Ch. 19 Heart and Neck Vessels Flashcards
What is occurring during S1?
Closure of the tricuspid and bicuspid valves (AV valves)
What is occurring during S2?
closure of the pulmonic and aortic valves (Semilunar Valves)
What is S3?
occurs when ventricles are resistant to filling. occurs right after S2 “Ken-Tuck-EE”
What is S4?
Ventricle resistance to fill also but happens before S1. “Ten-es-see
The intensity of S1 depends on what three factors?
1) position of the AV valve at the start of systole
2) structure of the valve leaflets
3) how quickly pressure rises in the ventricles
Where can you hear S1 best?
Loudest at the Apex
Why is it sometimes true that both S1 and S2 are equally loud at the apex?
b/c S1 is lower pitched than S2
Both S1 and S2 are diminished with what type of conditions?
conditions that place an increased amount of tissue between the heart and your stethoscope: emphysema (hyperinflated lungs), obesity, pericardial fluid
What does hearing a split S1 mean?
it is normal but occurs rarely. It means you are hearing the mitral and tricuspid components separately.
Where can you hear a split S1 best?
it is audible in the tricuspid valve area, the left lower sternal border.
Where is S2 best heard?
over the base
Discuss hearing a split S2.
normal. occurs toward the end of inspiration in some people. During Expiration it will appear as one again. A split S2 is heard only in the Pulmonic Valve Area, the second left interspace
What do murmurs sound like?
blowing, swooshing sound
Why do murmurs occur?
b/c of turbulent blood flow in the heart or great vessels
If you hear a murmur what should characteristics should you indicate?
Timing Loudness Pitch Pattern Quality Location Radiation Posture
Compare the murmur of mitral stenosis to a murmur of aortic stenosis.
the murmur of mitral stenosis is rumbling, that of aortic stenosis is harsh.
What may a systolic murmur occur with?
a normal heart or with heart disease
What does a diastolic murmur always indicate?
heart disease
What is a pathologic S3 called and why does it occur?
“Ventricular Gallop”
occurs with heart failure and volume overload
What is a pathologic S4 called and why does it occur?
“Atrial Gallop”
occurs with CAD
Define an Innocent Murmur.
indicates having no valvular or other pathologic cause.
Characteristics
- soft (grade ii)
- midsystolic
- short
- crescendo-decrescendo
- vibratory/musical sound “Voot”
Define Functional Murmur.
is due to increased blood flow in the heart (i.e. in anemia, pregnancy, fever, hyperthyroidism)
Where are innocent murmurs heard?
at the 2nd or 3rd left intercostal space and disappears with sitting
When listening for murmurs how should you position the patient?
check first with patient supine. then roll the person toward his left side and listen with the bell at the apex of the heart.
What is Preload?
- volume of blood in the right atrium at the end of diastole.
- not only volume but the amount of stretch in the ventricles (more it stretches the more force it will have for ejecting out)
What is Contractility?
force of contraction of the heart
What is Afterload?
pressure in the great vessels(vessels branching off of the heart)
What is stroke volume?
the amount of blood ejected with each heart beat
What is Cardiac Output?
the amount of blood ejected from the left ventricle each minute
What major vessels are located in the neck?
Carotid Artery (in-between trachea and sternomastoid muscle)
Internal Jugular Vein(deep and medial to the sternomastoid muscle)
External Jugular Vein (superficial)
Compare an arterial pulse with a jugular pulse.
Arterial pulse is caused by a forward propulsion of blood (well defined wave form). The arterial has one component, the Dicrotic notch (D) caused by closure of the aortic valve. The jugular pulse results from a backwash, a waveform moving backward caused by events upstream. The jugular pulse has 5 components (A, C, X, V, Y)
Describe the Heart and Neck Vessels of Pregnant women
- more blood volume which creates an increased stroke volume, cardiac output, and pulse rate.
- Arterial blood pressure decreases as a result of peripheral vasodilation
- don’t lay on right side b/c baby will impede inferior vena cava)
Describe the heart and neck vessels of infants and children.
- heart pumps at 3 weeks gestation
- lungs don’t work until birth therefore the baby relies completely on mother for oxygenation. which is also why they have the Foramen Ovale and Ductus Arteriosus.
- heart is positioned more horizontally in the infant than the adult, thus the APEX IS HIGHER (4th left intercostal space) reaches adult position by age 7.
What is the Foramen Ovale?
an opening in the atrial septum of the fetus’s heart to bypass the lungs. 2/3 of blood going into right atrium is shunted through this opening directly into the aorta.
What is the Ductus Arteriosus?
the rest of the blood that does not go through the foramen ovale is detoured through this extra vessel into the aorta
Describe the heart and neck vessels of the aging adult.
- hemodynamic changes
- hypertrophy (left ventricular wall thickness increases)
- abnormalities w/valves
- heart takes longer to fill
- fatty plaques in coronary arteries
- ventricular dysrhythmias
What are the 9 modifiable risk factors for CVD (cardiovascular heart disease)?
abnormal lipids smoking HTN diabetes abdominal obesity psychosocial factors consumption of fruits and veggies alcohol use regular physical activity
who is at risk for HTN/HBP?
-men below 45
-women above age 64
-women taking oral contraceptives
-African Americans
-
who is at risk for High cholesterol?
-Mexican americans
Which race is more prevalent to obesity?
Mexican americans and Blacks especially Black Women
Discuss heart disease in women.
they present differently with heart disease than men. usually complain of fatigue and being nauseous.
Discuss heart disease in men.
More likely to have heart disease than women
What is the effect of obesity on the heart?
- heart has to pump harder (higher afterload)
- contributed to more heart issues
Who is at risk for DM2?
- obese persons
- abdominal fat
- African Americans and Mexican Americans
What is someone referring to when saying there is a “Pump” issue in the heart?
Congestive HF
-left ventricle isn’t pumping enough
What topics should you focus your health history questions on?
- Chest pain & tightness (referred pain?)
- Dyspnea
- Orthopnea
- Cough (fluid in lungs)
- Fatigue
- Cyanosis/Pallor
- Edema
- Nocturia
- Cardiac History (specifics)
- Family Cardiac History
- Personal Habits (cardiac risk factors)
What kind of dyspnea would we be on the lookout for with Heart problems?
Dyspnea on exertion. i.e. DOE after walking two level blocks.
Paroxysmal Nocturnal Dyspnea (PND) occurs with heart failure. Person will wake during sleep because laying down increased volume of intrathoracic blood, and the weakened heart cannot accommodate the increased load. Typically the person awakens after 2 hours of sleep with the perception of needing fresh air.
define orthopnea.
Orthopnea is the need to assume a more upright position to breathe
You will see edema in a patient’s entire body with what kind of heart failure?
Right sided
Define Nocturia.
recumbency at night promotes fluid reabsorption and excretion; this occurs with heart failure in the person who is ambulatory during the day.
What is a Carotid Artery Bruit?
A blowing, swishing sound indicating blood flow turbulence. Caused by a local vascular defect, such as atherosclerotic narrowing or plaque build up
To inspect the jugular and venous pulse, what position must the patient be in?
patient must be at 30-45 degree angle
What part of the stethoscope do you use to check for Bruit?
bell
Where can you feel the apical impulse?
5th intercostal space, midclavicular at the apex of the heart
What are you looking for when you palpate across the precordium?
looking for thrills and heaving
What is important to remember when palpating the carotid arteries?
palpate one at a time! don’t want to constrict blood flow to the brain!
What does Heaving indicate?
the heart is close to the surface. Enlarged/Hypertrophied heart
How will you use the stethoscope during auscultating for heart sounds?
Use Diaphragm 1st to check all areas for murmurs then listen with the Bell in all areas to check for S3 and S4 sounds.
What are the 5 sites for auscultation?
1) second right intercostal space
2) second left intercostal space
3) third left intercostal space
4) fourth left intercostal space
5) fifth left intercostal space
Where will you find the Aortic Valve Area?
second right intercostal space
Where will you find the Pulmonic Valve Area?
second left intercostal space
Where will you find the Tricuspid Valve Area?
Left Lower Sternal Border
Where will you find the Mitral Valve Area?
Fifth intercostal space around the left midclavicular line
Where is Erb’s Point?
3rd left intercostal space
What is a Thrill?
a palpable vibration. It feels like the throat of a purring cat. The Thrill signifies turbulent blood flow and accompanies loud murmurs.
Does absence of a Thrill mean there is no murmurs?
NO
Cardiac Enlargement is due to increased ventricular volume or wall thickness and occurs with what disorders?
HTN, CAD, Heart Failure, Cardiomyopathy
When examining the Infant what should we take into consideration?
Their rates are faster
When examining the aging adult what should we take into consideration?
- rise in systolic pressure is common
- orthostatic hypotension
What are the abnormal findings we could find while assessing the Heart?
- S3 or S4
- Murmur
- Pericardial Friction Rub
- Thrill or Heave during palpation
Describe the Direction of Blood Flow.
Body –> Inferior & Superior Vena Cava –> Right Atrium –>Tricuspid Valve –> Right Ventricle –> Pulmonic Valve –> Pulmonary Arteries –> Lungs –> Pulmonary Veins –> Left Atrium –> Mitral/Bicuspid Valve –> Left Ventricle –> Aortic Valve –> Aorta —> Body
Describe the Cardiac Cycle.
DIASTOLE
1.ventricles relax and the AV valves (tri/bicuspid) are Open
2.blood pours rapidly into the ventricles
3. atria contract and push last amount of blood into the ventricles
(Note that ^^ atria systole occurs during ventricular diastole)
SYSTOLE
- Ventricular pressure > Atrial pressure so mitral/tricuspid valves swing shut (S1)
- for a brief moment at the beginning of systole, all 4 valves are shut, which helps to build pressure inside ventricles*
- Ventricular pressure > pressure in the Aorta so the semilunar valves open
- after emptying, Ventricular Pressure < Aortic pressure so the semilunar valves swing shut (S2)
Describe the flow of Conduction of Electricity in the heart.
- SA node (pacemaker) sends impulse
- current travels across the atria to the AV node
- current is slightly delayed at the AV node so that the atria have time to contract before ventricles are stimulated
- impulse travels to the Bundle of His
- Impulse travels to the right and left bundle branches
- impulse goes through ventricles and ventricles contract
