Cardio Flashcards
S1
first heart sound
CLOSING of the mitral and tricuspid valves
- hear the mitral more because higher pressure here
S2
second heart sound
CLOSING of the pulmonic and aortic valves
systole
contraction of ventricls
so valves that have to be open
- aortic valve and pulmonary valves
atrium relaxes
tricuspid (right side)
mitral (left side) should be CLOSED
valves that prevent blood from going from atrium to ventricle
tricuspid (right side)
mitral (left side)
S3
rapid ventricular filling - seen in CHF - congestive heart failure
will happen in diastole
S4
atrial contraction
will happen in diastole
adventitious sounds
S3 - rapid ventricular filling seen in CHF
S4 - atrial contraction
Splitting
splitting sound associated with
Pulmonic and aortic valves
aortic valve will close first followed by pulmonic valve
occurs during inhalation - more blood coming in so more blood going out
AV node does what
slows the impulse down
- give time to fill the right ventricle
P wave is
depolarization of the atrium
SA node location
atrium
QRS complex
depolarization of the ventricles
T wave
repolarization ffor ventricles
S1 and S2 when
systole
S1 dduring QRS complex
S4 occurs before?
S1
cardiac output =
stroke volume X heart rate
tries to maintain so if HR drops , stroke volume tries to increase
vise versa
if stroke volume goes down- heart rate will increase
preload is
stretch of cardiac muscle prior to contraction
more blood in the heart
afterload is
the vascular resistance against which the cardiac muscle must contract
take pulse for ___
60 seconds if irregular
normal - radial pulse for 15 seconds and can multiply by 4
bruit
murmer like over the blood vessel
thrill
feel vibration over pulse
carotid pulse when
unconscious prob
CPR situations
brachial pulses important with which population
kids - pediatric population
and blood pressure cuffs – stethescope over artyer
general breakdown of rhythm
regular
irregular
regular irregular (may see with a - fib)
normal HR
60-100 bpm
bradycardia - less than 60
tachycardia - more than 100 bpm
how to measure blood pressure
artery occluded
then sounds of turbulent - systolic - see it fluttering then when silence - diasstolic – flow free and inadiuble
common mistakes when taking BP with cuff
cuff or bladder is too small – false elevated high blood pressure
length = 80% of limb’s circumference
width = to 40% of limbs circumference
pulse pressure
systolic - diastolic
mean arterial pressure
SBP + 2(DBP) / 3
if BP = 110/80 : MAP =
110 +2(80)/ 3
270/ 3= 90
MAP - better tells you perfusion of organs
minimal palpated sytolic pressure at radial femoral and carotis
80 - radial
70 - femoral
60 - carotid
heart murmers are?
6 mechanisms
turbulant flow
- flow acorss a partial obstruciton (stenotic valve)
- flow across a valvular or intravascular irregularity without obstruction
- increased flow through a normal structures
- flow into a dialted chamber
- backward or regurgitant flow across an incompetent valve or defect
- shunting of clood out of a high presusre chamber or artery through an abnromal range
why important to know about heart murmers?
in terms of pre-medication patients
also when sedating patients – will valvular conditions drop blood pressure too much
failure of the aortic valve to close?
causes back flow of blood into the left ventricle
aortic valve ethat is leaky
unable to close tightly - may cause back flow and this would occur during DIASTOLIC - because these should be closed
aortic stenosis would occur in
systole – blood unable to freely flow from left ventricle to the aorta
location of aortic valve
right 2nd interspace 2cm
location of pulmonic vlave
left 2nd interspace 2cm
tricuspid and mitral location
valve locations to listen
tricuspid left lower sternal border 2cm
mitral Left interspace 709 cm
crescendo and decrescendo
sounds going from lower to higher - late murmer pattern
decrescendo - sounds going from higher to lower - early systolic murmer
sound classic for aortic stenosis
crescendo- decrescendo
plateua
murmer stays same level all the way through
VSD
intensity of heart murmers
grade 1-6
1-2 very faint to quiet but heard
3- moderate
4 loud
5 very loud
6 very loud heard w/out stethescope
systolic murmers having to do with mitral or tricuspid
these are suppose to be closed in systoly so they would be regugitation murmers
mitral valve prolapse occurs
systolic
systolic murmers having to do with pulmonic and aortic
these should be open during systol so if hear a murmer in these areas during systol you know these are stenotic
ventricular septal defect
plateu - so heard all the way across - hear in systolic
diastolic murmers
regugitation in those that should be closed like aortic (aortic regurgitation or pulmonic regurgitation)
and stenosis in those valves that shuold be open - like mitral stenosis or tricuspid stenosis
pansystolic (holosystolic) murmers
caused by flow from high pressure chaber to low pressure chamber
- ventricular septal defect
- mitral regurgitation
- tricuspid regurgitaiotn
diagnostic test for heart murmers
echocardiogram
echo (ultrasound) cardiogram (heart
ultrasound of the heart
provide info about
- valves of the heart - calcification
- force of contraction of the heart - ejectioon fraction
- motion and thickness of the walls of the heart
who needs pre medicated
only highest risk patients
1. unrepaired cyanotic congenital heart disease, including palliative shunts and conduits
- any repaired CHD with residual shunts or valvular regurgitation at the site of or adjacent to the site of a prosthetic patch or a prosthetic device - which can inhibit endothelization
- a CHD that is completely repaired with prosthetic material or device, whether placed by surgery or catheter intervention - for the FIRST 6 MONTHS after the repair procedure
- prosthetic cardiac valves, including transcatheter- implanted prostheses and homographs
- prosthetic material used for cardiac valve repair, such as annuloplasty rings and chords
- history of infective endocarditis
- cardiac transplant with valve regurgitation due to a structurally abnormal valve
pre medication regime
amoxillin 2 grams
children 50 mg/ kg or if allergic
clindamycin 600 mg children 20 mg. kg
study results from propylaxis
results showed when stoped got an increase in IE cases
so the high risk populaton shoul still pre-medicate
cardiomegally
enlarged heart – may find point of maximum increase may drop further downin anatomy
ECG can show you
rate
rhythm
ischemic changes / hypertrophy
apex heart location and sound location
apical pulse
left ventricular area
- by ribs 4-5
