Cardiac - Unit 2 - Cardiac Assessment Flashcards
What happens during diastole?
Ventricles fill and they’re relaxed. pressure is low.
What valves are open during diastole?
AV valves are open, aorta/pulmonary valve are closed.
What makes the S1 sound?
Closure of AV (Mitral, Tricuspid) Valves
What happens during systole?
L/R Ventricles contract - Blood goes to aorta/pulmonary artery to leave the heart. AV Valves close.
Which valves are open during systole?
Aorta/Pulmonary Valve
What makes the S2 sound?
Closing of the Semi-lunar (Pulmonary, Aorta) valves
What is S3?
Ventricular gallop - “Kentucky” - Heard after S2 - Associated with heart failure.
Is S3 normal or abnormal?
Can be normal in people up to age 30
What is S4? Is it normal or abnormal?
Atrial gallop - heard priot to S1 - ALWAYS ABNORMAL.
Gallops heard better with ___ of stethoscope.
Bell.
What are murmurs?
Increased or turbulent blood flow through the heart. It’s a whooshy sound sound caused by incompetent or stenosed valves.
A murmur is heard better with the ___ of a stethoscope.
Diaphragm.
Murmur heard S1–>S2 =
Murmur heard S2–>S1 =
Murmur heard S1–>S2 = Systolic Murmur
Murmur heard S2–>S1 = Diastolic Murmur
Cardiac Output =
The amount of blood pumped out of the heart each minute.
CO = SV X HR
What’s the normal cardiac output?
4-8 liters/min.
What is the cardiac index?
The cardiac output in relation to body size.
CI = CO / Body Surface Area (BSA)
What is the normal Cardiac Index?
2.5-5.2 liters/min.
What are some factors that increase or decrease cardiac output?
Tachycardia or Bradycardia (at first, tachy increases it but then it decreases it over time) Hypertension or Hypotension, Exercise (Increase) Stress (Increase) Calcium (Increase) Epinephrine (Increase) Ventricular Hypertrophy (Decrease)
What is preload?
Degree of myocardial fiber stretch at the end of diastole (PRIOR to contraction).
What does ventricular hypertrophy mean?
The ventricle is stretched out too much.
What determines preload?
Left ventricular end-diastolic volume.
What is starling’s law?
the more the heart is filled during diastole the more forcefully it contracts.
Excessive filling = excessive LVED volume & pressure = Increased or decreased CO?
Decreased.
What is the afterload?
The amount of pressure the heart has to pump against to eject blood into the peripheral blood vessels - like how much pressure to open the valves up!
Afterload - amount of resistance is directly related to arterial BP and the diameter of the blood vessels. T/F?
True!
Afterload - Impedence - def
the pressure the heart much overcome to open the aortic valve depends on aortic compliance and total systemic vascular resistance.
Which med is good for decreasing afterload?
Nitroglycerin
What are some of the effects on aging in the heart?
Increased sclerosis and calcium (stenosis, conduction delays), decreased pacemaker cells (slowed HR, increased ectopy), lost pacemaker pathway (blocks), heart muscle is slower (S4, poor compliance)
What is ectopy?
Abnormal beats/dysrhythmia’s
What are some modifiable cardiac risk factors?
HTN, Lipids, Smoking, Exercise, Diabetes, Stress
What are some non-modifiable cardiac risk factors?
Race, Gender, Family history
What are some risk factors for CVD in women?
Waist and abdominal obesity, Postmenopausal, Diabetes
Do women have different symptoms for a heart attack?
Yes, sometimes! They might only have dyspnea on exertion, along with back pain, indigestion, N/V, anorexia, etc.
What are some medical history questions we should ask cardiac patients?
Childhood history (Strep? Rheumatic Fever?), medical disorders, cardiac studies, meds, allergies, family history, psycho-social, etc.
What should we ask about cardiac symptoms?
What are the precipitating factors? What relieves the symptoms? Pain rating scale
The absence of symptoms doesn’t guarantee the absence of heart disease - T/F?
The magnitude of symptoms doesn’t necessarily parallel the severity of heart disease. T/F?
TRUE TRUE!
What are some cardiac causes of chest pain? What are some non-cardiac causes?
Cardiac = angina, MI, pericarditis.
Non-cardiac = pulmonary embolism, pleurisy, dissection of the aorta, esophagitis, hiatal hernia, peptic ulcer, cholecyctitis, etc.
What questions should we ask someone who comes in with chest pain?
How long does it last for and how often does it happen?
Is the pain different from pain you have had before?
Where is the pain? What does it feel like?
Do you have any other signs and symptoms?
Palpitations - def
feeling your heart beat
DOE - what is it?
Dyspnea on exertion
What is othopnea?
Dyspnea when laying down.
What is PND - Paroxysmal Nocturnal Dyspnea?
Happens with heart failure patients - it occurs at night - they have fluid build up and it feels like they’re drowing so it’s harder to breathe.