Chapter 19-Heart and Neck Vessels Flashcards
What is the cardiovascular system composed?
Heart and blood vessels
What are the two circulatory loops responsible for transporting blood throughout the body?
Pulmonary circulation and Systemic circulation.
What is the precordium?
The area on the anterior chest directly overlying the heart and great vessels.
What is middle third of the thoracic cage called?
The mediastinum
What does the mediastinum contain?
Heart and great vessels
Where is the Apex of the heart located?
5th intercostal space, 7-9cm from the midsternal line.
what are the great vessels in the heart?
Superior/Inferior vena cava, pulmonary arteries/veins, and aorta.
What are the three layers of the heart?
pericardium, myocardium, and endocardium
What is the pericardium?
This is the tough, fibrous, double-walled sac that surrounds and protects the heart. It has pericardial fluid between the layers.
What is the myocardium?
The muscular wall of the heart, that provides the pumping.
What is the endocardium?
This is the thin layer of epithelial tissue that lines the inner surface of the heart chambers and valves.
The right side of the heart pumps blood where?
the right side of the heart pumps blood into the lungs providing for the pulmonary circulation.
The left side of the heart pumps blood where?
the left side of the heart pumps blood into the body, providing for the systemic circulation.
What are the four chambers of the heart?
Right atrium, left atrium, right ventricle, and left ventricle.
What are the four heart valves and where located?
The four heart valves: 2 Atrioventricular AV valves: Bicuspid (mitral), tricuspid, 2 Semilunar (SL) valves: aortic, and pulmonary.
Tricuspid: Right AV Bicuspid Mitral): Left AV.
Aortic: Left side of heart Pulmonary: Right side of heart
What is systole?
Systole: Pumping action of the heart.
What is the cardiac cycle? What are its two phases?
Cardiac cycle: Rhythmic movement of blood through the heart. 2 Phases: Systole and Diastole. Systole: contraction phase, diastole: relaxation phase.
what is the first passive filling phase in which blood pours into the ventricles?
Early or protodiastolic filling.
What is the active filling phase in which the atria contract and push blood into the ventricles?
presystole or atrial systole
What is the S1 sound? Where is this sound heart predominately?
S1 is the first heart sound; which indicates closure of AV valves and signals beginning of systole. This sound is heard over the apex of the heart.
What is the S2 sound? Where is this heard best?
S2 is the second heart sound which indicates a closure of the semilunar valves and signals the end of systole. The S2 sound is heard best at the base of the heart.
What are four characteristics to describe heart sounds?
Pitch (frequency) Intensity (loudness), Duration, and Timing.
On a heart rhythm, what does the P, PR interval, QRS complex, and T waves represent?
P wave: Depolarizaion of the atria
PR interval: 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: Depolorization of ventricles
T wave: Repolarization of ventricles
What is cardiac output?
Cardiac Output (CO): volume of blood in each systole. CO=SV(stroke volume) X R (heart rate).
what is preload and after load?
Preload: Venous return that builds during diastole.
Afterload: Opposing pressure that ventricles must generate to open the aortic valve.
What vessels are evaluated in a CV assessment?
the carotid artery and jugular veins. (external jugular is most superficial)
How does the CV system adapt for pregnancy?
Blood volume increases by 30-40% with most rapid expansion during the second trimester. Increase in stroke volume, cardiac output, and increased pulse rate of 10-15 beats/min.
What changes occur with pulse rate during pregnancy?
Pulse rate rises in first trimester, peaks in the third trimester, and returns to baseline within first 10 postpartum days.
What happens to arterial Blood pressure during pregnancy?
Arterial blood pressure decreases in pregnancy due to peripheral vasodilation. BP drops to lowest point in 2nd trimester and rises after that.
When does the fetal heart begin to beat
three weeks gestation.
What is the foramen ovale?
The opening between the two atria of the heart.2/3 of fetal blood is shunted from the placenta to the foramen ovale to the left side of the heart
What is the ductus arteriosus?
Blood vessel that connects the pulmonary artery to the proximal descending aorta
What is the method for auscultating for heart sounds?
Auscultate over precordium from base of the heart to apex in zig zag formation over four valve areas (aorta, pulmonary, tricuspid, and bicuspid).
What do murmurs sound like?
gentle, blowing, swooshing sound heard on the chest wall.
How much blood does the heart pump per minute throughout the body in a resting adult?
The heart pumps 4-6 liters of blood per minute throughout the body in a resting adult.
Why should you only assess one carotid artery at a time?
If you compress both carotid arteries, you will occlude blood flow to the brain.
Where is the carotid artery located? How should this pulse feel?
Between the trachea and sternomastoid muscle. The carotid pulse should feel soft and pliable.
How are Bruits sounds assessed and what do they sound like?
Bruits are assessed by auscultation, heard as a blowing or swishing sound.
What would make a Bruit sound louder? what happens when the vessel with a Bruit is totally occluded?
Bruits become louder as atherosclerosis worsens, when totally occluded, they will disappear.
What is the major cause of stroke?
Carotid Artery Stenosis.
Hemorrhagic stroke is often related to what?
Hypertension
Ischemic stroke is related to
Atherosclerosis
What is CVP?
Central Venous Pressure
The Jugular vein empties unoxygenated blood into what vessel?
Superior Vena Cava
What would you observe in the jugular vein of someone who has heart failure?
The vein would be elevated more than 3cm above the sternal angle when the patient is elevated at a 45 degree angle.
Why is it difficult to isolate the CV in the aging adult?
Because it is so closely related to lifestyle, habits, and diseases.
What changes occur with BP of an older adult? What causes this change?
The systolic pressure increases as a result of thickening and stiffening of large arteries. The diastolic may decrease by the 6th decade.
what happens with the resting heart rate and cardiac output of the aging adult?
It remains unchanged.
What effect does aging have in regard to dysrhythmias?
Ventricular and supraventricular dysrhythmias occur more frequently with the aging adult population.
What are lifestyle factors that influence CV disease?
Smoking, alcohol use, obesity, lack of exercise, unhealthy eating.
What is Stage 1 hypertension?
140/90 or greater or currently taking hypertension medication.
What gender has the most hypertension and at waht age?
Males have higher BP until age 45. 45-64, both males and females in this age group have equal levels of hypertension. After age 64, women have a higher percentage of hypertension.
What effect do oral contraceptives have on blood pressure?
Hypertension in women who take oral contraceptives is 2-3 times higher than that of women who do not.
What is the leading cause of preventable disease, disability, and death in the United States?
Smoking
How does nicotine increase the risk of heart attack and stroke?
Nicotine causes the following: 1. increase in oxygen demand with a concomitant decrease in oxygen supply, 2. an activation of platelets and fibrinogen, 3. and an adverse change in the lipid profile.
How is LDL level related to stroke and heart disease?
high levels of LDL add to the lipid core of thrombus formulations in arteries.
How does DM type II contribute to stroke and heart disease?
There is a two-fold risk: Increase in DM results in an increase of morbidity and mortality among pts with CVD. The second part is that DM causes damage to large blood vessels that nourish the brain, heart, and extremities. This results in stroke, CAD, and PVD.
What are risk factors for developing CAD?
Elevated cholesterol, elevated BP, blood glucose over 100 mg/dL, known DM, obesity, smoking, low activity level, length of hormone replacement therapy.
What are the causes of cardiac ischemic pain?
Angina Pectoris (stable angina), Variant (Prinzmetal) angina, acute coronary syndrome: MI, unstable angina.
What are the symptoms, pain, and location of Angina Pectoris?
Pain: pressure, squeezing, tightness, burning and heaviness. Eases with rest; brought on by activity
Location: gen. substernal or retrosternal, can radiate to jaw, neck, arms (one or both), shoulders.
Associated Symptoms: Diaphoresis, nausea, vomiting, dyspnea.
What are the symptoms, pain, and location of Prinzmetal (variant) Angina
Pain:Pressure like discomfort often occurring at rest and early am hours.
Location: Retrosternal, can radiate to jaw, neck, left arm, or shoulder.
Assoc. Symptoms: Palpitations, syncope, or feelings of syncope.
What are the symptoms, pain, and location of Acute Coronary Syndrome (unstable angina, MI)?
Pain: Heaviness, vicelike, squeezing, tightness, crushing, burning. poorly localized, does not ease with rest. 20-30 minutes to hours
Location: Gen. substernal or retrosternal, can radiate to arm, jaw, shoulder, teeth, neck, (may be one or both arms/shoulders.
Assoc. Symptoms: Indigestion like feeling, nausea, vomiting, dizziness, flushing, perspiration, palpitations, dyspnea
What are some Cardiac nonischemic causes of chest pain?
Pericarditis, Mitral Valve Prolapse, Aortic Dissection, and Pulmonary Hypertension.
What are symptoms of pericarditis?
Sudden, sharp, stabbing pain. (relieved by sitting forward/ worsens by lying down), Substernal, may radiate to trapezius.
Assoc. symptoms: dry cough, muscle and joint aches, fever.
What are symptoms of mitral valve prolapse?
Sharp pain not assoc. w/activity. Chest pain that does NOT radiate.
Assoc. Symptoms: Fatigue, dyspnea, light-headed, irreg. heartbeat, palpitations, exer. intolerance.
What are symptoms of Aortic Dissection?
Sudden, severe pain with change of location and/or tearing sensation lasting for hours. Ant. chest pain, radiates to neck, jaw, or intrascapular region of back.
Assoc. Symptoms: Mental status changes, limb pain and weakness, dyspnea
How does pulmonary hypertension present?
Cardiac like chest pain with exertion. Pain in chest region,
Dyspnea, lower extremity edema, fatigue.
What are some PULMONARY causes of chest pain?
Pulmonary embolism, pneumonia, and pneumothorax,
How does pulmonary embolism present?
sharp stabbing pain, worse with deep breaths,
Location of pain: chest, back, shoulder, or upper abdomen. Assoc. symptoms: dyspnea, cough, hemoptysis.
What are symptoms/pain with pneumonia?
sharp or stabbing pain assoc. w/cough. Location of pain: usually one side of chest, can be upper abd. Assco. symptoms: cough, fever, dyspnea, chills, sputum, myalgia, malaise
How does pneumothorax pain present?
acute, sudden, and sharp. Located in lateral region of the chest, can be referred to shoulder. Assoc. symptoms: acute dyspnea, cough
What are some GI causes of chest pain?
GERD, esophageal spasm, cholecystitis, pancreatitis,
what are symptoms of GERD?
angina like pain, burning sensation, reproduced lying down, eased with sitting up. Pain in retrosternal region,
Assoc. Symptoms: cough, regurgitation of food, abd. pain
What are symptoms of esophageal spasm?
crushing chest pain, substernal location, symptoms: dysphagia, sensation of object in throat or esophagus.
How does cholecystitis present?
sudden onset of pain that peaks, usually after eating a fatty meal. can last up to 20 min.
Location: RUQ, epigastrium, may radiate to right intrascaplular region, shoulder, and back,
Assoc. Symptoms: n/v, anorexia, fever
How does pancreatitis present?
Pain: sudden, dull, boring, steady pain leaning forward or fetal position may relieve pain, lying down does not.
Location: epigastrium or perumbilical pain radiating to the back.
Assoc. Symptoms: N/V, anorexia, diarrhea may be present.
What is a dermatologic cause of chest pain? Location and symptoms?
Herpes zoster: Unilateral, burning, or borelike pain. Location: chest region in dermatome distribution. Assoc. symptoms: tingling, itching, burning
What are some musculoskeletal/neurologic causes of chest pain?
costochondritis and chest wall muscle strain
How does costochondritis present?
sharp, pleuritic pain, worsens with deep palpation, movement, and deep breathing. 2-5th intercostal space, can radiate to arm. Chest tightness, warmth at area of pain
How does chest wall muscle strain present?
sharp pain with movement, stretching, or pushing. palpation reproduces pain. Location: are of strained muscle, rib, or sternum. Assoc. symptoms: muscle spasm, crepitation, swelling, loss of strength.
what are two psychogenic causes of chest pain
depression and anxiety
What are some questions to ask when a person c/o dyspnea on exertion?
after walking, how far, does it interfere with completion of ADLs?
How does cardiac edema typically present?
Edema is bilateral, worse in the evening, and better in the morning.
What is a thrill?
Vibration felt upon palpitation
What does a thrill in the 2nd and 3rd right ICS indicate?
aortic stenosis and systemic hypertension
What does a thrill in the 2nd and 3rd Left ICS mean
pulmonic stenosis and pulmonic hypertension
What does a lift (heave) indicate at Left sternal border
right ventricular hypertrophy as is found in pulmonic valve disease, pulmonic hypertension, and chronic lung disease.
What do pulsations at the apex indicate? See page 501
When the apical pulse is displaced laterally and over a wider area due to left ventricular hypertrophy and dilation. Volume overload that occurs with heart failure, mitral regurgitation, aortic regurgitation, left to right shunts. When apical pulse is increased in force and duration: pressure overload found in aortic stenosis or systemic hypertension
