CH: 20 Heart and Neck Vessels Flashcards
bruit is caused by?
stenosis
where is the apex located?
left midclavicular 5th intercostal
*bottom of the heart
where is the base located?
2nd intercostal lateral to sternum
other terms for apex of heart?
mitral
apical
PMI (point of maximum impulse)
the pulmonary artery is the ONLY artery that carries _____?
DEOXYGENATED blood (leaves from right ventricle)
the pulmonary vein is the ONLY vein that carries _____?
OXYGENATED blood
where is S1 the loudest?
apex
*S1: beginning of systole
*lub: signifies closure of AV valves
where is S2 the loudest?
base
*S2: end of systole
*dub: signifies closure of SL valves
what are the atrioventricular (AV) valves?
tricuspid
mitral
how many flaps does the tricuspid valve have?
3
how many flaps does the mitral valve have?
2
which AV valve is located on the right side?
tricuspid
which AV valve located on the left side?
mitral
what are the semilunar valves (SL)?
pulmonic
aortic
which is the left SL valve?
aortic
which is the right SL valve?
pulmonic
S1 is the closure of?
AV valves
S2 is the closure of?
SL valves
regurgitation is usually?
mitral
stenosis is usually?
aortic
moRe to the ______, Less to the ______?
moRe to Right, Less to Left
what are the abnormal heart sounds?
S3 (possibly normal during pregnancy)
S4 (possibly normal in athletes)
carotid pulse coincides with which sound?
S1
which pulse site is assessed for CPR effectiveness?
carotid
palpating carotids?
ONE at a time
what can palpating carotids bilaterally cause?
*decrease blood to brain (cause stroke)
*stimulate vaso-vagal response (HR drops when nerve stimulated=BP drop)
the right jugular vein provides info about which side of the heart?
right
*this is why we assess from right side of patient
right side of heart provides info about?
heart failure
what question to ask if pt experiencing chest pain?
does it worsen with deep breaths?
if chest pain worse with deep breath, indicates?
lung association
chest pain same with deep breath, indicates?
heart association
layers of the heart wall?
pericardium: outer layer that protects/surrounds heart, tough fibrous double-walled sac
myocardium: muscle layer, does the pumping
endocardium: inner layer, thin endothelial tissue
blood flow direction?
-deoxygenated blood from body to right atrium
-through tricuspid valve to right ventricle
-through pulmonic valve to pulmonic artery
-artery delivers DEOXYGENATED blood to lungs
-lungs oxygenate blood
-pulmonary veins return blood to left atrium
-through bicuspid (mitral) valve to left ventricle
-through aortic valve to aorta
-oxygenated blood to body
venous blood=?
DEoxygenated
arterial blood=?
OXYgenated
what is the P wave?
depolarization of atria
what is the P-R interval?
from beginning of P wave to beginning of QRS complex (time necessary for atrial depolarization plus time for impulse to travel through AV node to ventricles)
what is QRS complex?
depolarization of ventricles
what is T wave?
repolarization of ventricles
what is S3?
usually abnormal
*vibration when ventricle is filling when lots of fluid- beginning or during diastole (heart failure)
also known as ventricular gallop
what is S4?
usually abnormal
*softer sound from vibration at end of diastole
the sinoatrial (SA) node is considered?
the pacemaker of the heart
what is the conduction pathway?
-atria contracts
-signal travels across atria to AV node
-through bundle of His
-down right and left bundle branches
-through purkinje fibers to ventricles
-ventricles contract
how many liters of blood does the heart pump throughout the body per minute?
4-6L
what is cardiac output?
the volume of blood in each systole (stroke volume) times the number of beats per minute (heart rate)
CO= SV x HR
what is preload?
volume
*venous return that builds during diastole
*length the ventricular muscle is stretched at end of diastole before contraction
what is afterload?
pressure
*opposing pressure ventricle generates to open aortic valve against higher aortic pressure
what side of stethoscope should you use for carotids?
bell
what abnormality are you looking for in carotids?
bruit
*means blockage or obstruction
(usually atherosclerosis) results in stroke bc blood cannot get to brain
*might be caused by CARDIAC STENOSIS
nocturia?
frequent urination at night
what could nocturia indicate?
heart failure
important cardiac disease history?
hypertension
increased cholesterol
MI
heart murmurs
important personal habit risk factors?
smoking
nutrition
drug use (cocaine)
exercise
when might you experience edema in lower extremeties?
heart failure
patient instruction when auscultating the carotid?
inhale, exhale, hold
what does cardiac stenosis increase risk of?
stroke
what is jugular vein distention?
edema in jugular vein
how to assess for JVD?
have pt lay flat
-if present, raise HOB to 30-40 degrees
what is the internal jugular vein?
not visible
-larger, deep, and medial to sternomastoid muscle
*pulsations may be seen in sternal notch when supine
what is the external jugular vein?
more superficial
-lateral to sternomastoid muscle and above clavicle
what does the circle of willis do?
provides extra blood flow to brain during damage
why do we tell pt to hold breath when auscultating carotid?
so we don’t hear bronchial sounds
what does JVD usually indicate?
right sided heart failure
what could pulsations of the aorta indicate?
abdominal aortic aneurysm
auscultate first with ______ then with ______?
diaphragm, bell
where is the aortic valve area?
second right interspace
where is the pulmonic valve area?
second left interspace
where is the tricuspid valve area?
left lower sternal border
where is the mitral valve area?
fifth interspace around left midclavicular line
what pattern do you use to auscultate heart sounds?
zigzag starting at base (top)
what is splitting of 2nd heart sound? where is it heard?
more blood flow with inspiration (right valves don’t close as quickly as left valves)
*only heard in pulmonic valve area
what is the medication requirement for mechanical valves?
must always be on blood thinners
-metal bell increases clotting risks
in what position can you best hear abnormal sounds?
left lateral
we see ______, we feel ______, and we hear _____?
we see heaves/lifts
we feel thrills
we hear bruits
aortic stenosis and pulmonic stenosis can cause what murmur?
midsystolic ejection murmur
mitral stenosis and tricuspid stenosis can cause what murmur?
diastolic rumbles of AV valves
mitral regurgitation and tricuspid regurgitation can cause what murmur?
pansystolic regurgitant murmur
aortic regurgitation and pulmonic regurgitation can cause what murmur?
early diastolic murmur
what is the most common extra sound?
midsystolic click
a diastolic murmur always indicates _____?
heart disease
left vs right sided heart failure?
left:
-fluid buildup or backflow
-usually effects lungs
right:
-fluid in veins (JVD)
-usually develops from left sided
S1 coincides with which wave on ECG?
R wave
where is erb’s point?
3rd interspace on the left
innocent murmur vs functional murmur?
innocent: no valvular or pathological cause
functional: increase blood flow in heart
paradoxical split is associated with?
left bundle branch block
aortic stenosis
wide split is associated with?
right bundle branch block
what are the congenital heart defects?
-patent ductus arteriosus
-atrial septal defect
-ventricular septal defect
-tetralogy of fallot
-coarctation of aorta
