Chapter 19: Cardiac Flashcards
Pericardium
tough, fibrous, double-walled sac that surrounds and protects heart
Myocardium
muscular wall of heart; it does pumping
Endocardium
thin layer of endothelial tissue that lines inner surface of heart chambers and valves
How many pumps does the heart have?
2
Are valves uni or multidirectional?
Unidirectional
Do the valves work active or passively?
Valves open and close passively in response to pressure gradients in moving blood
What is the S1 sound?
Closing of AV valve
What is the S2 sound?
Closing of semilunar valve
When do you hear S3 and S4
S3 is after S2 and S4 is before S1
What is systole?
Ventricular contraction
What is diastole?
Ventricular relaxation
What is friction rubs?
Rubbing of the pericardium
Heart murmur grades
1-6
Grade 1 needs a bell and grade 6 can be heard with diaphragm
Physiologic murmur
a heart murmur that is primarily due to physiologic conditions outside the heart.
Ex: first trimester in pregnancy
Pathologic murmur
a pathologic murmur is produced by blood flowing through a narrowed blood vessel or hole in the heart.
S3 murmur
“Ventricular gallop”
S3 occurs when ventricles resistant to filling and ventricles have reached the elastic limit (dilated ventricles)
Occurs immediately after S2, when AV valves open and atrial blood first pours into ventricles
**Normal in children
S4 murmur
“Atrial gallop”
Occurs at end of diastole, at presystole, when ventricle resistant to filling
Atria contract and push blood into non compliant ventricle
This creates vibrations that are heard as S4
S4 occurs just before S1
Always a disease, never innocent
How do you characterize heart sounds?
Frequency, Loudness/Intensity, Duration, Timing
What impacts BP?
C.O, PVR, Viscosity, blood vessel elasticity, volume of circulating blood,
Should you hear blood circulating through normal cardiac chambers and valves?
Blood circulating through normal cardiac chambers and valves usually makes no noise
Reasons for murumr
Velocity of blood increases (flow murmur), for example, in exercise, thyrotoxicosis
Viscosity of blood decreases, for example, in anemia
Structural defects in valves, narrowed valve, incompetent valve
Unusual openings occur in chambers, dilated chamber, wall defect
Conduction
SA to AV to Bundle of His to Purkinje fibers to Apex then up ventricles
ECG: Electrocardiograph
P wave: depolarization of atria
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)
QRS complex: depolarization of ventricles
T wave: repolarization of ventricles
Stroke volume
Volume of blood that ejected from the left ventricle with each contraction
Cardiac Output
- Stroke volume x Heart Rate
- Amount of blood heart pushes per minute
Carotid artery
Close to heart; timing closely coincides with ventricular systole
Located in groove between trachea and sternomastoid muscle, medial to and along-side that muscle
(+2 pulse)
Jugular vein purpose
Jugular veins empty un oxygenated blood directly into superior vena cava
Usually not visible, although diffuse pulsations may be seen in sternal notch when person is supine
Distended jugular vein means what?
Cardiac failure
How does oxygenation take place for a baby in utero?
Placenta is where oxygenation takes place because of shunts that allow it to bypass the lungs
-Foramen ovale and Ductus arteriosus
Heart rate for infant
110 - 160
What murmur is normal for infants in the first few hours
Physiologic S3
How many arteries and veins does an umbilical have?
2 arteries and a vein
Special considerations in pregnant females
Blood Volume increases, BP decreases, S1 louder, Mammary souffle (continuous murmur from breast vasculature) [Heard in 2nd, 3rd, 4th intercostal], Physiologic anemia (bc blood is diluted), Supine hypotensive syndrome
Special considerations in older adult
Risk for CVD, ability to augment cardiac output, Left ventricle thickens, Valves thicken, Systolic BP increases, Pulse pressure widens, Arteriosclerosis (hardening of blood vessels and BP increases)
Diabetes mellitus effects on heart
Increases risk for CVD
Hypertension is more common in who?
Blacks and women taking oral contraceptives and in obese women
Risk factors for Cardiac Disease
Obesity, High cholesterol, HTN, Smoking, Diet, Physical inactivity, Family history, Diabetes
When is it hard to find Apical pulse?
obese, have barrel chest, if a lot of muscle, if pregnant woman or child
Heaves vs Thrill
Thrill is palpable murmur
Heaves is lifting when you palpate the area
When percussing the heard and cardiac border what should you hear?
A dull sound, you should not hear it between 7 and 8 intercostal though
Where is S1 and S2 the loudest
S2 at the base and S1 at the apex
Where do you auscultate for murmurs?
Aortic, Pulmonary, Erbs, Tricuspid, Mitral
Developmental competence in infants
Heart rate may range from 100 to 180 beats per minute (bpm) immediately after birth
Infant murmurs
Usually a grade I or II
They are systolic and accompany no other signs of cardiac disease, and they disappear in 2 to 3 days
Murmur of patent ductus arteriosus is continuous machinery murmur, which disappears by 2 to 3 days
Signs in children that may indicate heart disease
Poor weight gain, developmental delay, persistent tachycardia, DOE, cyanosis, clubbing
Venous hum in children
Venous hum, due to turbulence of blood flow in jugular venous system, common in healthy children and has no pathologic significance
BP and HR in pregnant women
BP drops slightly and HR increases 10-15 bpm
Thrill at 2nd and 3rd right interspace occurs with
Severe aortic stenosis and systemic hypertension
Thrill in the 2nd and 3rd left intercostal space occurs with
pulmonic stenosis and pulmonic hypertension
Lift or Heave at the left sternal border indicates
right ventricular hypertrophy which is found in pulmonic valve disease, pulmonic hypertension and chronic lung disease
Cardiac enlargement displaces apical pulse which causes
Volume overload, heart failure, mitral regurgitation, aortic regurgitation and left to right shunts
Left ventricular hypertrophy occurs without dilation which causes
Pressure overload which is found in aortic stenosis or systemic hypertension
PDA: Patent Ductus Arteriosus
Connection of pulmonary artery and aorta
ASD: Arterial Septal Defect
Opening between aortas, increasing pulmonary blood flow
VSD: Ventricular septal defect
Opening between ventricles in usually the sub-aortic area
Tetralogy of Fallot
Right ventricular outflow stenosis, VSD, right ventricular hypertrophy, overriding aorta
Coarctation of the aorta
Severe narrowing of descending aorta usually at the ductus arteriosis and aortic arch
Associated w/ defects of aortic valve
Mitral stenosis
Narrowing of left mitral valve
Can be due to rheumatic fever or cardiac infection
Aortic Stenosis
Narrowing or aortic valve
Congenital bicuspid valves, rheumatic heart disease and atherosclerosis can cause it
Mitral regurgitation
Back flow of blood from left ventricle into the left atrium
Due to rupture of chordae tendineae, MI
Pulmonic stenosis
Narrowing of the opening between the pulmonary artery and the right ventricle
Congenital
Coarctation of the aorta
Different BP with higher and lower extremities
Pulse difference so, 3+ in top extremities and 1+ with lower extremities
