Cardiac Part 2 Flashcards
What is the precordium?
Area on anterior chest overlying heart and great vessels
How many chambers does the heart have?
Four chambers: atria and ventricles
What are the two major blood circulation loops?
- Pulmonary circulation
- Systemic circulation
What is the pericardium?
Tough, fibrous, double-walled sac that surrounds and protects heart
Define myocardium.
Muscular wall of heart
What is the endocardium?
Thin layer of endothelial tissue that lines inner surface of heart chambers and valves
What are the two pump systems in the heart?
Each side of the heart has an atrium and a ventricle
What is the main purpose of heart valves?
Prevent backflow of blood
How do heart valves operate?
Open and close passively in response to pressure gradients in moving blood
Name the types of valves in the heart.
- Two atrioventricular (AV) valves
- Two semilunar (SL) valves
What is the function of the tricuspid valve?
Right AV valve
What is the function of the bicuspid or mitral valve?
Left AV valve
What occurs during diastole?
Ventricles relax and fill with blood; 2/3 of cardiac cycle
What happens during systole?
Heart’s contraction, blood pumped from ventricles fills pulmonary and systemic arteries; 1/3 of cardiac cycle
What is isometric contraction?
Contraction against closed system that builds high level pressure in ventricles
What does S1 signify?
Closure of AV valves; signals beginning of systole
What does S2 signify?
Closure of semilunar valves; signals end of systole
True or False: The volume of right and left ventricular systole is always equal.
True, but can be affected by respiration
What is the third heart sound (S3) associated with?
Occurs when ventricles resistant to filling during early rapid filling phase (protodiastole)
What does the fourth heart sound (S4) indicate?
Occurs at end of diastole when ventricle resistant to filling
What are heart murmurs caused by?
- Increased blood velocity
- Decreased blood viscosity
- Structural defects in valves
What is cardiac output?
Volume of blood pumped by heart per minute; CO = HR x SV
Define preload.
Venous return that builds during diastole
What is afterload?
Opposing pressure ventricle must generate to open aortic valve against higher aortic pressure
What is the characteristic waveform of the carotid artery pulse?
- Smooth rapid upstroke
- Summit rounded and smooth
- Downstroke more gradual with dicrotic notch
What is the function of jugular veins?
Empty unoxygenated blood directly into superior vena cava
What does the A wave in jugular venous pulse reflect?
Atrial contraction; some blood flows backward to vena cava
What changes occur in blood volume during pregnancy?
Increases by 30% to 40%
What does isolated systolic hypertension indicate?
Increase in systolic BP due to thickening and stiffening of the arteries
What are common dysrhythmias in aging adults?
- Supraventricular and ventricular dysrhythmias
- Ectopic beats
What is the significance of the Frank-Starling law?
Greater the stretch, the stronger the heart’s contraction
What is the importance of health teaching in older adults?
Significant role in reducing risk for cardiovascular diseases
What should be assessed to evaluate carotid arteries?
Palpate only one carotid artery at a time to avoid compromising arterial blood to brain
What is the position for assessing jugular veins?
Supine with head and chest slightly elevated
What equipment is needed for cardiac assessment?
- Marking pen
- Small centimeter ruler
- Stethoscope with diaphragm and bell endpieces
- Alcohol wipe
What should be observed when inspecting jugular venous pulse?
Possible distention and characteristics of jugular versus carotid pulsations
What is the significance of the apical impulse during inspection?
Note location, size, amplitude, and duration
What are the auscultatory areas associated with heart valves?
- Second right interspace: aortic valve area
- Second left interspace: pulmonic valve area
- Left lower sternal border: tricuspid valve area
- Fifth interspace at left midclavicular line: mitral valve area
What is the aortic valve area location?
Interspace
What is the location of the pulmonic valve area?
Second left interspace
Where is the tricuspid valve area located?
Left lower sternal border
What is the mitral valve area location?
Fifth interspace at around left midclavicular line
What characteristics should be noted when assessing heart rate and rhythm?
Describe characteristics
What are the extra heart sounds that should be listened for?
Describe characteristics
What factors should be considered when listening for murmurs?
- Timing
- Loudness
- Pitch
- Pattern
- Quality
- Location
- Radiation
- Posture
- Change of position
What screening measure can detect hypertrophic cardiomyopathy?
Transition from standing to squatting
How can central venous pressure (CVP) be estimated?
By assessing jugular venous distention
What test should be performed if venous pressure is elevated or heart failure is suspected?
Abdominojugular test
When does the transition from fetal to pulmonic circulation occur?
In the immediate newborn period
What is the normal heart rate range for a newborn immediately after birth?
100 to 180 beats per minute (bpm)
What extracardiac signs may reflect heart status in newborns?
- Skin
- Liver size
- Respiratory status
Do murmurs in the immediate newborn period necessarily indicate congenital heart disease?
No
What characteristics do murmurs typically have in the immediate newborn period?
- Grade 1 or 2
- Systolic
- No other signs of heart disease
- Disappear in 2 to 3 days
Does the absence of murmurs in the immediate newborn period ensure a healthy heart?
No
What signs may indicate heart disease in infants?
- Poor weight gain
- Developmental delay
- Persistent tachycardia
- Tachypnea
- Dyspnea on exertion
- Cyanosis
- Clubbing
When does clubbing of fingers and toes usually appear?
Late in the first year, even with severe cyanotic defects
What is the characteristic rhythm in infants?
Sinus dysrhythmia
What is a common finding in children regarding heart murmurs?
Innocent (or functional) murmurs
What are the characteristics of most innocent murmurs?
- Soft
- Relatively short systolic ejection murmur
- Medium pitch; vibratory
- Best heard at left lower sternal or midsternal border
- No radiation to apex, base, or back
What is important for patient teaching regarding innocent murmurs in children?
Need to believe that this murmur is just a “noise” and has no pathologic significance
What vital signs changes occur in pregnant women?
- Increase in resting pulse rate of 10 to 15 bpm
- Drop in BP from normal prepregnancy level
What happens to the palpation of the apical impulse in pregnant women?
Higher and lateral compared with normal position
What heart sounds changes occur due to increased volume and workload in pregnant women?
Changes in heart sounds
What is a mammary soufflé?
Occurs near term or when woman is lactating
What cardiovascular change is common with aging?
Gradual rise in systolic blood pressure
What happens to the left ventricular wall thickness with age?
Increases
What increases with age regarding heart rhythm?
Presence of supraventricular and ventricular dysrhythmias
What are common causes of ischemic chest pain?
- Angina pectoris
- Prinzmetal or variant angina
- Acute coronary syndrome (ACS)
What are common causes of non-ischemic chest pain?
- Pericarditis
- Mitral valve prolapse
- Aortic dissection
- Secondary pulmonary HTN
What are some gastrointestinal causes of chest pain?
- Gastroesophageal reflux
- Esophageal spasm
- Cholecystitis
- Pancreatitis
What are dermatologic causes of chest pain?
Herpes Zoster
What musculoskeletal/neurologic conditions can cause chest pain?
- Costochondritis
- Chest wall muscle strain
What psychogenic factors can cause chest pain?
- Depression
- Anxiety
What are the variations in heart sounds?
- Loud (accentuated)
- Faint (diminished)
- Varying intensity
- Split
What are the types of abnormal extra sounds?
- Systolic ejection click
- Aortic prosthetic valve sounds
- Midsystolic click
- Opening snap
- Mitral prosthetic valve sound
- Third heart sound
- Fourth heart sound
- Summation sound
- Pericardial friction rub
What are abnormal findings related to pulsations in the precordium?
- Thrill at the base
- Lift (heave) at the left sternal border
- Volume overload at the apex
- Pressure overload at the apex
What congenital heart defects can be identified?
- Patent ductus arteriosus (PDA)
- Atrial septal defect (ASD)
- Ventricular septal defect (VSD)
- Tetralogy of Fallot
- Coarctation of the aorta
What murmurs are caused by valvular defects?
- Midsystolic ejection murmurs (Aortic stenosis, Pulmonic stenosis)
- Pansystolic regurgitant murmurs (Mitral regurgitation, Tricuspid regurgitation)
- Diastolic rumbles of atrioventricular valves (Mitral stenosis, Tricuspid stenosis)
- Early diastolic murmurs (Aortic regurgitation, Pulmonic regurgitation)
What should be observed when assessing the neck during a cardiovascular examination?
- Carotid pulse
- Jugular venous pulse
- Jugular venous pressure
What should be noted during the inspection and palpation of the precordium?
Describe location of apical pulse and note any heave (lift) or thrill
What is included in the auscultation assessment of heart and neck vessels?
- Identify anatomic areas noting rate and rhythm
- Listen in systole and diastole for murmurs
- Repeat with bell
- Listen at apex and base
