Chapter 12: Heart and Peripheral Vascular System Flashcards
Angina
chest pain or discomfort that happens when the heart doesn’t get sufficient oxygen-rich blood
Ankle/Brachial Index
test that compares the blood pressure measured at the ankle with the blood pressure measured at the arm
Aortic Valve
heart valve located between the left ventricle and the aorta
Apical
pulsation at the apex of the heart
Arteries
muscular-walled tubes in the circulation system that transport oxygenated blood from the heart to all parts of the body
- carry oxygenated blood away from the heart and the rest of the body
Amplitude
pulse volume; may be described as weak, faint, strong, or bounding
Atrioventricular Valve (AV-valve)
valves in the heart that causes blood flow through the heart in one direction from the right side to the left side
Bruit
blowing vascular sounds resembling heart murmurs
Carotid
blood vessels located on both sides of the neck that deliver blood to the brain and head
Contour
smooth outline or shape of carotid arteries with a rapid upstroke and normal strength
Diastolic
pressure of blood vessels after the initial force of contraction of the heart
- the minimum amount of pressure exerted on the vessels; this occurs when the ventricles relax and fill with blood
Dorsalis Pedis
pulse palpable on the dorsum of the foot in the first intermetatarsal space just lateral to the extensor tendon of the great toe
Edema
swelling due to small blood vessels (arteries and veins) leaking fluid into nerby tissues
Electrocardiogram
test to evaluate the electrical impulses generated by the heart during the cardiac cycle to assist with diagnosis of cardiac dysrhythmias, blocks, damage, infection, or enlargement
Jugular Vein
veins in the neck that drain blood from the head, brain, face and neck and convey it toward the heart
Mitral Valve
heart valve that lies between the left atrium and the left ventricle to support one-directional blood flow through the heart
Orthostatic Hypotension
form of hypotension that:
- is a decrease in systolic blood pressure of greater than or equal to 20 mm of mercury
- a decrease in the diastolic pressure of greater than or equal to 10 mm of mercury
- when a patient changes from a recumbent or sitting position to a standing position
Perfusion
passage of bodily fluids, such as blood, through the circulatory or lymphatic system to an organ or tissue
Popliteal
artery that is primary vascular supply in the region of the knee and lower leg or vein that runs posterior to the popliteal artery and receives blood from multiple tributaries
Posterior Tibial
artery that passes posterior to medial malleolus at the ankle
Pulmonic Valve
one of four valves that regulate blood flow in the heart; lies between the lower right ventricle and the pulmonary artery
Pulse Deficit
difference between the apical and peripheral pulse rates
Pulse
number of times the heart beats in one minute
Pulsation
act of pulsating: beating or throbbing, a beat or throb, as the pulse vibration or undulation
Radial
artery in the wrist
Rate
number of contractions
Rhythm
amount of electrical energy generated as a heart beats
Semilunar Valves
separates and controls the blood flow from the right ventricle of the heart to the pulmonary artery without any backflow
- pulmonary and aortic valves
Systolic
top number in a blood pressure reading
- the maximum pressure exerted on arteries when the ventricles contract or eject blood from the heart
Temporal
artery at the temple above the ear
Thrill
vibratory sensation felt on the skin overlying an area of turbulence; indicates a loud heart murmur usually caused by an incompetent heart valve
Tricuspid Valve
regulates blood flow from the heart’s upper right chamber (right atrium) to the lower right chamber (right ventricle)
Veins
return blood to the heart; dark red because oxygen has been replaced with carbon dioxide and other wastes
- carry deoxygenated blood back to the heart
- no (natural) force that propels blood flow
- valves, muscle contraction, and pressure gradient have to propel blood to heart
What are signs of right-side heart failure ?
- edema
- distension in jugular vein
- ascites
- weight gain
What are signs of left-side heart failure ?
- not much edema
- back upped blood goes to the lungs
- any symptoms that have to do with the lungs (dyspnea, crackles, cough)
- more serious since it’s the main pumping chamber
What is the pneumonic for knowing the cardiac landmarks ?
APETM
Where is the aortic valve heard ?
2nd right intercostal space
Where is S1 best heard ?
apex of the heart
Where is S2 best heard ?
base of the heart
- since blood is flowing towards the base
Where is the aortic valve heard ?
2nd ICS
- RSB
Where is the pulmonic valve heard ?
2nd ICS
- LSB
Where is Erbs point heard ?
3rd ICS
- LSB
- S1 & S2 heard equally
- where murmurs best heard
Where is the tricuspid valve heard ?
4th ICS
- LSB
Where is the mitral valve heard ?
5th ICS
- left midclavicular line
What side of the stethoscope does the diaphragm listen for ?
high-pitched sounds
- (lub/dub)
What side of the stethoscope does the bell listen for ?
low-pitched sounds
- murmurs
How does excess alcohol, cocaine, and nicotine affect the CVPV system ?
- associated with HTN and development of cardiomyopathy
- associated with MI (myocardial infraction aka heart attack) and stroke
- causes vasoconstriction
What is orthostatic hypotension ?
a decrease of SBP of at least 20 mmHg and/or DBP of at least 10 mmHg within 3 mins of standing
- associated with fluid volume deficit, antihypertensive medications or prolonged bed rest
When palpating the pulses what do you do ?
- use finger pads of first 2 fingers
- apply light pressure
- feel for rate, rhythm, and amplitude
- compare bilaterally (except carotid)
- use Doppler to amplify sound if needed
What are the different levels of the pulse amplitude ?
0+: absent
1+: diminished, barely palpable
2+: normal
3+: full volume
4+: full volume, bounding
5+: full volume, bounding hyperkinetic
What pulse do you palpate 1 at a time ?
the carotid because you don’t want to reduce blood flow to the brain
What pulse is commonly used in CPR adult assessments ?
carotid
What pulse is commonly used in CPR and cap refill in infants/small children ?
brachial
What is the Allen’s test ?
tests for blood flow or perfusion of the hand through the radial and ulnar artery
- color of hand should return within 10 secs and
What are the different levels of the edema scale ?
0+: no edema (we don’t use 0+ but instead just say “no edema”)
1+: (2 mm) barely perceptible but hard to tell
2+: (4 mm) deep pit with rebound in a few secs
3+: (6 mm) comes back in 20-30 seconds and is more deep
4+: (8mm) even deeper with rebound of more than 30 secs of return
What should the cap refill in infants be ?
<1 sec
What should the angle of the nail beds be ?
160 degrees
- >180 degrees is considered clubbing
What does the S1 sound mean and what occurs ?
- systolic BP
- closing of mitral (M1) and tricuspid (T1) valves at the same time
- ventricles contract
- beginning of systole
- heard best at apex
What does the S2 sound mean and what occurs ?
- diastolic BP
- closure of aortic (A2) and pulmonic (P2) valves
- ventricles relax
- beginning of diastole
- heard best at base
What are examples of abnormal heart sounds ?
- S3: Ken-tuck-y (slosh’ing-in) (s1,s2,s3)
- S4: ten-ness-ee (a stiff wall) (s4,s1,s2)
Is S3 an abnormal heart sound ?
when blood rushes quickly into the ventricle from the atrium
- can be normal in children and pregnant women
- when heard in adult over age 30 it can mean CHR, fluid volume overload or abnormal ventricular valves
- when heard its right after S2 (.16 secs after)
- can be indicative of heart failure (not always)
What occurs during S4 and is it abnormal ?
rush of blood heard with atrial contraction against the ventricles after atrial contraction
- can be normal in athletes and older adults, and adults younger than age 30
- usually an abnormal sound though
- also called noncompliant or stiff ventricle
- occurs just before S1 (.20 secs before)
What do P-waves mean ?
atrial depolarization (contraction)
What does the QRS complex mean ?
ventricular depolarization (contraction) and atrial repolarization
What do T-waves mean ?
ventricular repolarization
Where is the location of the SA nodes and the function ?
right atrium
- determine how much electrical impulse is given and it stimulates the atrium to contract (p-wave)
- 60-100 impulses
What is the function of the AV node ?
causes ventricles to contract
- QRS complex
- slow down to 40-60 impulses
What is arterial insufficiency (peripheral artery disease) ?
any condition that slows or stops the flow of blood through the arteries
- blood can’t go back down
- commonly because of atherosclerosis or hardening of the arteries
What are the symptoms of arterial insufficiency ?
- leg pain increases when elevated (painful because your blood isn’t going down and working against gravity)
- cooler skin temp
- minimal or no edema
- absence of hair (no blood flow to follicles)
- capillary refill >3 secs
- diminished/absent pulses
- shiny, thin, taut, pale
- cramping in legs because of exercise or activity
Where can arterial insufficiency happen ?
anywhere in the body
- if it affects your heart arteries it can give you a heart attack or chest pain
- if it affects brain arteries it can cause a stroke
- if it affects in the belly it can cause pain after eating
What is venous insufficiency ?
blood can’t go back up so it pools
What are some symptoms of venous insufficiency ?
- pain is aching or cramping (relieved with elevation)
- lower leg edema present (worse in evening since you’ve been on your feet all day)
- skin may feel warm or hot
- cramping is not reproducible consistently with exercise
- hair may be present or absent
- brown color on lower legs
- spider and varicose veins
- pulses present
- ulcerations (medial malleolus)
- thick, tough, brawny, woody skin
- cap refill <3 secs
What is telangiectasias ?
spider veins
- are skinnier veins (common in face)
What is Deep Vein Thrombosis (DVT) ?
when a thrombus (clot) develops within a vein
- usually on lower extremity, in deep veins
What are some signs/symptoms of Deep Vein Thrombosis (DVT) ?
- low grade fever
- fatigue
- Malaise (sick feeling)
- extremity may feel tense, full and heavy
- nodules or lumps (inflammation of vein wall)
- pain (50% are asymptomatic)
- warm to hot OR cool to cyanotic with severe edema
- red to blue color
What is important about aspirin with blood ?
prevents platelet aggregation (thins blood)
What are some health promotion activities that relate to the CVPV ?
- physical activity 30 mins 5x a week prevents coronary artery disease, HTN, and obesity
- stress raises BP
- caffeine can cause tachycardia
What is orthopnea ?
difficulty breathing while lying down
Is visible jugular veins normal ?
no
When assessing the jugular vein what considerations must be taken ?
- elevate HOB 30-34 degrees
- elevate chin slightly and tilt head away from side being examined
- visible pulsation is normal but you shouldn’t be able to see the jugular vein itself
