Cardiac Part 2 Flashcards
What is the precordium?
The area on the anterior chest overlying the heart and great vessels.
What are the four chambers of the heart?
The heart has two atria and two ventricles.
What are the great vessels?
Major arteries and veins connected to the heart.
What are the two continuous loops of blood vessels?
Pulmonary circulation and systemic circulation.
What are the layers of the heart wall?
The heart wall has three layers:
* pericardium,
* myocardium, and
* endocardium.
What is the pericardium?
A tough, fibrous, double-walled sac that surrounds and protects the heart.
What is the myocardium?
The muscular wall of the heart.
What is the endocardium?
A thin layer of endothelial tissue that lines the inner surface of heart chambers and valves.
What are the two pump systems of the heart?
Each side of the heart has an atrium and a ventricle.
* Atrium: thin-walled reservoir for holding blood
* Ventricle: thick-walled, muscular pumping chamber
What is the purpose of heart valves?
- To prevent backflow of blood.
- Valves are unidirectional.
- Valves open and close passively in response to pressure gradients in moving blood
How many valves are in the heart?
There are four valves: two atrioventricular (AV) valves and two semilunar (SL) valves.
What are the two AV valves?
- tricuspid valve (right AV valve)
- bicuspid (mitral) valve (left AV valve).
What anchors the AV valves?
Thin leaflets are anchored by collagenous fibers (chordae tendineae) to papillary muscles embedded in the ventricle floor.
When do AV valves open?
During the heart’s filling phase (diastole) to allow ventricles to fill with blood.
When do AV valves close?
During the pumping phase (systole) to prevent regurgitation of blood back into the atria.
What are Semilunar valves?
Valves set between ventricles and arteries, each with three cusps that look like half moons.
What are the two SL valves?
The pulmonic valve (right side of heart) and the aortic valve (left side of heart).
When do SL valves open?
During pumping (systole) to allow blood to be ejected from the heart.
Where are no valves present in the heart?
Between the vena cava and right atrium, or between pulmonary veins and left atrium.
What symptoms arise from high pressure in the left side of the heart?
Symptoms of pulmonary congestion.
What symptoms arise from high pressure in the right side of the heart?
Symptoms show in neck veins and abdomen.
What is the direction of unoxygenated blood flow?
Unoxygenated red blood drains into vena cava, follows
route of venous blood.
* From liver –> right atrium (RA) through inferior vena cava –> RV –> pulmonic valve –> pulmonary artery.
* Lungs oxygenate blood.
What occurs in the lungs regarding blood?
Lungs oxygenate blood.
Where does blood goes after oxygenated from lungs?
–> left atrium (LA) –> via mitral valve
–> left ventricle (LV) –> Aorta delivers oxygenated blood to body.
What characterizes blood circulation?
Circulation is a continuous loop, moving by continuous shifting pressure gradients.
What occurs during diastole in the cardiac cycle? and phases of diastole?
Ventricles relax and fill with blood; it constitutes 2/3 of the cardiac cycle.
* Protodiastolic filling (early passive phase)
* presystole (atrial kick).
What happens during systole?
The heart contracts, pumping blood from ventricles to fill pulmonary and systemic arteries; it constitutes 1/3 of the cardiac cycle.
What is a key point about atrial systole?
Atrial systole occurs during ventricular diastole.
What occurs during isometric contraction?
This contraction against a closed system builds high pressure in the ventricles.
What occurs during isometric relaxation?
All four valves are closed and ventricles relax.
How does the right side of the heart differ from the left side?
The right side requires lower pressure and the sequence occurs slightly later.
What is the first heart sound (S1)?
Occurs with closure of AV valves, signaling the beginning of systole.
What is the component of the first heart sound?
The mitral component (M1) slightly precedes the tricuspid component (T1).
What is the second heart sound (S2)?
Occurs with closure of semilunar valves, signaling the end of systole.
What is the first component of the second heart sound?
The aortic component (A2) slightly precedes the pulmonic component (P2).
Where is S2 loudest?
S2 is loudest at the base.
How does respiration affect heart sounds?
Volume of right and left ventricular systole is nearly equal but can be affected by respiration.
What is the phrase to remember regarding heart sounds and respiration?
MoRe to the Right heart, Less to the Left.
What is the third heart sound (S3)?
- Occurs when ventricles are resistant to filling during early rapid filling phase (protodiastole),
- immediately after S2, when AV valves open and atrial blood first pours into ventricles.
What is the fourth heart sound (S4)?
Occurs at the end of diastole, at presystole, when the ventricle is resistant to filling, just before S1.
What are heart murmurs?
Gentle, blowing, swooshing sounds heard on the chest wall due to turbulent blood flow and collision currents
What conditions can result in heart murmurs?
- Increased velocity of blood
- decreased viscosity of blood
- structural defects in valves.
What characteristics describe heart sounds?
- Frequency or pitch: high or low
- Intensity or loudness: loud or soft
- Duration: very short for heart sounds; silent periods are longer
- Timing: systole or diastole
What is automaticity in the heart?
- The heart’s ability to contract by itself, independent of any signals or stimulation from the body.
- Contracts in response to an electrical current conveyed by a conduction system
What initiates the electrical impulse in the heart?
- Specialized cells in the sinoatrial (SA) node, near the superior vena cava.
- Because it has an intrinsic rhythm that initiates heart contractions.
What does a P wave tell you?
Depolarization of atria
What is the P-R interval?
Time from beginning of P wave to beginning of QRS complex (includes atrial depolarization and AV node delay)
What is a QRS complex?
Depolarization of ventricles
What is a T wave?
Repolarization of ventricles
How do electrical events relate to mechanical events in the heart?
Electrical events slightly precede mechanical events in the heart
What is cardiac output (CO)?
Heart normally pumps 4–6 L/min at rest
CO = HR x SV
CO affected by preload and afterload
What is preload?
Venous return that builds during diastole
What does the Frank-Starling Law state?
Greater preload/stretch → stronger contraction → increased stroke volume
What is afterload?
Resistance ventricle must overcome to open aortic valve and eject blood
What are the features of the carotid artery waveform?
- Smooth rapid upstroke,
- rounded and smooth summit,
- gradual downstroke with dicrotic notch from aortic valve closure
What are jugular veins?
Two on each side of neck, empty unoxygenated blood into superior vena cava
What is the A wave in jugular pulse?
Atrial contraction causes slight backflow to vena cava
What is the C wave in jugular pulse?
Backflow from bulging tricuspid valve during early ventricular systole
What is the X wave descent in jugular pulse?
Atrial relaxation as RV contracts and pulls the atria downward
What is the V wave in jugular pulse?
Passive atrial filling with increasing RA volume and pressure
What is the Y descent in jugular pulse?
Passive ventricular filling when tricuspid valve opens
What is a notable cardiac change during pregnancy?
Blood volume increases by 30–40%; arterial BP decreases due to peripheral vasodilation
When does fetal heart development begin?
Fetal heart starts beating by 3 weeks’ gestation
What circulatory change occurs in newborns at birth?
Inflation and aeration of lungs at birth triggers circulatory changes
How is aging related to cardiovascular health?
Closely linked with lifestyle, habits, and comorbidities
What hemodynamic change occurs with aging?
- Isolated systolic HTN: Increase in systolic BP due to thickening and stiffening of the arteries
- Left ventricular wall becomes thicker but the overall size of the heart does not change.
- Pulse pressure increases.
- No change in resting heart rate or cardiac output at rest
- Ability of heart to augment cardiac output with exercise is decreased.
How dysrhythmias present in the aging population?
- Presence of supraventricular and ventricular dysrhythmia increases with age.
- Ectopic beats common; usually asymptomatic in healthy older people, may compromise cardiac output and blood pressure when disease present
- Tachyarrhythmias may not be tolerated as well in older people.
What causes ECG changes with aging?
Due to histologic changes in the conduction system.
What are the ECG findings in aging adults?
- Prolonged P-R interval
- prolonged Q-T interval
- unchanged QRS interval
- Left axis deviation, caused by mild LV hypertrophy and fibrosis in the left bundle branch.
- Increased BBB incidence
What kind of axis deviation in aging and why?
Left axis deviation, caused by mild LV hypertrophy and fibrosis in the left bundle branch.
What is the incidence of bundle branch blocks in the elderly?
Increased incidence.
How does coronary artery disease change with aging?
Incidence increases sharply with age; causes about half of deaths in older adults.
increased prevalence of HTN and HF, major contributed by cardiac health/lifestyle habits
How does physical activity affect the elderly?
Reduces risk of death from cardiovascular and respiratory diseases.
What is critical for reducing cardiac risk in the elderly?
Health teaching.
What subjective symptom should be asked about related to heart issues?
- Orthopnea.
- cyanosis or pallor.
- nocturia.
- edema
- Past cardiac hx (medical/surgical)
- comorbidities
- Dx tests + imaging studies
- family hx
- social/lifestyle (nutrition, smoking, alcohol, exercise, medication)
- Home meds (Rx or OTC, side effects awareness, compliance)
- Environment
What should be included in an edema history?
Onset, timing, amount, location, symptom relief, associated symptoms.
How should carotid artery palpation be performed?
Palpate one at a time to avoid compromising cerebral blood flow.
normal strength is +2, equal bil
What is assessed during carotid artery auscultation?
- Assess for carotid bruit.
- Do not compress the carotid artery during auscultation because it can cause false bruit
- keep neck in neutral position and apply stethscope lightly.
What is the purpose of jugular venous pulse inspection?
Used to assess central venous pressure (CVP) and heart’s pumping efficiency.
What position is best for jugular inspection?
Supine at a 30°–45° angle for best visualization.
What should be evaluated in the jugular vein?
Estimate pressure and observe for distention.
What are the auscultatory areas of the heart?
- Aortic: 2nd right interspace;
- Pulmonic: 2nd left interspace;
- Tricuspid: left lower sternal border;
- Mitral: 5th interspace at left midclavicular line.
What should be noted during heart auscultation?
- Note rate and rhythm, identify S1 and S2.
- listen for extra heart sounds
- listen for murmurs
What factors should be noted during murmur assessment?
Note timing, loudness, pitch, pattern, quality, location, radiation, posture, and position changes.
What is the standing to squatting maneuver?
A screening test to detect hypertrophic cardiomyopathy.
How does CVP can be assessed beside normal methods (hook pt to monitor)
- By assessing jugular venous distention.
- If venous pressure is elevated or heart failure suspected perform abdominojugular test.
What occurs in newborn circulation immediately after birth?
Transition from fetal to pulmonic circulation.
What is the normal heart rate range for newborns immediately after birth?
100–180 bpm.
What are extracardiac signs of heart issues in newborns?
Skin color, liver size, respiratory status.
What are the characteristics of newborn murmurs?
Common, due to shunt closure, usually grade 1–2, systolic, with no other signs of heart disease.
Do newborn murmurs indicate congenital heart disease?
Presence doesn’t necessarily indicate disease; absence doesn’t rule it out.
How should newborn murmurs be monitored?
Best to listen frequently and note murmur characteristics.
What are pediatric cardiac signs?
Poor weight gain, developmental delay, persistent tachycardia, tachypnea, DOE, cyanosis, clubbing.
When does clubbing typically appear in children?
Usually appears late in the first year, even with severe cyanotic defects.
How does the location of the apical pulse in children vary?
Location varies by age; palpate accordingly.
What is typical for pediatric heart rhythm?
Typically shows sinus dysrhythmia.
Physiologic S3 is common.
Venous hum has no patho significance
How common are innocent murmurs in children?
Very common; may be present in up to 100% of kids.
What are the characteristics of innocent murmurs?
Soft, short systolic ejection, medium pitch, vibratory quality.
Best heard at left lower or midsternal border, with no radiation
What should be emphasized to patients regarding innocent murmurs?
It’s harmless ‘noise’; educate to avoid overprotection or activity limits.
What are the cardiac changes in a pregnant woman?
Resting pulse increases by 10–15 bpm; BP decreases from prepregnancy level
How is the apical impulse affected during pregnancy?
Displaced higher and more lateral
What changes occur in heart sounds during pregnancy?
Change due to increased blood volume and workload
What is a mammary soufflé?
Systolic-diastolic murmur heard near term or during lactation
How does systolic BP change in aging adults?
Gradual rise with age; pulse pressure widens
What should be monitored for in elderly regarding orthostatic hypotension?
Be alert due to vascular changes
What happens to the LV wall in aging?
Thickens with age
What dysrhythmias are more common in the elderly?
Increased incidence of supraventricular and ventricular types
What ECG changes occur with aging?
Due to histologic changes in the conduction system
What are the causes of ischemic chest pain?
Angina pectoris, Prinzmetal angina, acute coronary syndrome (ACS)
What causes non-ischemic cardiac chest pain?
Pericarditis, mitral valve prolapse, aortic dissection, pulmonary HTN
What are the causes of pulmonary chest pain?
Pulmonary embolism, pneumonia, pneumothorax
What causes GI chest pain?
GERD, esophageal spasm, cholecystitis, pancreatitis
What is a dermatologic cause of chest pain?
Herpes zoster
What causes musculoskeletal chest pain?
Costochondritis, chest wall muscle strain
What are psychogenic causes of chest pain?
Depression and anxiety
What are the variations of S1 heart sound?
Loud, faint, varying intensity, split
What are the variations of S2 heart sound?
Accentuated, diminished, normal, fixed split, paradoxical split, wide split
What are systolic extra heart sounds?
Ejection click, aortic prosthetic valve sound, midsystolic click
What are diastolic extra heart sounds?
Opening snap, mitral prosthetic valve sound, S3, S4, summation sound, pericardial friction rub
What would you find in abnormal 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 are some of the congenital heart defects?
- Patent ductus arteriosus (PDA)
- Atrial septal defect (ASD)
- Ventricular septal defect (VSD)
- Tetralogy of Fallot
- Coarctation of the aorta
What are murmurs caused by valvular defects?
Midsystolic ejection murmurs
Ø Aortic stenosis
Ø Pulmonic stenosis
Pansystolic regurgitant murmurs
Ø Mitral regurgitation
Ø Tricuspid regurgitation
Diastolic rumbles of atrioventricular valves
Ø Mitral stenosis
Ø Tricuspid stenosis
Early diastolic murmurs
Ø Aortic regurgitation
Ø Pulmonic regurgitationMidsystolic ejection murmur
Heart and
Neck Vessels Examination
Neck
Ø Carotid pulse—observe and palpate
Ø Observe jugular venous pulse.
Ø Estimate jugular venous pressure.
Precordium
Ø Inspection and palpation
* Describe location of apical pulse.
* Note any heave (lift) or thrill.
Ø Auscultation
* Identify anatomic areas noting rate and rhythm.
* Listen in systole and diastole for murmurs.
* Repeat with bell.
* Listen at apex and base.
