Cardiovascular Flashcards
Where does the heart sit in the chest?
2nd to 5th ICS, from the rt. sternal boarder to left midclavicular line
precordium vs pericardium
precordium: the region or the thorax immediately in front of the heart.
pericardium: fibrous sac surrounding the heart
AV valves/ SL valves: what do they seperate
right and left
AV: seperate the atria and ventricles right: tricuspid left: mitral SL: seperate ventricles and the great vessels right: pulmonic left: aortic
There are no valuves between pulmonary veins and the LA. As a result what can left sided heart failure lead to
There are no valuves between the vena cava and the RA. As a result what can right sided heart failure lead to
left: blood backs up into the pulmonary system and the lungs
right: blood backed up into the systemic system
Systole venticular contraction
1/3 of the cardiac cycle
- SL valves open so ventrilces can eject blood into the great vessels (systemic/ pulmonary)
- AV valves close to prevent back flow into the ateria, creates a “LUB” sound= S1
Diasotle ventricular relaxation
2/3 of the cardiac cycle
- AV valves open to allow for ventricular filling
- SL valves close so ventrilces so blood does not pass into the great vessels (systemic/ pulmonary), creates a “DUB” sound= S2
Palpation and auscultation of the carotid arteries
what are you feeling for?
wghat are you listening for?
strength (0-3+) and presence of a thrill (vibration)= turbulant blood flow
Use bell, presence of bruits= atherosclerosis= stinosis= increased risk of CVA
Jugular Vein Assessment APPI position abnormal normal
- Inspection only because you cannot palpate veins well
- pt. supine w/o pillow, using pen light
- Semi-fowler’s (45degree), If visable then + for JVD:
- bilateral= Rt sided HF, unilateral= local kinking or aneurysm
- Normal= cannot see
Inspection and palpation of the Precordium
Inspect for pulsations (lifts and heaves), apical impulse (PMI) at the 5th ICS, just medial to MCL
Palpate PMI: have pt. exhale then hold breath, can have pt. lean forward or roll to the left.
Thrill should be absent
FVO
fluid volume overload
Auscultation
Pt. with HF
S1/S2
use the diaphrgam listen for rate and rhythm
Listen at the apex for those with HF, DO NOT use the radial pulse
S1 is louder at the apex (b/c AV valves are closing)
S2 is louder at the base (b/c SL valves are closing)
APETM "LUB": Aortic: 2nd ICS Rt sternal border Pulmonic: 2nd ICS Lft " " "DUB": Erb's Point: 3rd ICS Left sternal border Tricuspid: 4th ICS " " " Mitral: 5th ICS Lft MCL (apex)
Follow up with the bell to hear and extra heart sounds.
Have pt. lay on their Lft side to listen for S3 and S4 at teh apex
S3:
what it is/ when it occures
patho
phys
S4:
what it is/ when it occures
patho
phys
Using the bell, at the apex, vibrations within left ventrical filling
S3= ventrical gallop, early diastolic sound (right after DUB), assoc. with rapid filling (splashing) in an overaly compliant LV
Pathologic: systolic HF
Physiologic: children, athletic adults <35 yo, during pregnancy
S4= atrial gallop, late diastolic sound (right before LUB), assoc. with fluid kickback in a hypertorphied LV.
Pathologic: diastolic dysfunction (poorly compliant LV when filling)
Physiologic: older adults after exercise
Murmurs:
functional
innocent
patho
what to document
functional: caused by increased SV and CO (fever, pregnancy, hyperthyroidism)
innocent: heard when there is no patho cause
patho: murmur due to valvular disease (regurg/ stinosis)
what to document: timing- systole (poss. normal), diastole (patho) location- APETM quality- musical, blowing, rumbeling pitch- high, med, low pattern- crescendo/ decrescendo loudness- 1-6 scale posture: enhanced or diminished with change in position
crescendo
decrescendo
crescendo—decrescendo murmurs
Crescendo murmurs progressively increase in intensity.
Decrescendo murmurs progressively decrease in intensity.
With crescendo—decrescendo murmurs, a progressive increase in intensity is followed by a progressive decrease in intensity.
Splitting
normal
abnormal
heard with diaphragm
normal if occures only during inspiration ONLY due to delayed tricuspid (S1, at apex, end of diastole)/ pulmonic (S2, at base, early diastole) closure
Abnormal if split is wide, paradoxical or fixed
Inspection and palpation of outter extremities
symm, edema, tenderness, temp, clubbing, cap refill, lymph nodes
palpate: brachial, radial, ulnar
pulse deficit: apical - radial (if ,1 = poss. HF)
Modified Allan Test: Pressure is applied over the ulnar and the radial arteries so as to occlude both of them. The hand is elevated and the patient is asked to clench their fist for about 30 seconds until had is white. Still elevated, the ulnar artery is released hand should turn pink.
Inspection and palpation of lower extremities
Ankle- brachial Index:
symm, edema (asymmetry >1cm= poss. DVT), tenderness, temp, hair distribution, cap refill, varicose veins, color changes (elevation pallor- 12 in off table, delayed venous filling- >15 sec= artial blockage)
Palpate pulses: strength and symmetry- femoral, popliteal, posterior tibialis, dorsalis pedis (weak femoral? ausculate for bruits)
Pitting edema
Ankle- brachial Index: ankel/ brachial SPB (<0.9 = PAD)
6 P’s
CMS
assessment for profusion circulation motor sensory (PAD)
Paralysis
Pain
Pallor
Paresthesis (pins and needles, burning)
Pulselessness
Poikilothermia (the inability to regulate core body temperature (unable to regulate body temp by sweating to cool off or by putting on clothes to warm up)
Developmental Comp: infants HR bardycardia auscultation location of apex
HR 100- 180bpm
bardycardia <90bpm
Listen at the apex
apex at the 4th ICS until age 7
Developmental Comp: older adult (6)
- arteriosclerosis leading to increased risk of PAD and then increase in SBP(= wider PP). (arterio causes SBP to increase faster than DBP)
- increaded thinkness of LV wall (can cause S4 with activity)
- decreased ability to augment CO with exercise= decrease max HR
- increase dysrhythmias
- increased risk of DVT
- fewer lymph nodes (they atrophy over time)
Developmental Comp: pregnancy (4)
- blood volume increases by 30-40% (can cause S3)
- increase SV and HR (thus increase increase CO)
- peripheral vasodialation leading to decreased BP
-Growing uterus obstructs drainage of iliac veins and IVC causing an increase venous pressure leading to varicose vains and hemorrhids, dependent edema (pooing at lowest gravitational point)
Causes of CVD:
“the silent killer” (very few symptoms)
- HTN
- Smoking
- LDL
- Obesity
- DM
Heart Failure:
what it is
left vs right
FACES
-occures when either ventricle fails to pump blood efficiently
-Left=Lungs
PE, orthopnea, hypoxic, confusion
-Right= Rest of body
COPD, DJV, dependent edema, acities
FACES: Fatigue, limitation of Activites, Cough Chest congestion, Edema (bilateral), SOB
AHF
what it is
s/s
Acute Heart Failure
- Fluid volume overload (FVO), not vascular
- Crackles/ wheeze heard over lungs, decreased BP, n/v (fulid backup into the stomach), acities, pitting edema, faling O2 sat, JVD, S3 gallop, angina
HTN
BP range for Pre and True
what can it lead to (6)
PreHTN: 120/80 - 139/89
HTN: >140/90 (measured on 2 seperate occasinos
-Can lead to: MI, HF, CVA, Kidney disease, PAD, retinopathy
Angina Pectoris:
cardinal sign of CAD
s/s stable
s/s unstable
- Cardinal sign: heavy chest, radiating chest pain (CP) due to ischemia of myocardium. BUT CP can also be pulmonary, GI, or musculoskeletal in origin!!
- Stable: CP <15min, with exertion, relieved with rest
- Unstable: intense CP w/o relief from rest; can lead to MI (go to ER ASAP)
Valvular Heart Disease:
what is it
cause
s/s (aortic/ mitral, pulmonic, tricuspid)
- One or more of the heart valves do not open (stenosis) or close (regurgitation) completely and this prevents efficient blood flow through the heart
- Causes: congenital, rheumatic fever, endocarditis, IV drug use
- S/s: depends on valve site
1) Aortic and mitral valve: issues are on the left, S/S more consistent with L sided HF. Low stroke volume: poor blood flow to body (narrow pulse pressure, weak pulses). Blood will back up into lungs causing pulmonary congestion
3) Pulmonic and tricuspid valve issues are on the right, so S/S more consistent with R sided HF. Blood flow to lungs will be impaired and blood will back up into systemic circulation (weight gain, peripheral edema, JVD, ascites..) and
May hear “clicking” if Hx of prosthetic valve
Pericarditis:
what is it
s/s
-Inflammation of parietal and visceral layers of pericardium.
-s/s: Pericardial friction rub (S1 and S2) develops as inflamed layers of pericardium move against each other; best heard with patient leaning forward.
Pain described as sharp, stabbing, knife-like chest pain aggravated by deep breathing, lying supine, or coughing
DVT
cause
s/s
caused by: immobility, varicose veins, infection, obesity, immobility, trauma, HRT, hormone replacement therapy
-s/s: usually asymptomatic! Unilateral Edema; increased calf circ >1cm
Erythema- superficial reddening of the skin, usually in patches
Pain, Pulmonary Embolism (PE), Dyspnea, CP, tachycardia, hypoxia, cardiac arrest
(+) Homan’s sign (increased pain with dorsiflexion)
Lymphedema
cause
s/s
- Cause: Often a result of lymph node removal due to cancer
- s/s: Lymph builds up in interstitial spaces, causes hard, lumpy, non-pitting edema
*do not take BP in effected arm, or place IV from swollen limb
PVD
what it is
cause
s/s
Peripheral Venous Disease= pooling of blood
- dilated veins
- caused by: age, pregnancy, obesity, immobility, genetics
-s/s: heavy aching pain at the end of day; helped by elevating and walking, edema, varicose veins, brownish discoloration, wet ulcers
PAD
what it is
cause
s/s
Peripheral Artery Disease= decreased blood flow
- partial obstruction of a peripheral artery
- cause: athero, age, DM, hyperlipidemia
-s/s: sharp crampy pain caused by activity (claudication), helped by dangling legs (decreased elevation).
6Ps, ABI <0.9, elevational pallor w/ delayed venous filling, dependent rubor, dry ulcers
PVD vs PAD
PVD/ PAD: immobility/ athero wet/ dry ulcers pain without/ with elevation onset end of day/ claudication pain achy/ crampy
Compression socks are only good for veinous insufficiency!!
ankle-brachial index (ABI) test
a simple way to check how well blood is flowing.
performed by measuring the systolic blood pressure from both brachial arteries and from both the dorsalis pedis arteries
