Cardiac/MS Flashcards
What are the heart layers?
Pericardium, myocardium, and endocardium
What is the pericardium?
Sac that surrounds and protects the heart
What is the myocardium?
Muscular wall of the heart. Does the pumping.
What is the endocardium?
Thin layer of tissue that lines the inner surface of the heart chambers and valves
What are the four valves of the heart?
AV (atrioventricular valves)- Open during filing phase (diastole)
Right AV- tricuspid valve
Left AV- bicuspid (mitral) valve
SL (semilunar valves)- Open during pumping phase (systole)
Right SL- pulmonic valve
Left SL- aortic valve
Upside down
Base at the top
Apex at the bottom
Sinoatrial (SA) node
Pacemaker
Blood flow through Coronary Circulation
- Right atrium
- Tricuspid valve
- Right ventricle
- Pulmonic valve
- Pulmonary artery
- Lungs
- Pulmonary veins
- Left atrium
- Mitral valve
- Left ventricle
- Aortic valve
- Aorta
Pulmonary arteries carry __________ blood to the lungs.
deoxygenated
Pulmonary veins carry __________ blood from the lungs back to the heart.
re-oxygenated
Blood flow through the Cardiac Valves
Tissue Paper My Assets
Tricuspid, Pulmonic, Mitral, Aortic
Major risk factors for heart disease
Nutrition
Smoking
Alcohol Use
Exercise
Drug Use
IV drug users are at risk for
Bacterial Endocarditis
Endocarditis occurs when bacteria or other germs enter the bloodstream and travel to the heart. The germs then stick to damaged heart valves or damaged heart tissue. Endocarditis is a life-threatening inflammation of the inner lining of the heart’s chambers and valves. This lining is called the endocardium.
Orthopnea
DIB when supine/laying down
Hyperlipidema
High cholesterol
JVD
Jugular vein distention- bulging of major veins in the neck
It’s a key symptom of heart failure and other heart and circulatory problems.
Thrill
A thrill is a palpable vibration over artery (feels like the throat of a purring cat). It signifies turbulent blood flow. A thrill can accompany a loud murmur.
Lifts and Heaves
Thrust of ventricle
Bruit
A bruit is auscultated over an artery. Sounds like a blowing & swishing sound. Indicates blood flow turbulence.
__________ a Thrill.
__________ a Bruit.
Feel a Thrill.
Hear a Bruit.
What direction is used to auscultate the heart?
Listen in a “Z” pattern. Inching the stethoscope from base to apex. Use bell and diaphragm.
What are the Cardiac Landmarks for auscultation of the heart?
Aortic Valve- 2nd Intercostal Space, Right Sternal Border
Pulmonic Valve- 2nd Intercostal Space, Left Sternal Border
Erb’s Point Valve- 3rd Intercostal Space, Left Sternal Border
Tricuspid Valve- 4th Intercostal Space, Left Sternal Border
Mitral Valve- 5th Intercostal Space, Midclavicular Line
PMI
Point of Maximal Impulse
Auscultating Carotid Arteries
Ask patient to briefly hold their breath. Use bell of stethoscope. Listen for bruits.
** BELL for BRUITS **
Do NOT compress the carotid artery with the bell. It can cause an artificial bruit.
APE To Man
Aortic –> Pulmonic –> Erb’s Point –> Tricuspid –> Mitral
What is a murmur?
Gentle blowing, swooshing sound heard over heart valves
Normal heart sounds
S1 and S2
S1
1st heart sound – closure of AV valves, beginning of systole
S2
2nd heart sound – closure of SL valves, end of systole
Abnormal heart sounds
S3 and S4
S3
KEN - TU - CKY
LUB(1) DUB(2) DUB(3)
3rd heart sound – ABNORMAL – immediately after S2, when AV valves open and atrial blood goes into ventricles
S4
TEN - NE - SSEE
Hear before LUB(1)
Gallop
4th heart sound – ABNORMAL – just before S1, at end of diastole, ventricle resistant to filling
S3 sounds can be normal in
young adults & children
pregnancy
athletes
S3 sounds are abnormal in
Adults and elderly
S3 sounds indicate
Severe Mitral or Tricuspid Regurgitation
Cardiomyopathy
Heart Failure
S4 sounds are almost always __________.
Pathological
S4 sounds indicate
Indicates DIASTOLIC Heart Failure
Severe Left Ventricular Hypertrophy
Cardiac Ischemia
Uncontrolled HTN
Hypertrophic or Restrictive Cardiomyopathy
ABC’s of Heart Health
Appropriate Aspirin Therapy
Blood Pressure Control
Cholesterol Control
Lifestyle changes for Heart Health
Smoking cessation
Nutrition
Exercise
Weight management
Arteries are used to pump __________ blood.
oxygenated
Temporal, Carotid, Arm, and Leg arteries
Veins have an __________ flow than arteries.
opposite
Jugular, Arm, and Leg veins
What is the role of veins?
Absorb CO2 and waste and carry back to heart
Retrieve excess fluid and plasma proteins from interstitial spaces and puts them back in bloodstream
Lymphatics/Lymph nodes
Cervical nodes
Axillary nodes
Inguinal nodes
Leg pulses and location
Femoral- located along the crease midway between the pubic bone and the anterior iliac crest.
Popliteal- The popliteal artery is palpated behind the knee.
Dorsalis Pedis- The dorsalis pedis artery is located on the dorsum of the foot. Palpate just lateral to and parallel with the extensor tendon of the big toe.
Posterior Tibialis- The posterior tibial pulse is palpated in the groove between the medial malleolus and the Achilles tendon.
Edema Scale
0= No Pitting
1+= Mild pitting; slight indentation; no perceptible swelling of the leg
2+= Moderate pitting; indentation subsides rapidly
3+= Severe/Deep pitting; indentation remains for a short period of time; leg looks swollen
4+= Very Deep pitting; indentation lasts a long time; leg is grossly swollen & distorted
What is DVT?
Deep Vein Thrombosis
Signs and symptoms of DVT
Unilateral Edema
Warmth
Redness (Erythema)
Tenderness (Cramping)
What should you avoid doing for DVT patients and why?
Do not massage area, use SCDs, or have patient walk.
Can cause pulmonary embolism (PE).
Venous Disease/Insufficiency
Think about WalMart
A brown discoloration occurs with chronic venous stasis as a result of hemosiderin deposits (a by-product of red blood cell degradation).
Warm, brown or red, swollen
(bilaterally)
Weeping or excoriating skin
Pitting edema
Varicose veins
Arterial Disease/Insufficiency
Pallor, cyanosis, atrophic skin, and unilateral coolness are all signs associated with arterial problems.
Slow healing (if any)
Necrosis
Cold, pale extremity
Peripheral pulses weak
Hairless
Atrophic Skin (Thin, Shiny & tight)
Dry skin
Diabetic patients can have _________ Disease/Insufficiency.
Arterial
Microvascular complications –> Slow healing wounds –> Foot Ulcers –> Infection –> Necrosis
What are the two types of connective tissues?
Tendons and Ligaments
Tendons connect __________ to __________.
Tendons connect muscle to bone.
Ligaments connect __________ to __________.
Ligaments connect bone to bone.
Cartilage allows bones to __________ over one another.
Cartilage allows bones to slide over one another.
What is bursae?
Fluid filled sacs in area of friction. Act as a cushion for bone.
What is inflammation of bursae called?
Bursitis
What is tendonitis?
Inflammation of the tendon
What is the cartilaginous disc between bones called and what does it do?
Meniscus, acts as a cushion and absorbs shock.
What is fascia?
Flat sheets that line and protect muscle fibers
Flexion
Bending the limb at the joint, brings bones together
Extension
Straightening of the limb at the joint
Rotation
Turning of a joint around an axis
Ex: Turning head
Lateral flexion
Lateral movements in the frontal plane
Ex: Bring ear to shoulder
Abduction
Movement AWAY from the body
Adduction
Movement TOWARD the center of the body
Circumduction
Conical movement of a limb extending from the joint at which the movement is controlled.
Combines flexion, extension, abduction, and adduction.
Ex: Rotating arm in a circle
Inversion
Movement of the sole towards the median plane so that the sole faces in a medial direction
Eversion
Movement of the sole away from the median plane so that the sole faces in a lateral direction
Protraction
Movement of body part FORWARD & parallel to the ground
Retraction
Movement of the body part BACKWARD & parallel to the ground
Elevation
Raising a body part
Depression
Lowering a body part
Opposition
Approximation of the thumb and 5th digit (pinky)
Pronation
Turning the forearm so the palm is down
Pouring a bowl of soup out
Supination
Turning the forearm so the palm is up
Holding a bowl of soup
Dorsiflexion
Flexion of the ankle
Plantar flexion
Extension of the ankle
Step on the gas
Sprain involves
Ligament
Strain involves
Muscle and tendon
How does functional assessment /ADL’s tie into MSK issues?
Screens for the safety of independent living, need for home health services, and quality of life.
Joint Ranges of Motion
Active vs. Passive
Active- Patient moves
Passive- Examiner moves the patient
Types of spinal curvature
Kyphosis and Lordosis
Genu Valgum
“Gum” makes your knees stick together
Knock Knee
Genu Varum
“Rum” makes your knees spread apart
Bow-legged
Spasticity
Tone increases if the examiner moves the joint more quickly (i.e. the hypertonicity is affected by the rate of movement of the joint). This is the typical finding with an upper motor neuron lesion (e.g. stroke or spinal cord injury).
Rigidity
Tone remains increased regardless of how quickly the joint is moved. One example of this is Parkinson’s disease, where limb movement generates a ratchet-like sensation known as cog wheeling.
Flaccidness
Complete absence of tone. This occurs when the lower motor neuron is cut off from the muscles that it normally innervates.
How do you grade Muscle Strength?
-Compare side to side
-Use 0-5 Rating scale
-Interpretation must consider the expected strength of the muscle group being tested
Muscle Strength 0/5
NO MUSCLE CONTRACTION
Muscle Strength 1/5
Can visualize muscle contraction, NO MOVEMENT
Muscle Strength 2/5
Complete ROM with Joint Support
Cannot Perform Against Gravity
Muscle Strength 3/5
Complete ROM
Against Gravity, without resistance
Muscle Strength 4/5
Complete ROM, Moderate resistance
Muscle Strength 5/5
Complete ROM, Full resistance
Crepitus
Cracking or popping sound
Rice Krispies
Verbal ques
Ouch, whimper, scream
Non-verbal ques
Guarding
AROM of the shoulder
Flexion
Extension
Abduction
Adduction
Internal Rotation
External Rotation
Circumduction
Abnormal Findings
Back Pain
Falls
Osteoporosis
Osteoarthritis
Rheumatoid Arthritis
Bursitis
Joint Dislocation
Shoulder Dislocation
What is the most common musculoskeletal complaint?
Back pain
What is the leading cause of death for people 65 and older?
Falls
Falls are associated with
Poor balance
Prior falls
Poor muscle strength
Unfamiliar environment
Aging
Unfamiliar environment
Inconsistency in their surroundings such as rugs and animals (Trip Hazards) etc.
What is Timed Up & Go?
Get up from chair, walk 10 ft, turn around, come back, & sit down. Use stopwatch –> More than 12 seconds the risk for fall is increased.
At least 95% of hip fractures among older adults are caused by __________.
falls
Reabsorption
Osteoclasts break down bone and release minerals in the bloodstream
Deposition
Bone cells rebuild tissue by depositing minerals from the bloodstream –>Calcium redeposited in bone
Osteopenia
Reduced or thinning bone mass (precursor to osteoporosis)
Osteoporosis
is loss of bone mass with associated mineral deficiency
What does a Dexa scan do?
Determines calcium level in bone. Gives a T-score.
Normal T-score= +1 to -1
Low Bone Density (Osteopenia)= -1.0 to -2.5
High Risk for Osteoporosis= -2.5 or Higher
Osteoporosis Risk Factors
ACCESS leads to Osteoporosis
Alcohol use
Corticosteroid use
Calcium low
Estrogen low
Smoking
Sedentary lifestyle
Slender, female, Caucasian, alcohol users, & steroid users are highest at risk.
Dowanger’s Hump
Hyperkyphosis
What is osteoarthritis?
Age >40, Localized, Relieved by Rest, Worse at the end of day
What is Rheumatoid arthritis?
Age 20-40, Systemic (Autoimmune), Bilateral & Symmetrical, Stiffness worse in the AM
Joint dislocation
Ends of bones slip out of usual position
MSK Health Promotion and Patient Teaching
Diet, Exercise, Osteoporosis screening, and Fall prevention
What type of diet decreases the risk of osteoporosis?
Diet rich in dark leafy greens, eat the rainbow, and low in fired foods
Vitamin D deficiency can cause
muscle weakness thus falls and frailty
What types of patients may we see with low vitamin D levels?
Renal patients (CKD) and nursing home patients
How is tobacco and excessive alcohol use harmful to bone health?
Smoking reduces bone mineral density (BMD)
Excess drinking increases the risk for falls
Physical activity delays and prevents bone loss.
True or False
True
Fall Prevention- What is the cycle of falling?
Inactivity –> Physical deconditioning –> Increased risk of falling –> Fall incident –> Fear of falling –> Back to inactivity
In pregnant women, Lordosis compensates for
enlarging uterus
What does the Allis test check for in infants?
Checks for hip dislocation by comparing leg lengths
Barlow Maneuver
Tests for Developmental Dysplasia of the Hip. May hear a “pop” with hip dislocation.
Ortolani Maneuver
Done at each visit until age 1. Tests for Developmental Dysplasia of the Hip.
