Cardiovascular assessment Flashcards
Whats included in cardiovascular system?
- Blood, blood vessels and heart (low pressure on right (to lungs) and high on left(to body))
Where is the heart located?
The thoaratic cavity – in area called precordium
Base is around 2nd intercostal and apex on the 5th intercostal space
What is the pathway of blood around the heart?
- Veins (valves, elastic walls (calf muscle pump), thoracic pump (negative vs positive pressures)
- Vena cava
- Right atrium
- Atrioventricular valve (tricuspid)
- Right ventricle
- Semi-lunar valve
- Pulmonary artery (left and right)
- Lungs
- Pulmonary vein (4 times)
- Left atrium (very thick walls)
- Atrioventricular valve (mitral)
- Left ventricle (very thick walls)
- Aorta
What are the three layers of the heart muscle?
Tough – pericardium and myocardium is muscular (containing cardiac myocytes cells of heart)
Explain the cardiac conduction system
- SA node (sinoatrial) – in right atrium – the natural pacemaker cell (P wave)
- AV node (atrioventricular node) – slows and facilitates conduction down to bundle of his (hispurkyne system)
- Moves frown to purkyne fibres (ventricular depolarisation) – muscular contraction occurs (QRS)
What is Pulseless electrical activity?
PPA No mechanics occurring but there’s still electrical impulses that can be seen on ECG.
What are the two sections of the cardiac cycle?
Diastole – relaxation (rapid filling, slow filling then presystole) – lub
Systole – contracting (isometric contraction then ejecting of blood) - dub
Atrium and ventricle doing opposite to the other one.
What are coronary arteries?
Heart blood supply from the aorta – to oxidate the myocardium muscle layer.
Left and Right (nodal arteries) – can be blocked and so stop oxygenating.
What would you inspect during a cardiovascular system assessment?
- Inspection – general demeanour (restless, confused, pain, posture, anxiety, chest pain and sweating)
- Inspection – sputum and cough – haemoptysis (blood coughing) – frothy/coloured
- Inspection – cardiac distress – shortness of breath, wheeze, severe chest pain, radiation, fear of im pain ding doom
- Inspection – colour – cyanosis or pallor
- Inspection – dysmorphic features (misshapen face? Like down syndrome), peripheral oedema and leg/calf pain
What would you look at in the hands and arms of a cardiovascular assessment?
- Hands and arms – inspection (peripheral cyanosis (capillary refill), clubbing or splinter haemorrhages(bruise looking section on nail – sign of an infection in the heart)
- Hands and arms – palpation – temperature, moisture/sweating, capillary refill test – pulse (rate, rhythm, volume)
What would you look for in the face and neck of a cardiovascular assessment?
- Face and neck – inspection – conjunctiva (eye lid should be red if white could be anemic), xanthalasmata(lipid deposit around the eye), corneal arch’s (lipid causing a white ring around the eye), mouth – mucosa, dentition, colour
- Face and neck – palpation – carotid pulse
What precordium inspection would you look for in a cardiovascular assessment?
- shape (chest abnormalities) – scars – sternotomy, thoracotomy or pacemaker/devices
- Check pain/tenderness on chest – palpation
When asculatating what would you look for in a cardiovascular assessment?
- normal lub dub regular (2nd or 5th (mitral area for apex) 2. if louder around edge then enlarged heart cardio 3. hypertrophy due to enlargement of heart or blood vessels (can also listen to pulmonary oedema to fluid in the liquid can sound like crackling)
WHat would you focus your history on during a suspected cardiovascular problem?
- OLDCART – presenting complaint
- PMH, drugs and allergies
- Access specific risk factors – Hypertension (BP), high cholestrol, genetics and family history, smoking, diabetes, obesity, age, chest pain, breathlessness, sweating, age (over 50), exercise tolerance/fatigue and palpitations
What does the heart sounds (lub dub) signify?
S1 – Lub – mitral and tricuspid valve closing
S2 – Dub – closer of aortic and pulmonary valves together
If listening from the apex LUB should be loader however if lobstering from base of heart then DUP should be loader.
What is cardiovascular disease?
- Cardiovascular disease (chronic disease effecting all blood vessels) – umbrella term for lots of cardiovascular diseases
- Atherosclerosis (plaque forming) and arteriosclerosis (hardening)
Whats the difference between atherosclerosis and arteriosclerosis?
Atherosclerosis (plaque forming) and arteriosclerosis (hardening)
What is the pathophysiology of cardiovascular or inflammatory diseasE?
The chronic disease effecting all blood vessels.
Can be atherosclerosis (plaque form) or arteriosclerosis (hardening)
- Cholestrol assimilates in tunica intimate builds up and oxidises
- Trigger immune and monocytes accumulate
- Damage to endothelium increases membrane permeability and monocytes sent to engulf cholesterol and form foam cells
- Release cytokines and develop fatty plaque
- Smooth muscle cells migrate and ca[ cover play to harden artery
- If ruptures cause thrombogenic material and blood cloy and can block artery
Define myocardial infarction
- Heart attack
- Myocardial cell death due to prolonged myocardial ischaemic (cut of oxygen to kill cells)
- Death endothelium lining cause irritants/injury
Why does the zone of ischaemic infaraction matter?
- Effects are potentially reversible
- If perfusion is restarted quickly then cells can still be viable
What is angiogenesis?
Heart cells regenerating themselves.
Not show ischamias until a person is older
What are some consequences of coronary thrombosis?
Small - No ECG change - heal and plaque enlargement
Partial occlusive thrombus - ST segment depression and inversion of T wave on ECG - cause unstable angina or NSTEMI (multiple plaques use CABBAGE not stents)
Occlusive thrombus - ST elevation - causing STEMI
What are some tests you can use to investigate cardiovascular problems?
- Cardiac monitoring
- 12 lead ECG
- Chest X-ray
- Blood tests – full blood count, glucose, clotting factor
- Cardiac specific markers
- exercise testing
- Implantable loop recorder
- Cardiac MRI
