Cardiovascular Flashcards
What are the 3 layers of the heart? From distal to medial
- epicardium
- Myocardium
- Endocardium
What is the normal heart sound?
lub- dub
What is occurring during S1? S2?
S1 is systole, the ventricles are contracting and S2 is diastole the ventricles are relaxed
Which valves are opening and closing during S1?
during S1 the aortic and pulmonary valves are open and the AV valves ( mitral and tricuspid) are closed
Which valves are opening and closing during S2?
during S2 the AV valves are open and the Semilunar valves are closing
When does systole occur?
S1- S2
When does diastole occur?
S2-S1
What is the sound heard during an atrial gallop? When is it heard?
S4, it occurs before S1
What is the sound heard during a ventricular gallop? When is it heard?
S3, it occurs after S2
Describe S4
an atrial gallop that occurs because of the atrial contraction and ejection of blood int the ventricles in late diastole
Describe S3
when the AV open, blood flows into the ventricles causing vibrations creating the S3 sound during diastole
Johnny says that he considers himself an athlete due to running and constantly training. You are preparing to auscultate his heart, you hear an extra sound. What may this be extra sound? is it normal?
since he as athlete he may have an S4, atrial gallop, which is commonly found in athletes
What type of pts would you expect to hear S3 sounds?
pregnant women in 3rd trimester, and young adults, and younger children
If Sara, Sharon, and Jay say that have valvular diseases what type of heart sounds would you expect to hear?
clicks and snaps
What is the cause of a friction rub?
surface of the parietal and visceral layers of the pericardium cannot slide smoothly and produce the rubbing or grating sound
What is the result of a friction rub?
inflammation of the pericardial sac
What is the definition of a heart murmur?
harsh, bowing sounds caused by disruption of blood flow into the heart
When do the coronary arteries fill?
during diastole
What is the process of the conduction system?
SA Node -> AV Node -> Bundle of his-> R and L bundle branches -> Purkinje fibers
What is the heart’s natural pacemaker?
SA Node
What are the landmarks for the cardiovascular system?
sternum, clavicles, ribs and ICS
What is the purpose of the angle of Louis during a cardiovascular assessment?
the angle of Louis helps identify the 2nd ICS which to the left you hear the aortic and to the right is the aortic sound
Between which ICS spaces you find the heart?
2nd ICS is base the 5th ICS is the apex
What are the 3 phases in the electrical and mechanical Events?
- Period of ventricular filling
- Ventricular Systole
- Isometric Relaxation
Explain what is going on during the Period of Ventricular filling
70% of blood is passively entering the ventricles from the atria. When the SA conducts an electrical current the atria contract filling the 30% of blood into the ventricles
Explain what is going on during Ventricular Systole (S1)
The ventricles are being electrically stimulated causing them to contract. The pressure in the ventricles force the opening of the semilunar valves which then open, which then causes blood to expel from the ventricles
Explain what is occurring during Isometric Relaxation (S2)
the pressure in the aorta and pulmonary artery are more than the ventricles causing the valves to close. Simultaneously, the atria are filling which then have an increased pressure the valves can open, causing the process to repeat
What is the purpose of an ECG?
Electrical representation of the cardiac cycle by deflections
What is indicated by a P wave?
atrial depolarization which is emitted by the SA node causing the atria to contract
What is indicated by the QRS interval?
ventricular depolarization and atrial repolarization
What is indicated by the T wave?
ventricular repolarization
What does the QT interval indicate?
ventricular contraction or systole
What is the normal stroke volume?
55-100 beats/min
What is the difference between preload and afterload?
Preload is influenced by the vol of blood in the ventricles and afterload is the P that ventricles must overcome in order to open the aortic and pulmonic valvular cusps
What 2 structures are present in babies before birth?
foramen ovale and ductus arteriosus
What occurs to the cardiovascular system once a baby takes his/her 1st breath?
the lungs inflate for the first time, so the foramen ovale closes shortly and 6-8 hrs after the ductus arteriosus closes
Where is the apex of the heart in an infant?
4th ICS
How does the heart change in pregnant women?
- heart is displaced to the left and upward
- apex is pushed laterally to the left
- Blood volume, CO, SV increase
- S1 may split causing S3
How does older age affect the heart?
- the heart may stay the same or atrophy
- heart walls may thicken
- loss of ventricular compliance and vascular rigidity
- S4
- conduction system loses automaticity
What are psychosocial factors that cardiovascular?
- stress
- culture
- SES
- diet
- drugs (cocaine)
- ETHOL
What are some medical conditions that can contribute to CVD?
- diabetes
- HTN
- high cholesterol and triglycerides
- thyroid fxn
If a pt is complaining of chest pain, how can you differentiate between chest pain or heart problems?
if it is chest pain the pt points w/ one or 2 fingers and if its the heart like an MI the pt. will use ALL 5 fingers and place them on his/her chest
How do males and females experience MIs?
males have the following Sx: prolonged dull chest pain radiating to the shoulder or jaw accompanied w/ diaphoresis, SOB, and Nausea
females have the following Sx: N/V, indigestion, SOB, extreme fatigue with no chest pain
_______ is one of the key interventions that a pt can control when working to minimize the effects of aging, slowing the progression of disease, or maintaining optimum health while experiencing cardiac disease
diet
_____ is linked to HTN and contributes to injury in the ______ therefore accelerating the development of ______.
Smoking, artery walls, atherosclerotic plaque
What can one benefit from that is contributed to increasing HDLS?
exercise
What type of activities of by a pregnant woman can contribute to her baby having fetal cardiovascular development problems?
smoking, consuming ETHOL, and recreational drugs
Sara is 1 yr old and her dad says she squats a lot, what may this indicate?
the squatting position decreases venous return to the RA from the legs, she may squat when she SOB
What are some Sx of preeclampsia?
HTN. swelling, chest pain, visual changes, and abdominal pain
For an older adult, what is important discharge teaching regarding cardio?
a lot of meds interact with cardiovascular meds, so assess their knowledge about their meds and be clear about food and drug interactions
What type of individual is most at risk for developing a CVD?
a 35 year old female who smokes and takes oral contraceptives
What disease is also known as the silent killer Why?
HTN b/c it is asymptomatic in most individuals
If George has a fever and you are auscultating his chest for heart sounds and you notice a murmur? Are you concerned? Why or why not?
he is experiencing an innocent murmur which is common is individuals with an increase metabolism like fever or anemia
If you are percussing the anterior chest when do you expect to hear dullness?
MCL at the 5th ICS
While inspecting the face, you notice Ashley is looking a red across her nose and cheeks. She claims she is not blushing and has been this color for a while. What test would you run? Why?
CBC because they may indicate polycythemia
Kelly is flushed in the skin and is complaining of sore throat, you take her temp and is 100.3 F. What are you considering when you call the Dr?
rheumatic heart disease
What may it indicate if a pt has grayish undertones?
CAD or in shock
Xanthelasma is an indication of what?
premature atherosclerosis
A degenerative disease of the connective tissue. which over time may cause the ascending aorta to either dilate or dissect leading to abrupt death
Marfan Syndrome
Which congenital heart disease is common with those with Noonan’s syndrome?
pulmonic stenosis
Frank came into the clinic and you noticed during your assessment he is bobbing his head up and down in synchrony with his heartbeat, what do you think is the cause?
aortic regurgitation
Obvious pulsations that are present during both inspiration and expiration and coincide with arterial pulse is commonly seen with what?
sever CHF
Inspecting Ken’s chest you see dilated, distended veins, what may this indicate?
obstruction of the superior vena cava
Bulges are abnormal and may indicate what?
obstructions or aneurysms
Lincoln’s entire chest pulsates and shakes with every heartbeat, what may be the cause?
extreme valvular regurgitation or shunting
Define thrills
soft vibratory sensations best assessed w/ either fingertips or the palm flattened on the chest
Define bruit
a loud blowing sound most associated with narrowing or stricture of the carotid artery
Is it normal to have a bruit?
no may be associated with atherosclerotic plaque
What would indicate a pulse deficit?
an apical pulse > carotid rate
What are the 4 diseases of the myocardium mentioned by the book?
- Myocardial ischemia
- Myocardial Infarction(MI)
- Heart failure (L and R)
- Ventricular hypertrophy
After auscultating Tate’s chest and listening to her apical pulse you notice she is having cardiac dysrhythmias and is tachycardia. She is c/o of chest pain, dizziness after jogging and SOB. You read her chart and is says she is born with a congenital heart disease. What are considering is occurring with Tate?
She may have ventricular hypertrophy
What is the narrowing of the left mitral valve?
mitral stenosis
Shaun is 45 years old and is coughing up decrease O2 sat, frothy sputum, you auscultated his lungs and heard either crackles and his Dr. has rhonchi in the chart. He is c/o of dyspnea and SOB. Why might you be hearing crackles? Possible Dx?
you may hear crackles because left-sided HF causes pulmonary edema due to the backflow of fluids
What are some Si/Sx of right-sided HF and what may the pt c/o of?
Si/Sx: JVD, HTN, liver congestion, peripheral edema
Pt. may complain of fatigue, weakness, mental confusion, loss of appetite and RUQ pain
What is the backflow of blood from the LV into the RA?
Mitral regurgitation
What is the narrowing of the aortic valve?
aortic stenosis
What is Myocardial ischemia?
O2 needs of the heart are not met as it works harder causing ischemia
What is the narrowing of the opening between the pulmonary artery and the RV?
Pulmonic stenosis
Sean is c/o of SOB, Nausea, anxiety, and pain in his chest and neck. He is diaphoretic, pallor, vomiting. Do you check his sugar b/c you think he is hypoglycemic or should you run another test?
I would still check his glucose level to rule out hypoglycemia. If his sugar level is normal, I would get an EKG because it may be cardiac related
If you look at Sean’s EKG and notice an ST segment elevation. You call the Dr and inform her of your findings, what may she say?
due to the ST segment this would indicated possible myocardial ischemia
What is the backflow of blood from the aorta into the LV?
Aortic regurgitation
Tricuspid stenosis
the narrowing or stricture of the tricuspid valve of the heart
Mitral valve prolapse
the mitral valve leaflets so they prolapse into the LA “ballon”
What is the etiology of mitral stenosis?
rheumatic fever or cardiac infxn
What is the etiology of aortic stenosis?
congenital bicuspid valves, rheumatic heart disease or athersclerosis
What is the etiology of mitral regurgitation?
rheumatic fever, MI, rupture of chordae tendineae
What is the etiology of tricuspid stenosis?
rheumatic heart disease, congenital defect, right atrial myxoma (tumor)
What is the etiology of mitral valve prolapse?
unknown but may occur w/ pectus excavatum
What is the etiology of aortic regurgitation
rheumatic heart disease, Marfan’s syndrome, and syphilis
What are 2 types of septal defects?
ventricular and atrial septal defect
When do you hear auscultate ventricular septal defects?
regurgitation occurs resulting in a holosystolic murmur that is loud, coarse, high-pitches and heart at the Left sternal border at the 3rd and 5th ICS
What do you hear when you auscultate an atrial septal defect?
regurgitation occurs resulting in a harsh, loud, high-pitches murmur at the left sternal border at the 2nd ICS
What 4 cardiac defects occur in tetralogy of Fallot?
- pulmonary stenosis
- ventricular septal defect
- the aortic semilunar valve is right above the ventricular septal defect
- RV hypertrophy
Explain patent ductus arteriosus
occurs when the ductus arteriosus fails to close completely between 24-48 hrs after delivery.
Explain coarctation of the aorta
the aorta is severely narrowed in the region inferior to the left of the subclavian artery restricting blood flow from the LV to the aorta causing CHF
Of the congenital heart disease mentioned in the book, which one can be treated not only surgically, but also via pharmacologic therapy?
patent ductus arteriousis
Describe an EKG showing ventricular tachycardia
rapid, 200 beats/ min. (what it looks like when you squiggle lines through a mistake when you write
Describe an EKG showing ventricular fib
total absence of reg heart rhythm
Describe an EKG showing heart block
no P wave
Describe an EKG showing with atrial flutter
3 deflections after QRS complex
Describe an EKG showing A fib
no P, Q, S, or T waves
chaotic
no SA node
