Cardio (Complete) Flashcards
Mediastinum Structure
Heart
Great vessels
Types of Great Vessels
-Aorta
-Pulmonary artery
-Superior vena cava
-Inferior vena cava
Where is Point of maximal impulse (which ventricle)
Left ventricle
Pericardium: Layers of the heart
Endocardium
Myocardium
Epicardium
Heart Valves _____
Unidirectional
Prevents backflow
Open and close passively
Atrioventricular valves (AV) Types and Location
Tricuspid Valve- Between the right atrium and the right ventricle of the heart
Mitral valve- Between the left atrium and the left ventricle of the heart
Semilunar Valves (SL) Types and location
Aortic- between the left ventricle and the aorta
Pulmonic valve- between right ventricle and the pulmonary artery
What happens during…Diastole (AV)
valves are open, filling phase-ventricles fill with
blood
What happens during..Systole (AV)
valves are closed, pumping phase-prevents blood
from backing into the aorta (regurgitation)
What happens during…Systole (SL)
valves are open, pumping phase-blood is ejected from
the heart
What happens during…Diastole (SL)
valves are closed, ventricles are relaxed, pressure
inside drops, preventing blood from flowing back into the heart
No valves are present between vena cava and right atrium, or
between pulmonary veins and left atrium which means…..(physiology)
-Abnormally high pressure in left side of heart gives a person symptoms of pulmonary congestion.
-Abnormally high pressure in right side of heart shows in neck veins and abdomen.
Deoxygenated Blood flow- Where does it enter from?
Enters the heart through the superior vena cava from the
upper body and the inferior vena cava from the lower body
Deoxygenated blood flow- First chamber of the heart
R atrium
Deoxygenated blood- First valve
Tricuspid valve: opens, blood flows from right atrium to the right ventricle
Deoxygenated blood- Second chamber of heart
R ventricle -contracts and pumps the blood to the lungs
Deoxygenated blood- second valve
Pulmonary valve- opens, blood flows from the right
ventricle to the pulmonary artery
Blood becoming oxygenated…
First artery
Pulmonary artery- Pulmonary artery carries the deoxygenated blood to the
lungs
Oxygenated blood flow- Returns to the heart through the ______ veins
Pulmonary veins
Blood goes through the pulmonary veins and
enters the _____
Left atrium
oxygenated blood flows from the left atrium
into the _____
Left Ventricle
Left ventricle: pumps the oxygenated blood to the ____
Aorta
What is the cardiac cycle?
movement of blood through the heart
Two phases of the cardiac cycle: Systole (what is happening physiologically)
Systole
Contraction of the heart
Blood is pumped from the ventricles and fills the pulmonary
and systemic arteries.
Represents one third of the cardiac cycle
…..Ventricular pressure becomes higher than that in atria
Mitral and tricuspid valves close
Closure of AV valves contributes to first heart sound (S1)
and signals beginning of systole
AV valves close to prevent any regurgitation of blood back
up into atria during contraction
Brief moment, all four valves are closed and ventricular
walls contract
Contraction against closed systembuilds pressure in the
ventricles
pressure in ventricles exceeds pressure in the aorta
Two phases of the cardiac cycle: Diastole (what is happening physiologically)
Ventricles relax and fill with blood
Represents two-thirds of the cardiac cycle
Ventricles relaxed
Tricuspid and mitral valves are open
Pressure in atria higher than that in ventricles, so
blood pours rapidly into ventricles
Toward end of diastole, atria contract and push last
amount of blood into ventricles
Types of heart sounds (basic overview)
normal
heart sounds and,
occasionally, extra heart
sounds and murmurs
S1 heart sound
Occurs when AV valves close
(beginning of systole)
Can hear S1 over all
precordium, but loudest at
apex
S2 heart sounds
Occurs when semilunar
valves close
Signals end of systole
Heard over all of precordium,
S2 loudest at base
S3
S3 occurs when ventricles resistant to filling during early rapid filling phase
Normally diastole is silent event
Occurs immediately after
S2, when AV valves open and atrial blood first pours into ventricles
However, in some conditions, ventricular filling creates vibrations that can
be heard over chest
S4
S4 Occurs at end of diastole, when ventricle resistant to filling
Atria contract and push blood into noncompliant ventricle
This creates vibrations that are heard as S4
S4 occurs just before S1
Stenotic murmer
Valve opening progressively decreases in size
Forward flow of blood is restricted
Affected chamber becomes hypertrophied
Valvular heart disease
Result of turbulent blood flow
Gentle, blowing, whooshing or swishing sound heard
Causes a specific murmur, either systolic or diastolic
Heart Murmurs (forward and backwards)
FORWARD flow of blood through stiff stenotic
OPEN valves
BACKWARD flow of blood through incompetently
CLOSED valves
Regurgitation murmer
Insufficiency or incompetent
Valve does not completely close
Backflow into chamber, causing overload and dilated chamber
Heart murmur locations
Aortic Area: Right 2nd ICS
Pulmonic Area: Left 2nd ICS
Erb’s point 3rd Left ICS
Tricuspid Area: 4-5th ICS Left Sternal Border
Mitral Area: 5th ICS MCL
How are heart sounds described?
Timing: systolic or diastolic
Duration: short or long
Location: where is it the loudest, radiates
Position patient: left lateral decubitus or sitting up
Shape: crescendo, decrescendo, or holosystolic
Grading and Intensity
Pitch (low, medium, or high)
Quality: blowing, harsh, rumbling, or musical
Properties of Cardiac cells
Automaticity: the ability to initiate an impulse spontaneously and continuously.
Excitability: the ability to be electrically stimulated.
Conductivity: the ability to transmit an impulse along a membrane in an orderly manner.
Contractility: the ability to respond mechanically to an impulse.
Cardiac output (how much?) (Equation?)
4-6 liters
HR X stroke volume
Stroke volume (output and definition)
(50 – 100 mL)
Volume of blood ejected with each heartbeat, and it is
Dependent on preload, myocardial contractility, and
afterload.
Preload
Volume of blood in the ventricles at the end of diastole
Stretching of the cardiac cells prior to contraction
Preload is venous return, which builds during diastole
How well ventricular muscle can stretch at end of diastole
According to Frank-Starling law, the greater the stretch, the stronger the heart’s
contraction
This increased contractility results in an increased volume of blood ejected,
increased stroke volume
Ejections fraction (percentage and definition)
50-70%
Percentage of blood ejected during each heartbeat
Mayocardial contractibility
Ability of the heart to contract
Maximum force of contraction a heart can achieve.
Afterload
Force against which the heart has to contract to eject the
blood.
Degree of vascular resistance which the left ventricle must
pump (contraction)
Afterload is the opposing pressure that the ventricle must generate to open aortic valve
Afterload is the resistance against which ventricle must pump its blood
After aortic valve opens, rapid ejection occurs
Developmental Considerations:
Infants and Children
Fetal heart begins to beat after 3 weeks’ gestation
Right and left ventricles equal in weight and muscle wall thickness
and both pumping into systemic circulation
Inflation and aeration of lungs at birth produces circulatory changes
Now blood is oxygenated through lungs rather than through placenta
Now left ventricle has greater workload of pumping into systemic
circulation
Heart rates for children at rest
Age (Yrs.) Avg. Rate Range
1-2 110-120 88-155
2-6 100-110 65-140
6-10 75-90 52-130
Developmental Considerations:
Pregnancy
Blood volume increases by 30% to 40% during pregnancy
Most rapid expansion occurs during second trimester
Creates an increase in stroke volume and cardiac output and an increased pulse rate of 10 to 15 beats per minute
Despite increased cardiac output, arterial blood pressure decreases in pregnancy as a result of peripheral vasodilation
Blood pressure drops to lowest point during second trimester, then rises after that
Blood pressure varies with person’s position
Developmental Considerations:
Aging Adult (12 points)
Lifestyle: diet, exercise, alcohol, smoking, drug use, and stress have an influence on coronary artery disease
Lifestyle affects the aging process; cardiac changes once thought to be due to aging due to sedentary lifestyle accompanying aging
Systolic BP increases: thickening and stiffening of the arteries
Diastolic BP: decreases or no change
Left ventricular wall becomes thicker, usually the size of the heart does not change
No change in resting heart rate or cardiac output at rest
Decreased ability of heart to adjust cardiac output with exercise
Amount of collagen in the heart increases and elastin decreases.
Changes affect the contractile and distensible properties of the myocardium
Heart valves become thick and stiff
Increased need for pacemakers
SA node fails
Risk of orthostatic hypotension
Increase incidence of CAD, HTN, and HF
Cardiad assessment: Inspection
General appearance and vital signs
Skin color, temperature
Edema
Diaphoresis
Blood pressure: normal range
Extremities: perfusion
Pulses: brisk and easily palpable
JVP: normal range
Lower extremities for edema
Palpation: Carotid Artery
Carotid artery is a central artery
Palpate the carotid pulse, including the carotid upstroke, its amplitude and contour, and the presence or absence of thrills.
Close to heart; timing closely coincides with ventricular systole (beginning of S1)
Located in groove between trachea and sternomastoid muscle, medial to and along-side
that muscle
Carotid artery provides information about cardiac function
Aortic valve stenosis and regurgitation.
Palpate each medial to sternomastoid muscle
Palpate for carotid upstroke, amplitude and contour, and the presence or absence of thrills.
Height of pulsations unchanged by position
Height of pulsations not affected by inspiration
Avoid excessive pressure
Patient should be supine with the head of the bed elevated to about 30°.
Inspect the neck for carotid pulsations
Often visible just medial to the sternomastoid muscle
Jugular Vein Pressure (physiology)
Reflects the right side of the heart
Assess filling pressure and volume status
Volume and pressure increases when right side of heart fails to pump efficiently
JVP gives information about the right side of the heart because no cardiac valve exists to separate superior vena cava from right atrium
Empties unoxygenated blood directly into superior vena cava
Two jugular veins present on each side of neck.
Internal and external
JVP (how to assess)
Position head of the bed 30°, or when you see pulsations
Turn the patient’s head lightly to the left, then the right, and identify the external jugular vein on each side.
Focus on the internal jugular venous pulsations on the right, transmitted from deep in the neck to the overlying soft tissues.
Inspect for pulsations of internal jugular veins in area of suprasternal notch or around origin of sternomastoid muscle around clavicle.
Distinguish internal jugular vein pulsation from that of carotid artery
JVP Abnormal
JVP: >3 cm above the sternal angle, or more than 8 cm in total distance above the right atrium, is considered elevated above normal
An elevated JVP correlates with both acute and chronic heart failure.
Elevated JVP: tricuspid stenosis, chronic pulmonary hypertension, superior vena cava obstruction, cardiac tamponade, and constrictive pericarditis
Ascultation (Heart sounds)
Patient supine
Follow a “Z” pattern
Begin with diaphragm of stethoscope
Use bell of stethoscope for bruits
Identify S1 and S2
Determine if there are abnormal heart sounds
S3 or S4
Are the sounds regular or irregular
Assess for a pulse deficit
Apical and radial pulse rates should match
Palpation (Apical pulse)
Palpable in about half of adults
Not palpable in obese or people with thick chest walls
High cardiac output states
Apical impulse increase in amplitude and duration
Anxiety, fever, hyperthyroidism, anemia
Displaced to the left in heart failure
Auscultation (carotid cartery)
Use the bell of stethoscope
Better for higher grade stenosis
Have client take a breath, exhale,
and hold it briefly for < 10 seconds
while you listen
Listening for Bruits
Place the bell of stethoscope near
upper end of thyroid cartilage,
below the angle of the jaw
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