cardiovascular Flashcards
heart chambers
⬤ Four chambers separated by valves, whose
main purpose is to prevent backflow of blood
⮚ Valves are unidirectional
⮚ Valves open and close passively in response to pressure gradients in moving blood
heart valves
⬤ Four valves in heart:
⮚ Two atrioventricular (AV) valves, tricuspid and bicuspid (mitral)
⮚ Two semilunar (SL) valves, pulmonary and aortic
AV valves
⬤ Two AV valves separate atria and ventricles:
⮚ Tricuspid valve: right AV valve
⮚ Bicuspid, or mitral valve: left AV valve
* Valves’ thin leaflets are anchored by collagenous fibers (chordae tendineae) to papillary muscles embedded in ventricle floor
⮚ AV valves open during heart’s filling phase, or diastole, to allow ventricles to fill with blood
⮚ During pumping phase, or systole, AV valves close to prevent regurgitation of blood back up into atria
semilunar valves (exam)
⬤ SL valves are set between ventricles and arteries
⮚ Each valve has three cusps that look like half moons
⮚ Pulmonic valve: SL valve in right side of heart, at the bottom
⮚ Aortic valve: SL valve in left side of heart, at the bottom of the heart
* Open during pumping, or systole, to allow blood to be ejected from heart
⮚ No valves are present between vena cava and right atrium, or between pulmonary veins and left atrium:
* 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
blood flow throughout the heart
Blood flows through the heart in the following route: from the vena cava into the right atrium, then through the tricuspid valve to the right ventricle, through the pulmonary valve to the pulmonary artery, to the lungs for oxygenation, back to the heart via the pulmonary veins into the left atrium, through the mitral valve to the left ventricle, and finally through the aortic valve into the aorta, which carries it to the body
heart sounds - the first heart sound (S1)
⬤ First heart sound (S1) -> lub
⮚ Occurs with closure of AV valves—signals beginning of systole
⮚ Mitral component of first sound (M1) slightly precedes tricuspid component (T1)
heart sounds - the second heart sound (S2)
⬤ Second heart sound (S2) -> dub
⮚ Occurs with closure of semilunar valves—signals end of systole
⮚ Aortic component of second sound (A2) slightly precedes pulmonic component (P2)
* S2 loudest at base
extra heart sounds
⬤ Third heart sound (S3)
⮚ Occurs when ventricles resistant to filling during early rapid filling phase (protodiastole)
⮚ Occurs immediately after S2, when AV valves open and atrial blood first pours into ventricles
⬤ Fourth heart sound (S4)
⮚ Occurs at end of diastole, at presystole, when ventricle resistant to filling
⮚ S4 occurs just before S1
murmurs
⬤ Gentle, blowing, swooshing sound that can be heard on chest wall
⬤ Conditions that create turbulent blood flow and collision currents
some common conditions that can result in murmurs
velocity of blood increases
viscosity of blood decreases
structural defects in the valves
conduction of the heart (exam)
⬤ Heart has unique ability: automaticity
⮚ Can contract by itself, independent of any signals or stimulation from body
⮚ Contracts in response to an electrical current conveyed by a conduction system
⮚ Specialized cells in sinoatrial (SA) node, near superior vena cava initiate an electric impulse
⮚ Because SA node has intrinsic rhythm, it is called the pacemaker
what is an ECG
An electrocardiogram (ECG), also known as an EKG, is a medical test that records the electrical activity of the heart. It helps to assess the heart’s rhythm, rate, and electrical conduction pathways
neck vessels
⬤ The Carotid Artery Pulse
⬤ Jugular Venous Pulse and Pressure
⮚ Two jugular veins present on each side of neck -> internal & external jugular
⮚ Empty unoxygenated blood directly into superior vena cava
⮚ Reflect activity/function of right side of heart
developmental competence in pregnant women
⬤ Pregnant woman
⮚ Blood volume increases by 30% to 40% during pregnancy
⮚ Increase in SV, HR & red cell mass
⮚ Despite increased cardiac output, arterial blood pressure decreases in pregnancy as a result of peripheral vasodilation (exam)
developmental competence in infants and children
⬤ Infants and children
⮚ Fetal heart begins to beat after 3 weeks’ gestation
⮚ Lungs nonfunctional 🡪 fetal circulation compensation
⮚ Inflation and aeration of lungs at birth produces circulatory changes
developmental competence in the aging adult
⬤ Aging adult
⮚ Closely interrelated with lifestyle, habits, and diseases
⮚ Lifestyle, smoking, diet, alcohol use, exercise patterns, and stress have
an influence on coronary artery disease
hemodynamic changes with aging -> pressure/pulse changes
⮚ Isolated systolic HTN: Increase in systolic BP due to thickening and stiffening of the arteries
⮚ Pulse pressure increases
* Difference between systolic and diastolic BP
* Reflects cardiovascular health
⮚ No change in resting heart rate or cardiac output at rest
⮚ Ability of heart to augment cardiac output with exercise is decreased
hemodynamic changes with aging - dysrhythmias
⮚ Presence of supraventricular and ventricular dysrhythmia increases with age
⮚ Ectopic beats common in aging people; usually asymptomatic in healthy older people, may compromise cardiac output and blood pressure when disease present
⮚ Tachyarrhythmias may not be tolerated as well in older people
hemodynamic changes with aging - electrocardiogram
⮚ Occur as result of histologic changes in conduction system; these changes include:
* Prolonged P-R interval (first-degree AV block) and prolonged Q-T interval,
but the QRS interval is unchanged
* Left axis deviation from age-related mild LV hypertrophy and fibrosis in left bundle branch
* Increased incidence of bundle branch block
genetics and the environment - what is the #1 cause of death (exam)
cardiovascular disease, it is a complex interplay between genetics and lifestyle factors
- is an umbrella for multiple other diagnoses
genetics and the environment - cardiovascular and health issues
⮚ Hypertension (HTN) 🡪🡪 ethnicity🡪🡪 accelerates process of
atherosclerosis
⮚ Smoking & Tobacco Use🡪🡪 impacts oxygenation
⮚ Elevated Cholesterol 🡪🡪 LDL adds to plaque formation
⮚ Type 2 Diabetes🡪🡪 need for glycemic control
⮚ Nutrition & Diet 🡪🡪 healthy choices & limit processed/refined foods
⮚ Exercise & Physical Activity🡪🡪 beneficial
⮚ Overweight & Obesity 🡪🡪 caloric restriction & counseling
⮚ Sex & Gender Differences in CVD
chest pain questions
Any chest pain or tightness? Ask about
onset and location
characteristics
precipitating events
associated symptoms
relieved by or made worse by
pain relieved by rest or medication
dyspnea questions
Any shortness of breath? Ask about
type of activity and occurrence
onset and duration
effect of positional changes and interruption of sleep
presence of orthopnea
affect ADLs
questions to ask about a cough
⮚ duration and frequency
⮚ characteristics of type and productive versus non-productive
⮚ effect of positional change
⮚ affect ADLS
⮚ alleviating factors or precipitating factors
⮚ medications or treatments