Cardio/Blood Vessels Flashcards
Where is the heart situated in related to costal cartilages
3rd - 6th
How is the heart position different in taller and smaller people?
Taller: vertically oriented and centrally
Smaller: horizontally oriented and more to the left
What is situs inversus?
Heart and stomach are to the right and liver to the left
What layer of the heart is responsible for pumping?
Myocardium
What is myocardium responsible for?
Pumping
Thick, muscular middle layer
What layer of the heart lines the chambers and covers the valves of the heart?
Endocardium
Diastole
Ventricle relaxation and atrial contraction that moves blood into ventricles
S1 sound
Mitral and tricuspid valves close
“Lubb” first heart sounds
AKA: atrioventricular (AV) valves
S2
“Dubb”
Aortic and pulmonic valves close
AKA: semilunar valves
Explain entire systole
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)
Valves only make noise when?
When closing
S3
Blood moves from atria to ventricles
S4
Causes complete emptying of atria
Extra little “squirt”
Explain events of diastole
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)
Cycle slightly slower on ______ side of the heart aka _______
Right
Splitting
Heart has what type of electrical conduction system that enables heart to contract within itself
Intrinsic
P wave
Spread of stimulus through the atria
Ala atria depolarization
PR interval
Time from initial stimulation of the atria to initial stimulation of the ventricles
QRS complex
Spread of a stimulus through the ventricles
Aka depolarize
ST segment and T wave
Return of stimulated ventricular muscle to a resting state
Repolarization of ventricle
U wave
Small deflection after T wave related to repolarization of purkinje fibers
QT interval
Time elapsed from the onset of ventricular depolarization until the completion of ventricular repolarization
What is hidden within the QRS complex
Atrial repolarization
Changes in heart at birth
- Ductus arteriosus and interatrial foramen ovale close
- Right ventricle assumes pulmonary circulation
- Left ventricle assumes systemic circulation
Positioning of heart in children
More horizontally and apex is higher
Normal positioning by 7 years
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
Changes in heart rate with elderly
Slows
Changes in stroke volume with elderly
Decreases
Cardiac output change with elderly
Declines 30-40%
Heart wall layer changes with elderly
Endocardium: thickens
Myocardium: less elastic
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
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
Considerations if diagnosed with heart disease
- drug reactions
- potassium depletion
- digitalis toxicity
- ADLs capability
- coping
- orthostatic HoTN
What side should you stand on of the patient to examine the heart
Right
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
Is it an issue is the apical impulse in absent from inspection?
No, unless you ausculate and sound is also faint
What is heave or lift?
If apical impulse is more vigorous than expected
What is a thrill
Fine, palpable, rushing VIBRATION, a PALPABLE MURMUR
Mc to feel at semilunar valves
What is the best way to judge the left ventricle size?
Location of apical impulse better judge than percussion
What direction does RV tend to enlarge?
AP diameter
Ausculate aortic valve
2nd right intercostal space on right eternal boarder
Ausculate pulmonic valve
Second left intercostal space of left sternal boarder
Ausculate eras point
Third left IC on left sternal boarder
Auscultate tricuspid
Fourth L IC on L sternal boarder
Auscultate mitral
5th IC space on midclavicular line
Which is longer—systole or diastole
Diastole
Characteristics of listening with diaphragm
High
Hard pressure
Regurgitation
S1/s2
Characteristics of listening with bell
Low
Light tough
Stenosis
S3/s4
S1 sound and best heard where
Closure of AV valves
@ apex of heart
What is splitting
In s2 usually aortic valve closes first due to higher pressure and hear “d-dump”
When does splitting occur
S2 during semilunar valve closure. Aortic closes first
Where is s2 sound best heard
2nd IC space
Can splitting occur in s1?
Yes, but tricuspid closes so quietly that probably cannot hear it
Gallops
If you can hear s1-s4 sounds
Mitral snaps
Mitral valve opens loudly due to thicker valve leaflets
Ejection clicks
Aortic/pulmonic valves open loudly
Due to dilated aorta or pulmonary artery
What are the two things that you can hear noises when valves open
Mitral snaps and ejection clicks
Mnemonic to remember diastole and systole heart murmurs
ARMS and PRTS
Irregular rhythm of heart in a repeated pattern may be indicative of what
Sinus dysrhythmia-a cyclic variation of the heart rate
Patternless, unpredictable, irregular rhythm may indicate what
Heart disease
Conduction system impairment such as A-fib
What may the liver be like in infant with heart function issues
Harder and lower. 5-6cm below rib cage
What are good things to identify quality of heart in infant
Vigor and quality
When are murmurs common in infants
First 48 hours
What may you see in children with long standing heart conditions
Bulging precordium
Are heart rates more variable in children or adults
Children
With an increase of one degree heart rate of a child increases how much
10-20 bpm
Murmurs in infants and children are result of what usually?
Congenital heart disease
What accounts for most acquired murmurs in children
Kawasaki disease
Changes in apical impulse in pregnant women
Shifts up and laterally 1-1.5cm
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
What heart sound is more common to hear in older adults and what may it indicate
S4
Decreased left ventricular compliance
Mc cause of angina
Coronary artery disease
Stable angina
Predicable
On exertion
Disappears with rest/medication
Unstable angina
Occurs at rest
Unexpected
May not disappear with rest
Due to plaques or clots and narrowed arteries
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
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
Who are most at risk for bacterial endocarditis
Congenital/acquired heart defects
Previous history
IC drug users
Poor dental health
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