Cardiovascular System Flashcards
apex of the heart
left ventricle at tapered tip
base of the heart
where right ventricle meets the pulmonary artery superiorly
great vessels of the heart (3)
pulmonary artery, aorta, SVC/IVC
tricuspid valve
right side
bicuspid
left side
Circulation of blood through the heart
SVC/IVC, Rt atrium, tricuspid valve, rt ventricle, pulm valve, pulm artery, lungs, left atrium, lt ventricle, aorta, rest of body
S1
MV & TV of heart closing. Beginning of systole.
S1 split
delay in tricuspid valve closure.
S2
AV & PV of heart closing. Beginning of diastole
S3
“S3 gallop” pathologic change in ventricular compliance.
Cause of S3 sound (4)
anemia, fever, pregnancy, thyrotoxicosis
S4
atrial contraction and happens before S1, Pathologic change in venricular compliance.
S4 Cause
noncompliant left ventricle
P2
Pulmonic valve closure
When does P2 happen?
With S2, AV closure.
Cause of Heart Murmors
turbulent blood flow. longer in duration. potential valvular disease
Valve abrnomalities (2)
stenotic valve (aortic stenosis) - harsh closing, regurgitant valve (aortic regurgitation) - failure to close fully casing leakage.
4 sites for heart sounds
Mitral, tricuspid, pulmonic, aortic
Mitral best heard at
apex, 4th to 5th ICS at midclavicular line (V4)
Tricuspid best heard at
4th LICS
Pulmonic best heard at
2nd LICS at sternal border
Aortic best heard at
2nd RICS at sternal border
Timing of P wave
up to 80ms
PR interval
120-200ms
QRS complex
up to 100ms
Preload
load that stretches the cardiac muscle before contraction. Volume of blood in RV at end of diastole = preload for next beat
factors that increase preload
inspiraion, increased volume (Exercise), CHF
factors that decrease preload
exhilation, decreased lv output, pooling of blood in capillary bed/venous system.
myocardial contractility
ability of cardiac muscle when given a load, to shorten.
factors that increase contractility
sympathetic ns
factors that decrease contractility
blood flow or oxygen delivery to the myocardium is impaired
afterload
vascular resistance to ventricular contraction (tone in walls of arterial system)
JVP
jugular venous pressure
(right) JVP =
right atrial pressure
measurement of JVP
vertical distance above sternal angle
Cardiac Tamponade
Cardiac tamponade is pressure on the heart that occurs when blood or fluid builds up in the space between the heart muscle (myocardium) and the outer covering sac of the heart
Causes of chest pain
angina, MI, dissecting aortic aneurysms
Palpitations
awareness of heartbeat
Dyspnea
awareness of breathing inappropriate to a given level of exertion
orthopnea
dyspnea when pt is laying down and improves when the pt is sitting up. Quantified by # of pillows patient sleeps with.
paroxsymal nocturnal dyspna (PND)
episodes of sudden dyspnea or orthopnea that awakens pt. can trigger need to go to window for air.
Obstructive sleep apnea
increased risk for cardiovascular disease
MET
Metabolic Equivalent of Task (1-12, 1 being eating, working at a computer, dressing, 12 being running rapidly for moderate to long distances)
History of Rheumatic Fever
look out for murmurs, valve disease
Non-modifiable cardiac risk factors
age, gender, heredity
Modifiable cardiac risk factors
tobacco, physical inactivity, obesity, htn, diabetes, hypercholesterolemia, stress.
Target LDL levels
<100
4 techniques of physical exam
inspection, palpation, precussion, ascultation
mmHg to inflate bp cuff over when pulse disappears
30mmhg
Components of the CV Exam
JVP pulsations. Carotid upstrokes, presence of bruits. PMI (point of maximal impulse) and any heaves, lifts, or thrills. 1st & 2nd S1/S2. Extra heart souds: S3,S4. Cardiac murmurs
Thrill
humming vibration felt during palpation of a vessel
Bruit (‘brewee’… it’s french)
a mumur like sound of vascular other than carotid artery. Ask pt to hold breath and listen with the bell.
Examination of brachial artery
for pts with carotid obstructions.
PMI stands for
Point of maximal impulse
PMI represents
when LV contracts/touches chest wall
Anatomical location of PMI
V4
The bell is best for ____ pitched sounds
low. S3/S4 sounds and mitral stenosis, murmor
The diaphragm is best for ____ pitched sounds
high, S1,S2, murmurs of aortic and mitral regurgitation, pericardial function
The biggin’ of the stethoscope is the ______
diaphragm
Systolic murmors
Between S1->S2
Diastolic murmors
Between S2->S1
Murmor scale intensity
graded on a 6 point scale 1= faint 6=very loud thrill
Aortic stenois sound
“Lub SHHHHH dub”
Aortic stenosis defined as
mid-systolic ejection murmor, heard best over aortic area, radiates to neck
Mitral stenosis
valve gets thick, stiff (heh), distorted because of rheumatic fever
Mitral valve prolapse
mid-systolic cclick, heard best over mitral valve
Mitral regurgitation
Pansystolic - valve is unable to contain blood within the ventricle during systole,
Mitral regurgitation cause
volume overload in LV can lead to dilatation and hypertrophy,
Tricuspid regurgitation = tall systolic C-V wave/loss of x dscent
valve fails to close completely during systole. Heard over left sternal border. cause: pulm HTN or LV failure.