Cardio Flashcards
S1:
As systole begins, ventricular contraction raises the pressure in the ventricles and forces the mitral and tricuspid valves closed, preventing backflow. This valve closure produces the first heart sound “lub”
S2:
When the ventricles are almost empty, the pressure in the ventricles falls below that in the aorta and pulmonary artery, allowing the aortic and pulmonic valves to close.
S3:
As ventricular pressure falls below atrial pressure, the mitral and tricuspid valves open to allow the blood collected in the atria to refill the relaxed ventricles. Diastole is a relatively passive interval until ventricular filling is almost complete. This filling sometimes produces a third heart sound
Filling of V’s in early diastole
S4:
Then the atria contract into non compliant ventricles
This is never physiological, always abnormal
Seen in HTN and hypertrophic cardiomyopathy
Late diastole
Explain how the relationship between the duration of the systolic and diastolic phases changes at higher heart rates.
As heart rate increases, systole and diastole become more similar in length. With slower heart rate, diastole is longer than systole.
Define the term pulse pressure.
Pulse pressure: difference between the upper and lower (systolic and diastolic) numbers of your blood pressure. This number can be an indicator of health problems before you develop symptoms. Your pulse pressure can also sometimes that you’re at risk for certain diseases or conditions – valve regurgitation
List expected cardiovascular system changes that occur during pregnancy
Blood volume, cardiac output,
PREGNANCY: The pregnant patient’s blood volume increases 40% to 50% over the prepregnancy level. The rise is mainly due to an increase in plasma volume, which begins in the first trimester and reaches a maximum after the 30th week. The heart works harder to accommodate the increased heart rate and stroke volume required for the expanded blood volume. The left ventricle increases in both wall thickness and mass. The blood volume returns to prepregnancy levels within 3 to 4 weeks after delivery. HR increases in first trimester, peaks in second trimester, and decreases 3rd. The cardiac output increases approximately 30% to 40% over that of the nonpregnant state and reaches its highest level by about 25 to 32 weeks of gestation. As the uterus enlarges and the diaphragm moves upward in pregnancy, the position of the heart is shifted toward a horizontal position, with slight axis rotation.
List expected cardiovascular system changes that occur in older adults.
OLDER ADULTS: Heart size may decrease with age unless hypertension or heart disease causes enlargement. The left ventricular wall thickens and the valves tend to fibrose and calcify. Stroke volume decreases, and cardiac output during exercise declines by 30% to 40%. The endocardium thickens. The myocardium becomes less elastic and more rigid so that recovery of myocardial contractility is delayed. The response to stress and increased oxygen demand is less efficient. Tachycardia is poorly tolerated, and after any type of stress, the return to an expected heart rate takes longer.
Jugular venous pulse
a wave
a wave The upward a wave, the first and most prominent component, is the result of a brief backflow of blood to the vena cava during right atrial contraction. This peaks slightly before the first heart sound (S1).
Atrial contraction
jugular venous pulse
C wave
The upward c wave is a transmitted impulse from the vigorous backward push produced by closure of the tricuspid valve during right ventricular systole.
tricuspid closure with bulging from ventricular contraction
julular venous pulse
x slope
The downward x slope is caused by passive atrial filling. This ends with the initiation of the v wave.
Jugular vennous pulse
v wave
The upward v wave is caused by the increasing volume and concomitant increasing pressure in the right atrium. It occurs after the c wave, late in ventricular systole.
passive build up of blood in R atria while tricuspid still closed
jugular venous pulse
y slope
y slope The y slope following the v wave reflects the open tricuspid valve and the rapid filling of the right ventricle.
passive emptying into the Ventricle when tricuspid opens
Explain how to distinguish the internal jugular venous pulse wave from the carotid artery pulse wave.
Quality and Character
Explain how to distinguish the internal jugular venous pulse wave from the carotid artery pulse wave.
Effect of Respiration
JVP
Effect of Respiration Level of pulse wave decreased on inspiration and increased on expiration
Carotid
No effect
Explain how to distinguish the internal jugular venous pulse wave from the carotid artery pulse wave.
Venous Compression
JVP
Venous Compression Easily eliminates pulse wave
carotid
No effect
Describe the proper technique to properly measure the right internal jugular venous pressure; define what is considered an abnormally high pressure.
TECHNIQUE: Place the patient in the supine position using a bed or examining table with an adjustable back support. Use a light to supply tangential illumination across the right side of the patient’s neck to accentuate the appearance of the jugular venous pulsations. When the supine patient is initially placed flat, note the engorgement of the jugular veins. Gradually raise the head of the bed until the jugular venous pulsations become evident between the angle of the jaw and the clavicle. Place a ruler with its tip at the midaxillary line (the position of the heart within the chest) at the level of the nipple and extended vertically. Place the second ruler at the level of the meniscus of the JVP, extended horizontally to where it intersects the vertical ruler. The vertical distance above the level of the heart is noted as the mean JVP in centimeters of water.
A value of less than 9 cm H 2 O is the expected value.
Less than 3cm if using angle of Louis at 45 degree angle
Discuss normal and abnormal findings accentuated by each auscultation positioning maneuver.
Cardio
