Cardiovascular: Heart and Neck Vessels Flashcards
What is the Precordium?
area on the anterior chest that overlies the heart and great vessels
What is the apical impulse?
where apex beats against chest wall
What is systole?
the first heart sound (lub)
results in closure of tricuspid and mitral valves
What is diastole?
second heart sound (dub)
results in closure of the aortic and pulmonic valves
When does the heart of an infant begin to beat?
end of the 3 week’s gestation
What are some clues to cardiopathology?
height, weight, and feeding patterns
What cardiovascular alterations are seen in the pregnant female?
30-40% increase in blood volume
increase of cardiac output and pulse rate
What is orthostatic hypotension?
Orthostatic hypotension is defined as a decrease in systolic blood pressure of 20 mm Hg or a decrease in diastolic blood pressure of 10 mm Hg within three minutes of standing when compared with blood pressure from the sitting or supine position.
What are ectopic beats?
- Ectopic heartbeats are small changes in a heartbeat that is otherwise normal. These changes lead to extra or skipped heartbeats
What are some congestive heart failure symptoms?
The symptoms of congestive heart failure vary, but can include: fatigue, diminished exercise capacity, shortness of breath, and swelling (edema).
In which ethnic group is heart disease and stroke highest?
African american
White men and women are more likely to be overweight true or false?
true
Which ethnic groups have the highest prevalence of diabetes?
African americans and Mexican americans
For a cardiovascular assessment what are some health assessment topics are discussed to collect subjective data?
Angina Dyspnea With exertion? Heart failure Orthopnea Paroxysmal Nocturnal Dyspnea (PND) Heart failure Cough
What is angina?
- Angina is chest pain or discomfort caused when your heart muscle doesn’t get enough oxygen-rich blood. It may feel like pressure or squeezing in your chest. The discomfort also can occur in your shoulders, arms, neck, jaw, or back. Angina pain may even feel like indigestion. But, angina is not a disease.
What is dyspnea?
difficult or labored breathing
What is orthopnea?
Orthopnea or orthopnoea is shortness of breath (dyspnea) that occurs when lying flat, causing the person to have to sleep propped up in bed or sitting in a chair.
What is paroxysmal nocturnal dyspnea (PND)?
Paroxysmal nocturnal dyspnea or paroxysmal nocturnal dyspnoea (PND) refers to attacks of severe shortness of breath and coughing that generally occur at night. It usually awakens the person from sleep, and may be quite frightening.
What is cyanosis?
Cyanosis refers to bluish discoloration of skin, nail beds and mucous membranes. Normally haemoglobin carries most of the oxygen in blood. This oxygen carrying capacity of haemoglobin in the blood (present in the arteries) is called oxygen saturation.
What is pallor?
an unhealthy pale appearance
What is edema?
Edema is the medical term for swelling. Body parts swell from injury or inflammation. It can affect a small area or the entire body. Medications, infections, pregnancy, and many other medical problems can cause edema.
Edema happens when your small blood vessels become “leaky” and release fluid into nearby tissues. That extra fluid builds up, which makes the tissue swell.
What is nocturia?
Nocturia is a condition in which you wake up during the night because you have to urinate. This condition becomes more common as people age and occurs in both men and women, sometimes for different reasons.
What are some risk factors for cardiovascular disease?
Elevated serum cholesterol Elevated blood pressure Blood sugar levels above 130 Diabetes Mellitus Obesity Smoking Sedentary lifestyle Stress/depression Low socioeconomic status Diet high in saturated fat Family history
Which gender is more at risk for coronary artery disease?
-females
Coronary artery disease leading cause of death in women
1 out of 2.4 due to cardiovascular disease
1 out of 29 breast cancer (women perceive breast cancer as greater risk)
All women should be screened for risk factors
What atypical symtoms are women experiencing when they have heart disease or myocardial infarction?
Angina: hot/cold burning sensation; tender to touch in back shoulders, arms or jaw Often no chest discomfort or pain Nausea vomiting, indigestion, shortness of breath or extreme fatigue Throbbing above waist Breathlessness Cold sweat Feeling of impending doom Edema
What is the assessment order for a cardiovascular assessment?
Assessment Order Inspection Precordium and neck vessels Palpation Precordium and neck vessels Extremities Auscultation Heart sounds
What side of the heart does the jugular vein tell you about?
right side of the heart
observe for distention
What are the expected findings when palpating the carotid artery (remember one side at a time)?
smooth contour
amplitude is 2+ moderate
equal bilaterally
What are the abnormal findings when palpating the carotid artery?
diminished pulse (decreased stroke volume, 1+)
significantly strong pulse (4+)
unequal bilaterally
When palpating the precordium what are the expected and unexpected findings?
- precordium is the outer aspect of the heart so palpate apex, left sternal border, and base
- expected: nothing
- abnormal: thrill: vibration (purring cat): indicates turbulent blood flow. heave: sustained forceful thrust
What are the expected and unexpected findings when auscultating the carotid artery?
Lightly place the bell on the carotid At the angle of the jaw At the midcervical area At the base of the neck Expected findings Hear nothing Abnormal findings Bruit – blowing swishing sound; turbulent blood flow
What pattern is used in the auscultation of heart sounds?
utilize the diaphragm and bell in a z pattern
What are the expected findings when auscultating heart sounds?
S1 (lub) Closure of AV valves Start of systole (contraction) Loudest at apex Can coordinate with carotid pulse S2 (dub) Closure of semilunar valves (aortic/pulmonic) End of systole Loudest at base Split can be normal with inspiration, especially in young patients Rate and Rhythm Regular – sinus rhythm Sinus arrhythmia: irregular rate in young adults and children; increases with inspiration, decreases with expiration 60-100 bpm
What are the unexpected findings when auscultating heart sounds?
Irregular rhythm or rate:
Bradycardia is less than 60
Tachycardia is greater than 100
Arrhythmias: irregularity of rhythm
EXTRA HEART SOUNDS (Diastolic)
S3
Heard immediately after S2, early in diastole (filling)
Difficulty with filling causes vibration when AV valves open
S4
Heard immediately before S1, end of diastole
Ventricles resistant to filling
Clicks
May indicate valve dysfunction
Opening snaps
Valve having difficulty opening; stenosis
Prosthetic heart sounds
Sounds made by artificial valves; check history
Pericardial friction rub
Grating sound; inflammation of pericardium; very painful
What are murmurs?
whooshing sound as a result of turbulent bloodflow
What is a stenosis?
flow through a constricted area/vessel
What is a mitral valve prolapse?
Regurgitant (Regurgitant fraction is the percentage of blood that regurgitates back through the aortic valve to the left ventricle due to aortic insufficiency, or through the mitral valve to the atrium due to mitral insufficiency.) or backward flow
What is shunting?
septal wall defects
What are the causes of murmurs?
Whooshing sound as a result of turbulent blood flow
3 basic types of flow “pathology”
Flow through a constricted area/vessel (i.e. stenosis)
Regurgitant or backward flow (i.e. mitral valve prolapse)
Shunting (i.e. septal wall defects)
Other non-pathological causes of murmurs
Exercise
Decreased blood viscosity
How are abnormal heart sounds described?
Location Timing Duration Frequency Intensity Quality Change with reposition?
What are some causes of heart failure?
decreased cardiac output
kidney’s compensatory mechanism
What is decreased cardiac output going to cause?
Heart fails as a pump; Circulation becomes backed up and congested
Heart unable to pump enough blood to meet metabolic demands
What are the kidney’s compensatory mechanisms?
Abnormal retention of sodium and water to compensate
for the decreased cardiac output increases blood volume
and venous return, causing further congestion
What are some acute causes of heart failure?
Myocardial infarction (heart attack), dysrhythmias, pulmonary emboli causes direct damage to the heart’s contracting ability
What are some chronic causes of heart failure?
Hypertension, coronary artery disease (CAD), valve disorders
Chronically working against increased pressure
What are the clinical manifestations of left sided heart failure?
Left ventricular dysfunction Back up into pulmonary veins: LUNGS Pulmonary edema, crackles, wheezes S3 & S4 sounds Weakness, fatigue Dyspnea Shallow resp; rate 32-40, dry cough; low O2 sat Paroxysmal Nocturnal dyspnea, orthopnea Nocturia
What are the clinical manifestations of right sided heart failure?
Less common Right ventricular dysfunction Back up into systemic circulation: ABDOMEN JVD, liver spleen, GI, peripheral edema Weight gain, ascites Anasarca Fatigue Dependent, bilateral edema Nausea Anorexia, bloating
