Cardio/Blood Vessels Flashcards
(196 cards)
1
Q
Where is the heart situated in related to costal cartilages
A
3rd - 6th
2
Q
How is the heart position different in taller and smaller people?
A
Taller: vertically oriented and centrally
Smaller: horizontally oriented and more to the left
3
Q
What is situs inversus?
A
Heart and stomach are to the right and liver to the left
4
Q
What layer of the heart is responsible for pumping?
A
Myocardium
5
Q
What is myocardium responsible for?
A
Pumping
Thick, muscular middle layer
6
Q
What layer of the heart lines the chambers and covers the valves of the heart?
A
Endocardium
7
Q
Diastole
A
Ventricle relaxation and atrial contraction that moves blood into ventricles
8
Q
S1 sound
A
Mitral and tricuspid valves close
“Lubb” first heart sounds
AKA: atrioventricular (AV) valves
9
Q
S2
A
“Dubb”
Aortic and pulmonic valves close
AKA: semilunar valves
10
Q
Explain entire systole
A
Ventricles contract Mitral/tricuspid (AV valves) close (s1) Pressure continues to rise Aortic and pulmonic valves open (semilunar) Pressure falls Aortic and pulmonic valves close (s2)
11
Q
Valves only make noise when?
A
When closing
12
Q
S3
A
Blood moves from atria to ventricles
13
Q
S4
A
Causes complete emptying of atria
Extra little “squirt”
14
Q
Explain events of diastole
A
Mitral and tricuspid (AV) valves open
Blood moves from atria to ventricles (s3)
Ventricles dilate
Atria contract as ventricles are almost filled
Complete emptying of atria (s4)
15
Q
Cycle slightly slower on ______ side of the heart aka _______
A
Right
Splitting
16
Q
Heart has what type of electrical conduction system that enables heart to contract within itself
A
Intrinsic
17
Q
P wave
A
Spread of stimulus through the atria
Ala atria depolarization
18
Q
PR interval
A
Time from initial stimulation of the atria to initial stimulation of the ventricles
19
Q
QRS complex
A
Spread of a stimulus through the ventricles
Aka depolarize
20
Q
ST segment and T wave
A
Return of stimulated ventricular muscle to a resting state
Repolarization of ventricle
21
Q
U wave
A
Small deflection after T wave related to repolarization of purkinje fibers
22
Q
QT interval
A
Time elapsed from the onset of ventricular depolarization until the completion of ventricular repolarization
23
Q
What is hidden within the QRS complex
A
Atrial repolarization
24
Q
Changes in heart at birth
A
- Ductus arteriosus and interatrial foramen ovale close
- Right ventricle assumes pulmonary circulation
- Left ventricle assumes systemic circulation
25
Positioning of heart in children
More horizontally and apex is higher
Normal positioning by 7 years
26
4 changes in heart/blood in pregnant
Blood volume increases 40-50%
Cardiac output increases 30-40%
LV increases in thickness and mass
Heart shifts more horizontally
27
Changes in heart rate with elderly
Slows
28
Changes in stroke volume with elderly
Decreases
29
Cardiac output change with elderly
Declines 30-40%
30
Heart wall layer changes with elderly
Endocardium: thickens
Myocardium: less elastic
31
Related history: family history to heart issues that is pertinent
- long QT syndrome
- Marfan
- diabetes
- dyslipidemia
- congenital heart defects
- family members with cardiac risk factors
32
Indications of heart disease during pregnancy
- progressive/severe dyspnea
- progressive orthopnea
- hemoptysis
- syncope with exertion
- chest pain related to effort or emotion
- paroxysmal nocturnal dyspnea
33
Considerations if diagnosed with heart disease
- drug reactions
- potassium depletion
- digitalis toxicity
- ADLs capability
- coping
- orthostatic HoTN
34
What side should you stand on of the patient to examine the heart
Right
35
Apical impulse
Point of maximum impulse
@ 5th left intercostal space midclavicular line
May be visible in 4th
Should not be been in more than one IC space if heart healthy
36
Is it an issue is the apical impulse in absent from inspection?
No, unless you ausculate and sound is also faint
37
What is heave or lift?
If apical impulse is more vigorous than expected
38
What is a thrill
Fine, palpable, rushing VIBRATION, a PALPABLE MURMUR
Mc to feel at semilunar valves
39
What is the best way to judge the left ventricle size?
Location of apical impulse better judge than percussion
40
What direction does RV tend to enlarge?
AP diameter
41
Ausculate aortic valve
2nd right intercostal space on right eternal boarder
42
Ausculate pulmonic valve
Second left intercostal space of left sternal boarder
43
Ausculate eras point
Third left IC on left sternal boarder
44
Auscultate tricuspid
Fourth L IC on L sternal boarder
45
Auscultate mitral
5th IC space on midclavicular line
46
Which is longer—systole or diastole
Diastole
47
Characteristics of listening with diaphragm
High
Hard pressure
Regurgitation
S1/s2
48
Characteristics of listening with bell
Low
Light tough
Stenosis
S3/s4
49
S1 sound and best heard where
Closure of AV valves
| @ apex of heart
50
What is splitting
In s2 usually aortic valve closes first due to higher pressure and hear “d-dump”
51
When does splitting occur
S2 during semilunar valve closure. Aortic closes first
52
Where is s2 sound best heard
2nd IC space
53
Can splitting occur in s1?
Yes, but tricuspid closes so quietly that probably cannot hear it
54
Gallops
If you can hear s1-s4 sounds
55
Mitral snaps
Mitral valve opens loudly due to thicker valve leaflets
56
Ejection clicks
Aortic/pulmonic valves open loudly
| Due to dilated aorta or pulmonary artery
57
What are the two things that you can hear noises when valves open
Mitral snaps and ejection clicks
58
Mnemonic to remember diastole and systole heart murmurs
ARMS and PRTS
59
Irregular rhythm of heart in a repeated pattern may be indicative of what
Sinus dysrhythmia-a cyclic variation of the heart rate
60
Patternless, unpredictable, irregular rhythm may indicate what
Heart disease
| Conduction system impairment such as A-fib
61
What may the liver be like in infant with heart function issues
Harder and lower. 5-6cm below rib cage
62
What are good things to identify quality of heart in infant
Vigor and quality
63
When are murmurs common in infants
First 48 hours
64
What may you see in children with long standing heart conditions
Bulging precordium
65
Are heart rates more variable in children or adults
Children
66
With an increase of one degree heart rate of a child increases how much
10-20 bpm
67
Murmurs in infants and children are result of what usually?
Congenital heart disease
68
What accounts for most acquired murmurs in children
Kawasaki disease
69
Changes in apical impulse in pregnant women
Shifts up and laterally 1-1.5cm
70
Changes in heart sounds of pregnant woman
Audible splitting of s1 and s2
S3 readily heard after 20 weeks of gestation
Systolic ejection murmurs (SEMs) heard over pulmonic area in 90% of women
71
What heart sound is more common to hear in older adults and what may it indicate
S4
| Decreased left ventricular compliance
72
Mc cause of angina
Coronary artery disease
73
Stable angina
Predicable
On exertion
Disappears with rest/medication
74
Unstable angina
Occurs at rest
Unexpected
May not disappear with rest
Due to plaques or clots and narrowed arteries
75
Prinzmetal angina
At rest
Due to VASOSPASM of hearts arteries
Caused by stress, smoking, cocaine etc.
temporarily reduces blood flow
Like raynauds of the heart
76
Bacterial endocarditis
Infection of endothelial layer of the heart that spreads through blood and attaches to damaged areas of heart.
Can destroy valves of heart
77
Who are most at risk for bacterial endocarditis
Congenital/acquired heart defects
Previous history
IC drug users
Poor dental health
78
S/s of bacterial endocarditis
FEVER
Fatigue
Sudden CHF
Murmur
Neurological dysfunction
Jane way lesion: small hemorrhagic maculae on palms and soles
-Osler nodes: tops of fingers and toes by septic emboli-tender
79
Janeway lesion. what and associated with what?
Small, erythematous or hemorrhagic maculae on palms and soles that tend to be painless
Bacterial endocarditis
80
Osler nodes
On tops of fingers and toes by septic emboli that tend to be tender
Bacterial endocarditis
81
Left sided CHF due to....
LV hypertrophy
damaged aortic or mitral valves
Toxic chemicals
Cardiomyopathy
82
Systolic L CHF
LV cannot contract normally
| Not enough force to pump enough blood to body
83
Diastolic L CHF
LV cannot relax to fill properly
MC in elderly with diabetes
84
s/s of L CHF
```
JVD
Pulmonary edema
Tachycardia
Low systolic pulse pressure
Crackles on auscultation
Systolic CHF: narrow pulse pressure
Diastolic CHF: wide pulse pressure
```
85
Right sided CHF due to
MC due to left sided CHF
- C. Lung disease
- Pulmonic stenosis
- tricuspid stenosis/regurgitation
86
Where is congestion with L CHF
Pulmonic circulation
87
Where is congestion with R CHF
Systemic circulation
88
S/s of R CHF
Peripheral edema especially worse at the end of the day or prolonged sitting
- weight gain (ascites)
- swelling in abdomen
- LE pitting
- JVD
89
What causes pericarditis
- idiopathic. Potentially viral infection
- CA
- HIV/AIDS
- hypothyroidism
- kidney failure
- rheumatic fever
- TB
- Kawasaki disease
- MI
- heart surgery
- medications
90
S/s pericarditis
SHARP STABBING CHEST PAIN
- pain worse with coughing, swallowing etc
- relieved by SITTING UP/LEANING FORWARD
- neck, back, left shoulder pain
- DRY COUGH
91
What can pericarditis progress to?
Pericardial effusion and pericardial tamponade
92
Findings in pericarditis
- TRIPHASIC FRICTION RUB
- scratchy
- grating
- heard in 3rd-4th IC spaces during diastole
93
Cardiac tamponade
Effusion fluids/blood between pericardium
94
What causes cardiac tamponade
Pericarditis
Malignancy
Aortic dissection
Trauma
95
S/s of cardiac tamponade
```
Anxiety
Chest pain
Hard to breath
Syncope
Pale gray
Rapid breathing
Swelling of veins of abdomen, arms, or neck
-Becks triad ( JVD, HoTN, muffled heart sounds)
-weak, rapid pulse
```
96
Becks triad
JVD
HoTN
Muffled heart sounds
97
Cor pulmonale
Enlarged of RV secondary to chronic lung disease
98
Acute cor pulmonale
Right side of heart is dilated and fails
| Due to massive PE and A. Resp. Distress syndrome
99
Chronic cor pulmonale
Gradual hypertrophy or RV until failure due to COPD and pulmonary arterial HTN
100
S/s of cor pulmonale
```
Fatigue
Tachypnea
Exertional dyspnea
Cough
Hemoptysis
Light headed
Syncope
```
101
Exam findings of cor pulmonale
```
Nasal flaring
Orthopnea
Retractions
Barrel chest
Shortness of breath
Wheezes/crackles
Labored breathing
Clubbing of fingernails
JVD
LE edema
Cyanosis
Left parasternal systolic heave
Loud exaggerated s2
```
102
MI MC affects where in heart and is due to what?
LV
| Atherosclerosis of coronary BV
103
Exam findings in MI
```
Dysrhythmias
S4 usually present
Distant heart sounds
Soft systolic blowing apical murmur
Thready/weak pulse
```
104
Myocarditis causes what
Decreased ability of hearts ability to pump and causes rapid or abnormal heart rhythms
105
What causes myocarditis
MC viral
106
S/s of myocarditis
```
Fatigue
Dyspnea
Fever
Palpitations
Chest pain
S/s of viral infection
Gallop rhythms
Tachycardia
Pulses alternans (alt. Strong and weak pulses due to s/w ventricle contractions)
```
107
Tetralogy of fallout
DRIP or DAVeS PoS RV
Dextroposition of aorta
Right ventricular hypertrophy
Interventricular septal defect
Pulmonic stenosis
In infants and children
108
S/s of tetralogy of fallot
```
Poor growth
Exercise intolerance
Tet spell (dyspnea when feeding, LOC< central cyanosis)
Parasternal heave
Systolic ejection murmur
Clubbing
```
109
What is “tet” spell and associated with?>
Tetralogy of fallot
Dyspnea when feeding
LOC
Central cyanosis
Due to rapid drop of 02 when feeding usually
110
Exam findings with ventricular septal defect and chance it’ll close
30-50% close within first 2 years
```
Arterial pulse small
holosystolic murmur (aka all of systole) loud coarse, high-pitched best along left sternal boarder
```
111
What does ductus arteriosis connect in infant
Connects aorta and pulmonary artery to bypass lungs in uterus
112
S/s of patent ductus arteriosus
```
Dyspnea on exertion
Fast breathing
Rapid pulse
Short breath
Tire easily
Poor growth
Dilated pulsation neck vessels
Wide pulse pressure
MACHIENE LIKE QUALITY murmurs
```
113
Acute rheumatic fever
Untreated strep
MC in 5-15 years
Mitral or aortic valve damage
114
S/s of rheumatic fever
Fever
Swollen elbows, wrists knees, ankles
Painless rash with pink margins and pale centers
Chest pain
Palpitations
Aimless jerky movements (Sydenham chorea or St. Vitus’ dance)
115
Exam of acute rheumatic fever findings
```
Murmurs of mitral regurgitation and aortic insufficiency
Cardiomegaly
Friction rub
Signs of CHF
Onset: 2-4 weeks post strep
```
116
Insufficieny of valve aka
Regurgitation
117
S/s of mitral regurgition/insufficiency
```
High pitched PANSYSTOLIC murmur radiating to axilla
-May have 3rd heart sound
Shortness of breath
Pulmonary edema
Paroxysmal nocturnal dyspnea
```
118
Senile cardiac amyloidosis
Amyloid protein deposition in the heart due to chronic inflammation or neoplastic disease. Causes “stiff heart” syndrome
119
S/s of senile cardiac anyloidosis
```
Pleural effusion
Arrhythmia
LE edema
Dilated neck veins
Hepatomegaly or ascites
Thickened LV
Fatigue
Decreased activity tolerance
```
120
Atrial flutter
Regular uniform atrial contractions in excess of 200 bpm
Multiple P waves for each QRS
“Saw tooth appearance” on ECG
121
A-fib
Conduction system malfunction causing quivering rapid heartbeats
“Fluttering” in chest and shortness of breath
122
Sinus bradycardia
Slow but normal ECG
| <60bpm
123
Heart block
Electrical signal of heart is slowed or signal prevented due to MI (MC), heart disease, cardiomyopathy, drugs
3 categories
124
First degree heart block
Conduction still there but slow
Prolonged PR interval. Longer than .20 seconds
Usually considered bending/asymptomatic
125
Second degree heart blocks
Conduction not always there but then comes back
PR interval increases with each beat until a QRS is missed
Due to conduction block at the level of the AV node
126
Third degree heart block
No conduction
None of the P-waves are conducted to the AV nodes
127
Akas for second degree heart block
Mobitz type 1 and wenckenbachs
128
What is second degree heartblock due to
Conduction block at the level of the AV nodes
129
What is seen on an ECG in second degree heart block
PR interval increases until a QRS complex is missed
130
Type 2 aka mobitz type two heart block
Sporadically some electrical signals don’t reach the ventricles giving an irregular pattern
PR interval is consistent before QRS block disappears.
131
Which heart blocks require pacemakers
Type 2 2nds degree and 3rd degree
132
SVT (supraventricular tachycardia)
Abnormally fast heart rate with narrow QRS complexes
133
What causes supraventricular tachycardia
Arrhythmia start originate at or above the AV node
134
Ventricular tachycardia
Rapid, regulars heartbeat >200bpm
135
Where is the source of beat in ventricular tachycardia
Somewhere in the ventricles (NOT SA or AV nodes)
136
V-fib
Quivering of ventricles
MOST SERIOUS CARDIAC RHYTHM DISTURBANCE
137
ST segment elevation
Indicates acute MI
138
Sick sinus syndrome
Group of arrhythmias caused by malfunction of sinus node
SA signals are abnormally paced
Requires pacemaker
139
The activity of the right side of the heart is transmitted back through what?
Jugular veins as a pulse that can only be visualized
140
What are the five identifiable components in jugular vein
A, c, v wave and x and y slope
141
A wave
Brief backflow of blood into vena cava during right atrial contraction
142
C wave
Impulse from closure of tricuspid valve during ventricular systole
143
V wave
Increased volume and pressure in right atrium
144
X slope
Caused by passive atrial filling
145
Y slope
Reflects open tricuspid valve and rapid filling of ventricle
146
When does ductus arteriosis close?
12-14 hours
147
BP changes in pregnancy women
DECREASES
Lowest in 2ns trimester
Resistance decreases
Vasodilation occurs
Enlarged uterus causes impaired venous return and HoTN, varicosities in les and hemorrhoids
148
Resistance changes in elderly
Lose elasticity that causes increased peripheral vascular resistance and elevates BP
149
Types of Claudication
Vascular and neurogenic
150
Vascular claudication
Pain due to vascular angina of calf that causes decreased flow and leads to pain.
VERY PREDICTABLE
Due to atherosclerosis
151
Neurogenic claudication
Nerve problem causing pain
MC starts with low back due to DJD—> canal stenosis—> N. Inpindment
Unpredictable
LEADING FORWARD helps
152
If femoral pulse absent what is is most indicative of?
Peripheral artery disease
153
S/s of claudication
Dull aches
Muscle fatigue/cramps
Site of pain is distal to the narrowing
154
When may Jugular pulse not be evident
Severe right heart failure
Volume depletion
Obesity
155
A value of what or lower is expected for jugular venous pressure?
4cm of less
156
What is suspected if jugular venous pressure is higher than 4cm
```
Right-sided heart failure
Fluid volume overload
Constrictive pericarditis
Tricuspid stenosis
SVC obstruction if higher
```
157
Hepatojugular reflex exaggerated during
| And positive reflex
Right sided heart failure
When pressure on epigastric region JVP elevates, when pressure released JVP should decrease immediately. If slowly, it’s positive.
158
Where should the peripheral vein test be at when normal?
Should come to level that is identical to JVP earlier
159
Holman sign
Calf pain with passive dorsiflexion of foot
If negative, it cannot rule out
160
Grading edema in peripheral venous obstruction
1: slight pitting, no distortion, disappears quick
2: deeper pitting but no distortion. Disappears 10-15 seconds
3: deep pit lasting more than a minute and extremity looks fuller/swollen
4: very deep pit lasting 2-5 minutes and very distorted
161
Unilateral edema/pitting indicative of? Bilateral?
DVT
| CHF
162
How to tell impompetent varicose veins from competent
Have patient stand on toes 10 times to increase palpable pressure. If competent dilation will disappear. Varicosities will remain dilated
163
Venous hum
Common in children
Caused by turbulence of blood flow in internal jugular vein
It’s a continuous low-pitched sound loud during diastole
164
What changes in regard to waves/slopes with pregnancy and JVP
A and v waves easier to see due to increasing blood volume
JVP normal
165
Pulses harder to feel in elderly
Dorsal pedis and posterior tibial pulses
166
Temporal arteritis aka? And what?
Giant cell arteritis
Inflammatory disease of branches of aortic arch and temporal arteries
Causes arterial wall thickening and thrombosis that decreases blood supply causing tongue pain and jaw claudication
167
What can temporal arteritis lead to?
Stroke and blindness
168
S/s temporal arteritis
```
Flu-like s/s
Polymyalgia (hip/shoulders)
HA
SCALP TENDERNESS
Vision loss
Red, swollen, modular,
Temp. Pulse varies
```
169
Arterial aneurysm
1.5x dilation of normal artery width due to weakness of wall
MC in aorta
170
Risk factors for arterial aneurysm
Atherosclerosis
Tobacco
Increased BP
4x Men
171
S/s arterial aneurysm
```
asymptomatic until dissection (tearing)
Pulsation swelling along artery
Thrill/bruit
low back pain
Deep abdominal pain
```
172
What size is considered a AAA? ER emergency?
3cm
| 5cm
173
Arteriovenous fistula
Communication between artery and vein that may cause artery to vein shunting
MC in legs but anywhere
May lead to aneurysmal dilation
174
S/s of AV fistula
LE edema
Varicose veins
Claudication
Continuous bruit over fistula
175
Peripheral arterial disease
Stenosis of blood supply to extremities due to plaques
176
Risk factors for PAD
Diabetes
HTN
Dyslipidemia
Tobacco
177
PAD leads to increased risk of what
Stoke
| CV events
178
S/s of PAD
Pain in muscle post exertion that’s PREDICTABLE
Healthy appearing limb with weak/absent pulses
Cold/numb skin
Ulceration in severe cases
Muscle atrophy
RECALL NO FEMORAL PULSE
179
Arterial emboli disease
A-fib can lead to clot formation in arterial that is dispersed through arterial system
Emboli can also be formed by plaques or infection material
Emboli: EVERYthing that can cause block
180
S/s of arterial emboli disease
Pain
Parestesias
Occlusion of small arteries and necrosis: blood toe syndrome
With endocarditis: splinter hemorrhages in nail beds
181
What is blood toes syndrome and what’s it associated with?
Due to small artery occlusion that causes necrosis in toes
Arterial embolic disease
182
Venous thrombosis s/s
```
Tenderness in area
PE w/o warning
Ankle edema
Low fever
Tachycardia
Holman sign** —> ultrasound
```
183
Risk factors for venous thrombus
```
Obesity
Under 30 on BC
Smoking
Post-menopause hormone replacement therapy
Sickle-cell
```
184
Coarctation of the aorta
Stenosis MC at descending aortic arch (after 3 branches) that may cause heart failure
185
Where is coarctation of aorta if vascular insufficiency of UE seen? Exam findings?
After brachiocephalic branch (aka after first branch)
Differences in BP of arms
186
Where is coarctation of aorta if differences between systolic BP in arm and leg?
Descending aorta after 3 branches (ie sublavcian)
187
Describe pulse difference in femoral and radial in coarctation of aorta
Femoral pulses weaker than radial or absent
188
Kawasaki disease
Acute small vessel vasculitic illness MC in young males
Causes immune-mediated vessel damage that leads to vascular stenosis and aneurysm formation
189
What is the biggest concern with Kawasaki disease?
Aneurysms of coronary artery may develop due to BV damage
190
S/s of Kawasaki disease
```
Fever
Conjunctival infection
STRAWBERRY TONGUE
Edema or hands and feet
Lymphadenopathy
```
191
Preeclampsia-eclampsia
HTN after 20th week of pregnancy and presence of proteinuria
Eclampsia is preeclampsia with seizures that are idiopathic
Sustained BP of > 160/110
192
Treatment of preeclampsia-eclampsia
Delivery of baby
193
S/s of preeclampsia
HA
Dizzy/nausea
Visual disturbances
194
Venous ulcers
Due to chronic venous insufficiency that lack of venous flow leads to LE HTN
Due to: incompetent valves, obstruction or loss of pumping effect of leg muscles
195
What cause venous ulcers
Obstruction
Incompetent values
Lack of pumping effect of leg muscles
196
S/s of venous ulcers and who is MC to get them?
Elderly
- heavy legs that progress to edema/ulceration
- hyperpigmentation common
MAKE SURE YOU LOOK AT PT.
With static’s dermatitis
