Cardiovascular System Flashcards
1
Q
Define cardiovascular
A
the heart and blood vessels
2
Q
List the general assessment tools used for the cardiovascular system
A
inspection, palpation, auscultation, and in some rare cases percussion
3
Q
What is an important exam that is directly related to the cardiovascular system when a pt is experiencing abnormalities?
A
ophthalmoscopic exam of the eyes allows for the only direct visualization of the arteriovenous system
4
Q
What is hypercholesterolemia?
A
high cholesterol
5
Q
Hypercholesterolemia may cause….
A
xanthelasma and arcus senilis
6
Q
What is xanthelasma?
A
yellowish plaques on eyelids
7
Q
What is this?
A
xanthelasma
8
Q
What is arcus senilis?
A
extreme whitish ring around the iris
common in people 40 years old and younger
9
Q
What is this?
A
arcus senilis
10
Q
Doing an opthalmoscopic exam when assessing the cardiovascular system may help diagnose….
A
hypertension or diabetic retinopathy (proliferative and nonproliferative)
11
Q
What is this?
A
copper wiring, indicitive of hypertension
12
Q
What is this?
A
nonproliferative diabetic retinopathy, visible with the “tortorous” blood vessels
13
Q
Doing an oral exam when assessing the cardiovascular system may help diagnose…
A
petechiae on the palate, often seen with infective endocarditis (this infection begins in the oral cavity)
14
Q
What is JVD? What is it indicitive of?
A
bulging/distention of the jugular vein
indicitive of CVP, which is in the right atrium of the heart
15
Q
The angle of Louis is important for calcuating _____
A
JVD
16
Q
What is another name for the angle of Louis?
A
sternal angle or manubrium sternal angle
17
Q
Is the jugular notch easily palpable on all patients?
A
yes
18
Q
Where can you find the angle of Louis?
A
2nd rib is in line with it
19
Q
How far is the heart from the angle of Louis?
A
5cm inferior to the angle of Louis is the base of the heart
base of heart = superior portion of heart
20
Q
What is the “point” of the heart called?
A
the apex
21
Q
If you detect JVD through observation, it is time to measure for _____ next
A
JVP
If you detect JVD through observation, it is time to measure for JVP next
22
Q
How do you measure JVP?
A
bed at 30-45 degree angle
find the angle of Louis and position a ruler on the angle
use anything else vertical, like a tongue depresser and line that up with the highest point that you see the jugular vein bulging
you’re essentially making a right angle, take the height and add 5cm to the height
JVP= anything larger than 8cm is too high and deemed abnormal
6-8cm is WNL and CVP is okay
23
Q
Which patients should you be measuring JVP?
A
senior patients (60+ years old)
24
Q
What is a normal JVP?
A
6-8cm
25
What is an abnormal JVP?
8cm water or higher
26
When measuring JVP, what else should you be doing in this area?
auscultate and palpate the carotid pulse
27
What does COPD stand for?
chronic obstructive pulmonary disease
28
What does COPD include?
usually includes emphysema and chronic bronchitis
29
What is emphysema?
air sacs of lungs are damaged and enlarged, causing breathlessness
30
How does COPD affect PMI?
PMI will be shifted because the heart gets displaced from the enlarged lungs (over inflated)
PMI is usually lower in cases of COPD and more to the right
31
the apex of the heart hits the ________ chest wall every time it beats. This is called the \_\_\_\_
the apex of the heart hits the **anterior** chest wall every time it beats. This is called the **PMI**
32
Describe where you are palpating when assessing PMI
palpate till the 5th intercostal space and then feel for the mid-clavicular area on the left side
33
What does PMI stand for?
Point of Maximal Impulse
34
What is normal PMI?
width of impulse should be 2-3cm
35
What is an abnormal PMI?
larger than 3cm, this is indicitive of cardiomegly
36
What is cardiomegaly?
enlarged heart
37
How many fingers should you palpate with when assessing PMI?
4 fingers, feel for the apex
38
What does SV stand for?
stroke volume
39
What does a vigourous stroke volume mean? Example of cause?
increased stroke volume
blood volume is being ejected with each beat
vigorous exercise would appear as a bounding pulse
40
How do you confirm heaves or thrills after palpation?
with a stethoscope
41
How do you assess for thrills? What do thrills indicate?
palpate with metacarpals to feel for vibrations, called thrills
this is indicitive of turbulent blood flow
42
How do you assess for heaves? What are heaves/what does this mean?
palpate with your hand to the heart for heaves
heaves are sustained impulses
this usually means that ventricles are enlarged
43
What are the 4 positions for ausculatation of the heart?
1) supine
2) left lateral decubitus
3) upright
4) upright leaning forward
44
List the pt postion(s) for a normal heart auscultation
supine and upright
both of these positions you should be able to hear all areas of the heart
45
List the pt position(s) for abnormal heart auscultation (or was unheard in other positions)?
left lateral decubitus and upright leaning forward
only use these positions if:
* you cannot hear the mitral valve area or base of heart
* if it sounds abnormal
46
the b of "lub" is _________ than p in "dup"
the b of "lub" is **harsher** than p in "dup"
47
What is the first sound of the heart?
S1= closure of the AV valves "lub"
AV= atrioventricular valve
mitral valve + tricuspid valve.
48
What is the second sound of the heart?
S2= closure of the semilunar valves "dup"
49
What are the 4 valve areas of the heart?
aortic, pulmonic, tricuspid, and mitral valve areas
50
T/F
The mitral closes slightly before the tricuspid, and aortic slightly before the pulmonic, so there are 4 sounds, but indistinct
true
51
Which heart valve area is the loudest?
mitral
52
What position should the stethoscope be held when auscultating the heart?
angled slightly anteirorly
53
Which valvular area should you start with when auscultating the heart?
aortic
54
List the order of valvular areas you should auscultate
1) aortic
2) pulmonic
3) tricuspid
4) mitral
55
Where is the aortic valve?
count to the 2nd intercostal space on the right side
56
Where is the pulmonic valve?
straight across from the aortic valve, on the left side
57
Where is the tricuspid valve?
move down 2 more intercostal spaces from the pulmonic valve
58
Where is the mitral valve?
over the mid-clavicular line, in line with the nipple
with women, push in and up because you need to move through the breast tissue
59
Are S3 and S4 sounds commonly heard?
No, it is often only heard on patients with heart or vascular problems
60
When is the S3 sound heard?
S3 is heard if the left ventricle of the heart is non-compliant as blood rushes in after opening the mitral valve
the heart is usually non-compliant because of scar tissue (ex: scar tissue from a heart attack)
61
When is the S4 sound heard?
S4 is heard at the end of atrial contraction with the final release of blood
audible if the ventricle is non-compliant
it is normal to hear this in children or in slim adults
62
Which heart sounds are considered extra sounds, or subtle sounds?
S3 and S4
63
What are the 2 types of murmurs?
1) regurgitation of insufficeny (often mitral regurgitation)
2) stenotic murmurs (often aortic stenosis)
64
What is aortic stenosis?
a murmur caused by the narrowing/stiffening of the aorta
65
What is mitral regurgitation?
murmur caused by mitral valve not closing all the way
blood flows backwards
makes a swooshing sound
66
When listening to the heart its important to note what?
volume
radiating anywhere?
rhythm
67
What is considered a severe heart murmur?
if the murmur is radiating somehwere
68
Where does an aortic stenosis usually radiate to?
towards the neck
69
Where does a mitral regurgitation usually radiate to?
the axilla (armpit)
70
What is the grading scale for a heart murmur?
rated on a scale of 1-6 from faint to loud /6
71
What does a 1/6 on the heart murmur grading scale mean?
faint murmur
72
What does a 2/6 on the heart murmur grading scale mean?
easily heard murmur
73
What does a 3/6 on the heart murmur grading scale mean?
moderately loud murmur
74
Which murmur ratings are the most common?
1/6, 2/6, and 3/6
75
What does a 4/6 on the heart murmur grading scale mean?
loud murmur, thrill palpable
76
What does a 5/6 on the heart murmur grading scale mean?
thill present, can hear with edge of stethoscope its so loud
77
What does a 6/6 on the heart murmur grading scale mean?
thill present, can hear with your ear, no stethoscope needed because its so loud
78
What are the gallop sounds?
S3 and/or S4
79
When assessing the abdomen, what general assessment tools may you use?
inspection, palpation, and auscultation
80
Where is the abdominal aorta located?
lies left of the midline
81
When assessing the cardiovascular system where may you find a bruit sound?
Hint: there are 2 bruits in the neck chapter (carotid artery + thyroid gland). What is another bruit location we learned?
aortic abdomen
bruit may indicate turbulent blood flow usually due to atherosclerosis
82
What is lymphedema?
tissue swelling caused by an accumulation of fluid that's usually drained through the body's lymphatic system
ex: a complication from a mastectomy may cause this
83
What are the 2 types of blood insufficiencies?
venous and arterial insufficiency
84
What is venous insufficiency?
Describe the color, where it is commonly found, and whether it blanches or not
blood is unable to flow back to the heart properly
purplish-blue, black color
causes hemosiderin
lack of hair in areas of insufficiency
common in the LE
if you palpate it, it will blanch
85
What causes hemosiderin?
hemosiderin staining usually happens on the lower legs, near the ankles, or on your feet
caused by blood leaking out of capillaries
the blood pools under the skin and leaves a residue of hemoglobin that settles in the tissue there, causing skin discoloration
86
What is arterial insufficiency?
Describe the color and location
pale skin in LE, no blood flow to this area
87
What is this?
venous insufficiency
88
What is this?
arterial insufficiency
89
What is this?
gangrene
90
What is this?
cellulitis
91
What is gangrene?
no blood flow (ischemia), causes tissue to die
92
What is ischemia?
blood flow (and oxygen) is restricted or reduced somewhere in the body
93
What is cellulitis?
infection of the skin, very painful
red, swollen skin, common in LE
if you palpate it, it will blanch
94
What are the 2 types of edema?
diffuse edema (symmetical), and asymmetical edema
95
What is pitting edema?
if you palpate the skin, it will cause pits
takes a while for the skin to return back to "normal" after palpation
96
What is this
varicose veins
97
For patients with PVD, what should you be checking for? What is wrong with the blood?
check for spider veins and varicose veins
blood is not flowing the way it should, there is a blockage
98
What should you be noting for patients with vascular disease?
note dusky color, waxy appearance, and lack of hair
may cause "peau d'orange"
99
What is peau d'orange?
Peau d'orange is French for orange peel
characterized by edema and pitting and results from blockage of lymphatic drainage
symptom in which the skin becomes thick and pitted, with a texture and appearance similar to that of orange peel
100
What causes the thickening of nails?
bad blood flow results in thick nails
thick nails are subjected to get infected
101
What is an extreme ulcer we learned in class?
pedal ulcer
102
When examinig the LE, what should you be taking note of?
symmetry
color
temp. (use back of your hand)
texture, etc.
103
Venous and arterial insufficenies may feel ____ to the touch
**cool**
Venous and arterial insufficenies may feel cool to the touch
temp. of skin is colder than rest of body
104
cellulitis may feel ______ because of the increased blood flow to that area
Hint: think of a genetic temp word
**warm**
cellulitis may feel warm because of the increased blood flow to that area
105
What is PAD?
peripheral artieral disease
most common in LE, results in intermittent claudication (on/off)
106
What is intermittent claudication?
pain affecting the calf, and less commonly the thigh and buttock, that is induced by exercise and relieved by rest
also common in elderly with walking
107
Which pulses can you palpate?
brachial
radial
femoral
popliteal
dosalis pedis (DP)
posterior tibial (PT), etc.
108
Which pulse is the most difficult to find/palpate? What makes it so difficult?
popliteal
the biceps femoris muscle is in the way
109
Where is the dorsalis pedis (DP) pulse located?
lateral to the tendon of the extensor hallucis muscle
110
Where is the posterior tibial (PT) pulse?
posterior to the medial malleolus bone
111
Describe the capillary refill time test
push on the distal part of the hallux muscle, or on a nail
if it takes more than 3 seconds, then it is abnormal cap. refill
112
Describe the Allen test
have pt close their fist tightly
you will push/palpate on radial and ulner arteries and have pt open hand slowly
open palm should appear pale and color should return when you let go of arteries
should be within 5 seconds, anything longer is deemed abnormal
IF pt has abnormal result try again doing one artery at a time and one hand at a time to compare results
113
brady-
pertaining to: slow
ex: **brady**cardia
def: slow heart rate
114
-cardio-
pertaining to: heart
ex: **cardio**megaly
def: enlargement of the heart
115
sphygmo-
pertaining to: pulse
ex: **sphygmo**manometer
def: instrument for measuring BP
116
supra-
pertaining to: above
ex: **supra**ventricular
def: above the level of the ventricles
117
tachy-
pertaining to: fast
ex: **tachy**cardia
def: rapid heart rate
118
angi(o)-
pertaining to: blood vessel
ex: **angio**graphy
def: radiographic visualization of blood vessels
119
embol(o)-
pertaining to: wedge, stopper
ex: **embol**ism
def: sudden blocking of a vessel by a clot
120
phleb(o)-
pertaining to: veins
ex: **phleb**otomy
def: incision into a vein for blood removal
121
thrombo-
pertaining to: clot
ex: **thrombo**embolism
def: obstruction of a blood vessel by a clot that has broken loose from its site of formation
122
varico-
pertaining to: twisted, swollen
ex: **varico**se
def: unnaturally swollen and twisted
123
If a pulse is described as absent or nonpalpable, what does this mean in terms of scale? Examples that may cause this?
0 or 0/4
Ex: asystole, thrombosis, or occlusion
124
If a pulse is described as weak, diminished amplitude, or may have difficulty locating, what does this mean in terms of scale? Examples that may cause this?
1, 1/4, 1+/4
Ex: stenosis, left ventricular failure, hypovolemia, anemia, dehydration
125
If a pulse is described as normal or readily palpable, what does this mean in terms of scale? Examples that may cause this?
2, 2/4, 2+/4
Ex: hemodynamic stability
126
If a pulse is described as strong, increased amplitude, or quickly palpable, what does this mean in terms of scale? Examples that may cause this?
3, 3/4, 3+/4
Ex: anxiety, mild exertion, caffeine
127
If a pulse is described as bounding, what does this mean in terms of scale? Examples that may cause this?
4 or 4/4
Ex: fever, strenuous exercise, fear, cocaine
128
Define bradycardia
slower than expected heart rate, generally beating fewer than 60 bpm
129
Define tachycardia
very fast, rapid heart rate
130
What is the normal heart rate range?
60-90 bpm
131
What is normal BP?
120/80 or less
132
What is the prehypertension range?
120-139/ 80-89
133
If a pitting edema is rated +1, what does this mean?
roughly 2mm in depth, disappears rapidly
134
If a pitting edema is rated +2, what does this mean?
roughly 4mm in depth, disappears in 10-15 sec.
135
If a pitting edema is rated +3, what does this mean?
roughly 6mm in depth, may last more than 1min
dependent extremity swollen
136
If a pitting edema is rated +4, what does this mean?
roughly 8mm pit or deeper, may last 2-5min
dependent extremity grossly disoriented
137
What can indicate JVD (besides the jugular venous bulge)
varicose veins and spider veins
