Chapter 20:Heart and Neck Vessels Flashcards
where is the heart and greater vessels located
mediastinum
precordium
are on the anterior chest overlying the heart and greater vessels
venae cavae
return unoxygenated venous blood to the right side to the heart
pulmonary artery
leave the right ventricle, bifurcates, and carries the venous blood to the lungs
pulmonary vein
returns the freshly oxygenated blood to the left side of the heart
aorta
carrys blood out to the body
pericardium
tough, fibrous, double walled sac that protects the heart
myocardium
muscular wall of the heart
- does the pumping
endocardium
the thin layer of endothelial tissue that lines the inner surface of the heart chambers and valves
right AV valve
tricuspid valve
left AV valve
mitral valve
right side semilunar valve
pulmoric valve
left side semilunar valve
aortic valve
what happens in diastole
the ventricles relax and fill
- 2/3 of the cycle
wat happens during systole
- hearts contraction
- blood is pumped from the ventricles and fills pulmonary and systemic arteries
1/3 of cycle
what is the first diastolic phase
early or protodiastolic filling
what is the active filling phase called
presystole or atrial systole
isometric contractions
- all four ventricles closed
- contraction across a closed system works to build pressure inside the ventricles to a high level
S1 sounds heard
closure of the mitral valve can be heard just before tricuspid valve closure
S2 sounds heard
aortic valve closure occurs slightly before pulmonic valve closure
where can the S1 sound be heard the loudest
apex
where is the S2 sound heard the loudest
at the base
S3 soundswhich 3 conditions result in a murmur
- increases in velocity of blood flow
- decreases in viscosity of blood
- structural defects in the valves
what are the 4 characteristics of heart sounds
- frequency (pitch): high or low pitch
- intensity (loudness): loud or soft
- Duration: very shorrt
4. timing : systole or diastole
SA node is known as the
pacemaker
p wave
depolarization of the ventricles
P-R interval
interval from the begining of the P wave to the beggining of the QRS complex
- time required for atrial depolarizartion plus time for impulse to travel to the AV node the the ventricles
QRS complex
depolarization of the ventricles
T wave
repolarization of the ventricles
Co formula
CO=SVxRate
preload
- venous return that builds during diastole
- lenght to which the ventricular muscle is stretched at the end of diastole just before contraction
Afterload
- opposing pressure that the ventricle must generate to open the aortic valve against the higher aortic pressure
internal jugular vein location
lies deep and medial to the sternomastoid muscle
- not visable
external jugular vein location
lies lateral to the sternomastoid muscle above the clavical
- more superficial
A wave
- RA contracts
- tricuspid opens
X descent
- RA relaxes. starts to fill
- tricuspid closes
V wave
- RA filling
- tricuspid closed
Y descent
RA emptied
- tricuspid opens
blood volume increased by ____% during pregnancy
30-40%
pulse rate increases _____ during pregnancy
10-15 beats per minute
paroxysmal nocturnal dyspnea
- occurs with heart fialure
orthopnea
- need to assume a more upright position to breath
how to asses orthopnea
note the number of pillows used to sleep
Subjective data assesments
- chest pain
- dyspnea
- orthopnea
- cough
- fatigue
- cyanosis or pallor
- edema
- nocturia
- cardiac history
- family cardiac history
cyanosis or pallor occurs with
MI
hemoptysis often occurs as a side effect od
mitral stenosis
paroxysmal nocturnal dysnea occurs as a side effect of
heart failure
edema is dependent when caused by
heart failure
risk factors for CAD
- elevated cholesterol levels
- hypertension
- glucose levels obove 11.1
- known diabetes
- obesity
- cigareete smoking
sedentary lifestyle
how to asses for heart disease in infants
note fatigue during feeding
regional cardiovascular assesment should be preformed in what order
- pulse and blood pressure
- extremeties
- neck vessels
- precordium
bruit
blowing swishing sound indicating blood flow turbulance
- not usually present
you should austclate the carotid artery for sings of
bruit
what heart murmer can radiate to the carotid artery
aortic stenosis
carotid sinus hypersensitivity
- pressure over the carotid sinus leads to a decrease in HR and BP
- may occur in adults with hypertension or occulsion
abnormal finding during palpation of the pericordium
a thrill
- palpable vibration
- signifies turbulent blood flow and accompanies loud murmurs
should you precuss the pericordium
no
second righ tinterspace
aortic valve area
second left interspace
pulmonic valve area
fifth interspace at left lower sternal border
tricuspid valve area
fifth interspace at around left midclavicular line
mitral valve area
normal pulse
60-100 BPM
sinus arrhythmias
- occurs mostly in young adults and children
- rhythm varies with patients breathing (increases during inspiration and slows with expiration)
pulse deficit
-signals weak contraction of the ventricles
- occurs with artial fibrilation, premature beats, and heart failure
how to asses for pulse deficit
auscultating the apical pulse while simultaneously palpating radial pulse
S1 valves
closure of AV valves
S2 valves
closure of the semilunar valves
early systolic murmur sounds
Lshshshs(S1) Dup (S2) Lshshs (s1) Dup (s2)
midsystolic murmur
LubshshsDub LubshshshDub
late systolic murmur
Lub shshshp. Lub shshshp
holosystolic murmurs
shshshshshsh shshshshs
Loudness: grade 1
barely audible, only heard in a quite room and then with difficulty
Loudness: grade 2
clearly audible but faint
Loudness: grade 3
moderately loud; easy to hear
loudness: grade 4
loud, associated with a thrill palpable on the chest wall
Loudness: grade 5
very liud, heard with one corner of the stethoscope lifted off the chest; associated with a thrill
Loudness: grade 6
loudest; still heard with entire stepthoscope lifted off the chest wall; associated with a thrill
murmur of mitral stenosis is
rumbeling
murmur of aortic stenosis is
hearsh
innocent murmurs
have no valvar or other pathological cause
- like fiddle strings
functional murmurs
caused by increased blood flow in the heart
venous hum
- common in healthy children and has no pathologic significance
- turbulance of blood flow in the jugular venous sytem
orthostatic blood pressure
sudden drop in blood pressure when sitting or standing
S3 is associated with
heart failure
fixed split
is unaffected by respiration; split is always there
paradoxical split
the soudns fuse on inspiration and split on expiration
midsystolic click
- associated with mitral valve prolapse
- most common extra sound
right side of the heart
- receives blood from superior and inferior vena cava
- pumps blood through pulmonary arteries to pulmonary circulation
left side of the heart
- receives blood from the pulmonary veins
- pumps blood through aorta into systemic circulation
s3 sound
- after S2 - early diastolic
- blood entering the ventricles during early ventricle filling
- quiet, low pitched
- best heard at the apex, with bell
S4 sound
- before S1, late diastolic
- atria contract, push blood into resistant ventricle
- quiet, low pitched
- best heard at the apex with bell
- pathologic
Internal jugular vein location
- lower, more lateral, under or behing the sternomastoid muscle
Internal jugular vein quality
diffuse; 2 visable waves per cycle
Internal jugular vein respiration
varies with respiration
Internal jugular vein palpuability
none
Internal jugular vein pressure
light pressue obliderates
Internal jugular vein position of patient
levels drop and disappear when sitting
Carotid artery location
higher; medial to sternomastoid
carotid artery quality
brisk, localized, one waver per cycle
carotid artery respiration
does not cary
carotid artery palpuability
yes
carotid artery pressure
no change
carotid artery position of patient
unaffected
carotid artery expected findings
- no bruits
- smooth contour
- 2+ amplitude bilaterally
expected internal jugular measurement
<3cm
unilateral distention of the jugular vein is indicative of
aneurysm
fully distended jugular vein is indicative of
heart failure