Cardiac Assessment Flashcards
When blood stands still, what does it tend to do?
Clot
What are the layers of the heart, deep to superficial?
endocardium, myocardium, visceral pericardium, pericardial space, parietal pericardium, fibrous pericardium
Would the heart keep beating if you removed it from someone’s chest?
Yes, it beats on its own, intrinsically.
What is the intrinsic rate of the heart?
60-100 bpm
What is the job of the AV node?
To delay contraction of the ventricles, ensuring the atria have time to contract first.
What 4 things are we looking for in the arterial assessment?
blood pressure, circulation, atherosclerosis, aneurysms
What are the 2 things we are looking for in the venous assessment?
volume, congestion
What happens in cardiac cycle phase 1?
The ventricles are filling up…in atrial contraction the blood is being shoved into the ventricles, before this there is passive filling during ventricle relaxation (pressure pulls some blood into the ventricles)
What happens in cardiac cycle phase 2?
1) Ventricle contraction without ejection (isovolumentric contraction phase–the muscle is frozen and about to contract, increasing pressure to close valves) and 2) ejection with contraction (ventricular ejection phase)
What happens in cardiac cycle phase 3?
Isometric relaxation, ventricle relaxation without filling
Explain the Frank-Starling mechanism?
The heart can change the force of contraction based on the volume of blood it receives…so the more volume, the more forceful, the less volume, the less forceful. The more the fibers are stretched, the more force of contraction they give.
What is preload?
the maximum volume of blood in the ventricles at end-diastole, its peak state of relaxation, this should be a full ventricle, right before it contracts and pushes out to the system. increased by high bp, fluid intake. diuretics decrease it.
What is afterload?
the resistance that the ventricle has to push against to eject blood, the total peripheral resistance. htn, aortic stenosis, increases it
What are the 4 aspects of the inspection part of the cardiac assessment?
general survey, chest wall/precordial assessment, neck/jugular vein assessment, extremities assessment
What is a heave or lift?
rhythmic lifting of the your hand/fingers while palpating precordial areas, generally indicated that the heart is too big in that region
What is a thrill?
sensation of turbulence, or a buzzing blood flow, felt with ball/palm of hand while palpating the precordial areas
What vessels are reflective of what is happening in the right atrium?
the SVC and internal jugular vein
What does JVP help assess?
vascular volume
What is the waveform of the JVP?
fluttering, 2 peaks and 2 valleys
What are you doing to measure Hepatojugular reflux (HJR)
pushing on the IVC to artificially put more pressure (stressing, upping the preload) on the heart, the point is to see how the heart behaves when this happens. the heart should contract more forcefully since it is receiving more blood
What are Bruit(s)?
turbulent flow? when listening for artherosclerotic plaque it indicates plaques. If you don’t hear anything, they’re good
Where does plaque typically show up in an artery?
at a level of bifurcation, so this is where you want to listen to bruits
What else can occur when the atria are dilated/large?
The electrical conduction system is also being stretched, which can lead to arrhythmias
In the JV pulse waveform, what two letters correspond to atrial contraction and atrial filling?
A = atrial contraction. V = venous filling of the RA
What is the normal level of highest pulsation of the jugular vein from the sternal angle?
less than or equal to 3cm, when HOB is at 30 degrees.
What is normal and abnormal response to the hepatojugular reflex?
Normal: it rises but returns to normal within 10 seconds. Abnormal: it rises and does not return.
What is the heart sound of M1T1 closing?
S1
What is the heart sound of A2P2 closing?
S2
What extra heart sound is indicative of a dilated left ventricle in adults, but is normal in children?
S3
What extra heart sound is indicative of a thickened LV wall, but normal in children?
S4
What is a systolic click after S1?
A or P ejection due to abrupt oping of the SL valves with they are stiff or diseased
What is an opening snap after S2?
sudden arrest of opening of the mitral leaflets
What is a heart murmur?
Turbulent flow from a defective valve resulting in audible vibrations
What are the 3 causes of heart murmurs?
stenosis (forward flow issue), regurgitation/insufficiency (backward flow issue), congenital defects in heart septa
What are the 8 characteristics of heart murmurs that we need to say in describing them?
timing, shape, location, radiation, intensity, pitch, quality, augmenting/attentuating maneuvers
Describe a aortic stenosis murmur?
systolic, cresc-decresencdo, loudest at 2nd rib space, radiation to carotids, heard best with exhaling and leaning forward, louder with squatting, softer with other maneuvers
Describe a aortic regurgitation murmur?
early diastolic, decrescendo, heard over 3rd-4th ICS at left sternal border, louder with handgrip and squatting, softer with standing and valsalva
Describe a mitral valve prolapse murmur?
mid-systolic ejection click with late systolic murmur heard at the apex, gets louder with less pre-load and has an earlier systolic click; with more preload or more afterload, it is softer with a later click
Describe a mitral regurgitation murmur?
holostystolic high-pitched blowing murmur, loud at apex and radiates to the axilla, best in the left lateral recumbent position. louder with handgrip and squatting, softer with standing or valsalva
Describe a mitral stenosis murmur?
mid-diastolic murmur with opening snap, loudest at apex, louder with squatting and softer with valsalva or standing.
What are the 4 maneuvers that impact pre-load or after-load?
Squatting, abrupt standing, valsalva, isometric hand grip
How does squatting affect the heart?
Increases pre-load by compressing veins, increases afterload by compressing arteries
How does abrupt standing impact the heart?
decreases pre-load, decreases afterload
How does valsalva affect the heart?
increases intra-thoracic pressure compressing the chambers, which decreases preload and decreases afterload
How does isometric handgrip affect the heart?
makes it harder to eject, increasing afterload
What are 3 things that result in louder heart sounds?
exhalation, left lateral decubitis position, upright leaning forward
What are 4 things that result in softer heart sounds?
inhalation, thicker chest wall or overinflated lungs, thin/weak heart muscle, fluid in the pericardial sac
Where is the normal point of maximal impact?
apex, tapping sound, quarter diameter
Where is the point of maximal impact in an enlarged heart?
displaced laterally from the typical apex location, is heaving
What is the normal aorta width? What width is concerning?
normal is 3cm. concerning is >4cm.
Which type of murmur can also have an S4 heart sound added? (not necessarily associated with the murmur, but is consistent with the pathophys of the murmur cause)
Aortic stenosis, because the stenosed valve causes the LV to push harder to push blood through. As a result, the LV wall thickens, which then results in an S4 when the blood strikes the thickened wall.
