Ch 19 Heart & Neck Vessels Flashcards
Acute chest pain that occurs when myocardial demand exceeds its oxygen supply
Angina pectoris
Incompetent aortic valve that allows backward flow of blood into left ventricle during diastole (aortic insufficiency)
Aortic regurgitation
Calcification of aortic valve cusps that restrict forward flow of blood during systole
Aortic stenosis
The left semilunar valve separating the left ventricle and the aorta
Aortic valve
Tip of the heart pointing down toward the 5th intercostal space
Apex of the heart
When the apex beats against the chest wall
Pulsation created as the left ventricle rotates against the chest wall during systole, normally at the 5th left intercostal space in the midclavicular line (point of maximal impulse or PMI)
Apical pulse
Broader area of heart’s outline located at the 3rd right and left intercostal space
Base of the heart
Cup shaped end piece used for soft, low pitched heart sounds
Bell of the stethoscope
Slow heart rate, less than 50 beats per minute in the adult
Bradycardia
Bulbous enlargement of distal phalanges of fingers and toes that occurs with chronic cyanotic heart and lung conditions
Clubbing
Severe narrowing of the descending aorta, a congenital heart defect
Coarctation of aorta
Right ventricular hypertrophy and heart failure due to pulmonary hypertension
Cor pulmonale
Dusky blue mottling of the skin and mucous membranes due to excessive amount of reduced hemoglobin in the blood
Cyanosis
Flat end piece of the stethoscope used for hearing relatively high pitched heart sounds
Diaphragm of stethoscope
The heart’s filling phase
Diastole
Difficult or labored breathing
Dyspnea
Swelling of legs or dependent body part due to increased interstitial fluid
Edema
Traditional auscultatory area in the 3rd left intercostal space
Erb’s point
Occurs with closure of the atrioventricular (AV) valves signaling the beginning of systole
First heart sounds (S1)
Very soft, low pitched ventricular filling sound that occurs in late diastole when ventricles are done filling, vibrations right before S1 (atrial gallop)
People with CAD occasionally have this
After exercise, really high cardiac output states
Abnormal with cardio myopathy, CAD, high blood pressure, semi aortic stenosis
Extra fourth heart sound S4
The addition of a 3rd or a 4th heart soundmakes the rhythm sound like the cadence of a galloping horse
Gallop rhythm
Technique of moving the stethoscope incrementally across the precordium through the auscultatory areas while listening to the heart sounds
Inching
Increase in thickness of myocardial wall that occurs when the heart pumps against chronic outflow obstruction (aortic stenosis)
LVH (left ventricular hypertrophy)
Imaginary vertical line bisecting the middle of the clavicle in each hemithorax
MCL (midclavicular line)
Incompetent mitral valve impedes forward flow of blood into left ventricle during diastole
Mitral stenosis
Left AV valve separating the left atria and ventricle
Mitral
Uncomfortable awareness of rapid or irregular heart rate
Palpitation
Opposite of a normal split S2 so that the split is heard in expiration, and in inspiration the sounds fuse to one sound
Paradoxical splitting
High pitched, scratchy extra cardiac sound heard when the precordium is inflamed
Pericardial friction rub
Normal variation in S2, heard as 2 separate components during inspiration
Physiological splitting
Area of the chest wall overlying the heart and great vessels, chest wall in front of the heart
Precordium
Backflow of blood through incompetent pulmonic valve into right ventricle (pulmonic insufficiency)
Pulmonic regurgitation
Calcification of pulmonic valve that restricts forward flow of blood during systole
Pulmonic stenosis
Right semilunar valve separating the right ventricle and pulmonary artery
Pulmonic valve
Occurs with closure of the semilunar valves, aortic and pulmonic, and signals the end of systole
Second heart sound S2
Abnormal mid-diastolic heart sound heard when both the pathologic S3 and S4 are present
Summation gallop
Temporary loss of consciousness due to decreased cerebral blood flow (fainting) caused by ventricular asystole pronounced bradycardia, or ventricular fibrillation
Syncope
The hearts pumping phase
Systole
Rapid heart rate >90 beats per min in the adult
Tachycardia
Soft, low pitched ventricular filling sound (vibration from ventricles not wanting to fill easily) that occurs in early diastole (S3 gallop) and may be an early sign of heart failure
Heard after S2 and heard best at the apex
Might disappear as a person sits up
Usually abnormally with CHF, hyperthyroidism, anemia, and sometimes with pregnancy youll get an s3
Extra third heart sound S3
Palpable vibration on the chest wall accompanying severe heart murmur
Aortic or pulmonary stenosis, pulmonary HTN occur with it
Thrill
Right AV valve separating the right atria and ventricle
Tricuspid valve
The top of the heart is known as the..
Base
The bottom of the heart is known as the…
Apex
Which side of the heart sits more forward
The right side
Which chambers which chambers hold the blood and which chambers pump it
The atriums hold the blood
The ventricles pump it
The region between the lungs
Mediastinum
What space does the heart take up.. from what to what
2nd to 5th intercostal space
To the right border of the sternum
To the left midclavicular line
Arteries and veins that are connected to the heart
Great vessels
2 great vessels that return the deoxygenated blood to the right side of the heart
Superior and inferior vena cava
Artery carrying deoxygenated blood to the lungs
Pulmonary
Veins carrying oxygenated blood to the left side of the heart
Pulmonary
Artery carrying oxygenated blood to the rest of the body
Aortic
The outermost layer of the heart, a double wall sac surrounding and protecting the heart
Pericardium
The middle layer of the heart, the muscle wall, the area that contracts
Myocardium
The inner layer of the heart, lines the inside of the heart, chambers, and valves
Endocardium
The fluid in between all 3 layers of the heart that allow for smooth movements
Pericardial fluid
The thicker side of the heart containing more tissue, so it will take longer to heal
The right side
What are the 4 valves
Tricuspid, Bicuspid (mitral), aortic, pulmonic
The chambers of the heart are unidirectional meaning..
They prevent backflow of blood by only opening one way, the pressure pushing the blood to the next chamber
The phase of the heart when the AV valves open
Diastole
The phase of the heart when the AV valves close
Systole
The phase of the heart when the semilunar valves open, ejecting the blood from the heart
Systole
The phase of the heart when the semilunar valves are closed
Diastole
What will the patient experience with left sided heart failure
Pulmonary congestion: trouble breathing, SOB, crackles
What will the patient experience with right sided heart failure
A backing up of the venous blood: jugular neck veins will be distended (swollen/easy to see), edema or swelling of extremities
What does heart failure mean
The blood is not being efficiently pumped to the heart
The rhythmic flow of blood through the heart is called the
Cardiac cycle
Systole occurs between what 2 heart sounds
S1 (lub) and S2 (dub)
This phase is usually 1/3 of the cardiac cycle
Systole
This phase is usually 2/3 of the cardiac cycle
Diastole
You can hear S1 (the closure of the AV valves) loudest at..
The apex of the heart
You can hear S2 (the closure of the semilunar valves) loudest at…
The base of the heart
A respiration effect heard on S2 from pressure changes pushing air more to the right and less to the left, heard on inspiration, might sound like lub dub from valves closing separately
S2 Split
Turbulent blood flow in a vessel or in the heart, fluctuating or irregular flow
Murmur
What sound does a murmur make
Swishing, wooshing, blowing sound
What 3 things can cause murmurs
High velocity speed of blood –> when someone is exercising or if someone has thyroid problems so they have a high cardiac output
Thin blood caused by anemias
Heart defects –> problems with valves or chambers
What are the 4 characteristics you look at when describing a heart sound
Frequency or pitch –> high or low
Intensity or loudness –> loud of soft
Duration –> how long does it last (typical heart sounds are shorter and silence is longer)
Timing –> occurring during diastole or systole
What is the unique ability a heart has to conduct contractions by itself like its own electrical system
Automaticity
The heart contracts because of an electrical system called..
The conduction system
The hearts pacemaker that creates an electrical impulse and then sends it through the heart causing it to contract
SA node
What is the order of the conduction system
SA node –> AV node –> Bundle of HIS –> right and left branches –> purkinje fibers causing the ventricles to contract
The cardiac output is equal to …
stroke volume x heart rate per minute
The stroke volume is the..
blood pumped during each systolic phase
What is the stroke volume (liters of blood pumped per minute)
4-6 LPM
The venous return or the blood that is coming in the ventricles and building up during diastole
Preload
The ventricle resistance or the blood that is leaving the ventricles and causing high pressure in order to get aortic and pulmonic valves to open
Afterload
The artery between the trachea and sternomastoid muscle, close to the heart
Carotid artery
Internal and external veins that empty deoxygenated blood into the vena cava
Jugular veins
There are no valves in the jugular veins to prevent backflow and this is why you can get..
Jugular vein distention
What is the subjective data you should gather
Chest pain (#1 sign of a heart attack) --where, rate it, is it radiating Dyspnea Orthopnea Cough Fatigue Cyanosis or pallor Edema Nocturia Cardiac history Family history Personal habits
What are cardiac risk factors
Elevated serum cholesterol Elevated blood pressure Blood glucose above 130 Diabetes Obesity Smoking Low activity level Hormone replacement therapy
What objective data do you need to collect
Vital signs (BP and pulse) Palpate neck vessels one at a time Examine precordium of the chest Examine extremities for swelling Check posture when breathing Developmental changes
How do you inspect neck vessels
Should be able to see the jugular vein distended when pt is laying at 45 degrees or less, disappears as the bed rises
If CAD is suspected then auscultate carotid artery
–listen for bruiting which is turbulent flow that sounds like swooshing, have them breath in out and hold, and use the bell of the stethoscope
How do you inspect the precordium
Auscultate and palpate for apical impulse at the LMCL at the 4th of 5th ICS
its the PMI
Sometimes you can see and palpate
Where do you auscultate for the aortic valve area
2nd right interspace
Where do you auscultate for the pulmonic valve area
2nd left interspace
Where do you auscultate for the tricuspid valve area
Left lower sternal border
Where do you auscultate for the mitral valve area
5th interspace at left midclavicular line
What cardiac changes occur in an older adult
Increased systolic blood pressure
–common because arteries become stiffer with age
HTN
Systolic murmurs are common
You might hear a little click in mechanical valves with a
mitral prosthetic valve sound
When the pericardium becomes inflamed and you hear a high pitched, scratchy sound
Usually have pericarditis with this
Pericardial friction rub
Chest wall lifts up and you can see it rise with the beating of the heart
Sometimes occurs if R ventricle is enlarged, pulmonic valve disease or HTN, or with chronic lung patients
Lift or heave at sternal border
