions 30 degrees, sitting, leaning forward
JVD
modifiable risk factors for cardiac pt
HTN, smoking, hyperlipidemia, sedentary lifestyle, weight control, diet, diabetes, estrogen/OC’s, Type A personality
non modifiable risk factors
genetics, age, race
symptoms of heart disease
SOB palpitations syncope edema claudication chest pain cyanosis varacies fatigue
functional cardiac assessment
Class I - no incapacity
Class 2- slight limitation
Class 3- slight exertional incapacity
Class 4-incapacity at rest
peripheral vascular assessment
check blood pressure pulse pressure carotid pulse JVP Hepatojugular reflux Abdominal Aorta Edema lymphnodes pulses and grading them
Dopplers
quality of blood flow in arteries and veins
ABI
ankle brachial index; measure the blood flow between brachial and ankle. higher the number the better, lower number is more disease. >/=1 normal
Cardiomyopathy types
hypertrophic, dilated, restrictive
pediatric cardiac assessment
have they gained weight cyanotic spells dyspnea exercise intolerance heart murmur chest pain joint pain neurological symptoms medications frequent respiratory infections family HX: hereditary disease, cogential, rheumatic fever, sudden death
peripheral pulse in child
brachial or femoral not carotid
womens symptoms of heart disease
upper back pain, neck or jaw pain, SOB, paroxysmal nocturnal dyspnea, N/V, fatigue
leading cause of death of american
heart disease
leading cause of CHF
HTN
