Chapter 20- Heart and Neck Vessels Flashcards
Area in anterior chest overlying heart and great vessels
Precordium
How many chambers does the heart have?
4
2 ventricles, 2 atria
Major arteries and veins connected to the heart
Great vessels
Blood vessels arranged in 2 continuous loops:
Pulmonary circulation and systemic circulation
3 layers of the heart wall:
Pericardium: tough, fibrous, double-walled sac that surrounds and protects heart
Myocardium: muscular wall of heart; does the pumping
Endocardium: thin layer of endothelial tissue that lines inner surface of heart chambers and valves
Heart has how many pump systems?
2
Thin-walled reservoir for holding blood.
Atrium
Thick-walled, muscular pumping chamber
Ventricle
Valves are___.
unidirectional. and they open/close passively in response to pressure gradients in moving blood.
4 valves in heart:
2 atrioventricular (AV) valves 2 semilunar (SL) valves
What are the names of the 2 AV valves that seperate the atria and ventricles:
Triscupid valve: right AV valve
Bicuspid or mitral valve: left AV valve
AV valves open during ____.
diastole. during the hearts filling phase to allow ventricles to fill with blood.
AV valves close during ___.
Systole (pumping phase) to prevent regurgitation of blood back up into atria.
SL valves have __ cusps that look like half moons.
3
SL valve in right side of heart
Pulmonic valve
SL valve in left side of heart
Aortic valve
__ valves are present between vena cava and right atrium, or between pulmonary veins and left atrium.
NONE, 0.
Abnormally high pressure in ___ side of heart gives a patient symptoms of pulmonary congestion.
Left
Abnormally high pressure in ___ side of heart shows in neck veins and abdomen.
Right
___ blood drains into vena cava, following route of venous blood.
Unoxygenated
Blood goes from liver to ___ through inferior vena cava.
Right atrium
From RV, venous blood flows through ___ to pulmonary artery.
Pulmonic valve
__ oxygenate blood.
Lungs
From LA, arterial blood travels through __ valve to the __.
mitral
Left Ventricle
LV delivers blood to the ___.
Aorta.
Aorta delivers ___ blood to body.
oxygenated
__ is continuous loop; moving by continuous shifting pressure gradients.
Circulation
ventricles relax and fill with blood; 2/3 of cardiac cycle
Diastole
protodiastolic filling is the ___, where blood puts rapidly into the ventricles.
first/early passive phase
Presystole or atrial systole is also called the ___. this is when the atria contracts and pushes the last amount of blood into the ventricles.
atrial kick.
hearts contraction, blood pumped from ventricles fills pulmonary and systemic arteries; 1/3 of cardiac cycle
Systole
Atrial systole occurs during __.
ventricular diastole
For a brief moment, all four valves are ___ and ventricular walls undergo ___ and ___.
Closed
Isometric Contraction
Isometric Relaxation
This contraction against closed system works to build high level pressure in ventricles.
Isometric Contraction
All four valves closed and ventricles relax.
Isometric relaxation
Same events occur on __ sides of the heart. __ side requires lower pressure and sequence occurs slightly later because less energy is needed to pump blood to its destination.
Both
Right
Occurs with closure of AV valves- signals beginning of systole
Mitral component of first sound (M1) slightly preceded tricuspid component (T1)
First heart sound (S1)
Occurs with the closure of semilunar valves- signals end of systole
Aortic component of second sound (A2) slightly precedes pulmonic component (P2).
S2 loudest at base.
Second heart sound (S2)
The volume of right and left ventricular systole is just about equal, but this can be effect by respiration. consider the phrase:
MoRe to the Right heart, Less to the Left
Occurs when ventricles resistant to filling during early rapid filling phase (protodiastole)
Occurs immediately after S2, when AC valves open and atrial blood first pours into ventricles.
Extra heart sounds (third heart sound S3)
Occurs at end of diastole, at presystole, when ventricle resistant to filling phase (protodiastole)
Occurs just before S1
Fourth heart sound (S4)
Extra heart sound
Gentle, blowing, swooshing sound that can be heard on the chest wall
Conditions that create turbulent blood flow and collision currents
Murmurs
What conditions can result in murmurs?
Velocity of blood increases
Viscosity of blood decreases
Structural defects in the valves or openings occur in the chambers
Characteristics of sound:
Frequency or pitch: high to low
Intensity or loudness: loud or soft
Duration: very short for heart sounds; silent periods are longer
Timing: systole or diastole
Heart has a unique ability : ___.
Automaticity
Automaticity in the heart:
It can contract by itself, independent of any signals or stimulation from body
Contracts in response to an electrical current conveyed by a conduction system
Specialized cells in Sinoatrial (SA) node, near superior vena cava initiate an electric impulse
Because SA node has intrinsic rhythm, it is called the pacemaker.
Electrocardiograph (ECG): the waves are labeled ___. and what does each do?
PQRST
P wave- depolarization of atria
PR interval- from beginning of P wave to the beginning of the QRS complex (time needed for atrial depolarization)
QRS complex- time necessary for atrial depolarization plus time for impulse to travel through AV node to ventricles (depolarization of ventricles)
T wave- Repolarization of ventricles
Cardiac output in an adult:
4-6L of blood per minute throughout the body
Cardiac output equation
CO= HR x SV
cardiac output = number of beats per minute (heart rate) x volume of blood in each systole (strove volume)
venous return that builds during diastole
Preload
opposing pressure ventricle must generate to open aortic valve against higher aortic pressure
(resistance against which ventricle must pump its blood)
After load
Carotid artery’s pulse— characteristics of its wave form:
Smooth rapid upstroke
Summit rounded and smooth
Downstroke more gradual and has a dicrotic notch caused by close of aortic valve.
Jugular Venous empties __ blood into superior vena cava.
unoxygenated
Jugular Pulse: 5 components
A wave reflects atrial contraction.
C wave (ventricular contraction) is backflips from bulging upward of triscuspid valve when it closes at beginning of ventricular systole.
X wave descent shows atrial relaxation when right ventricle contracts during systole.
V wave occurs with passive atrial right because of increasing volume in right atria.
Y descent reflects passive ventricular filling when triscuspid valve open and blood flows from RA TO RV
Fetal heartbeat begins to beat after __ weeks’ of gestation.
3
Blood volume increase by ___ to ___ during pregnancy.
30% to 40%
The cardiovascular system consists of :
the heart and the blood vessels
The ___ and ___ return unoxygenated venous blood to the right side of the heart.
superior and inferior vena cava
The ___ leave the RV, bifurcated, and carries the venous blood to the lungs.
Pulmonary artery
The ____ returns the freshly oxygenated blood to the left side of the heart, and the ___ carries it out to the body.
Pulmonary veins
aorta
A tough, fibrous, double-walled sac that surrounds and protects the heart.
The pericardium
The ___ side of the heart pumps blood into the lungs.
Right
The __ side of the heart pumps blood into the body.
Left
Each side of the heart had an ___ and a ___.
atrium and ventricle
The four chambers are separated by swinging-door-like structures called ___ , whose main purpose is to prevent back flow of blood
Valves
The valves thin leaflets are anchored by collagenous fibers, called ____ , to papillary muscles embedded in the ventricle floor.
Chordae Tendinae
The SL valves open during ___ when blood ejects from the heart.
Pumping (systole)
The rhythmic movement of blood through the heart
Cardiac Cycle
Where is S1 loudest?
At the apex
The ___ component of the first sound slightly preceded the triscuspid component, but you usually hear these two components fused as one sound.
M1- mitral component
The ___ component of the second sound slightly precedes the pulmonic component.
Aortic component - A2
S2 is loudest at ___.
The base
The pacemaker of the heart
SA node
__ events slightly precede __ events in heart.
Electrical
Mechanical
The heart can alter its CO to adapt to __ needs of the body.
metabolic
__ and __ can affect hearts ability to increase CO.
preload and afterload
According to Frank-Starling law:
“great the stretch, the stronger the hearts contraction”
How many Jugular veins are present on each side of the neck?
2
I’m pregnant women, despite the increased cardiac output, arterial BO ___ in pregnancy as a result of peripheral vasodilation.
decreases
__ and __ of lungs at birth produced circulatory changes
Inflation, aeration
Increase in systolic BP due to thickening and stiffening of the arteries
Isolated systolic HTN
Pressure/pulse changes with Aging:
Left ventricular wall becomes thicker but the overall size of the heart does not change.
pulse pressure increases
no change in resting heart rate or CO at rest
Ability of heart augment cardiac output with excerise is decreased
The presence of supraventricukar and ventricular dysrhythmias ___ with age.
increase
___ beats are common in aging people; although these are usually a symptomatic in healthy older people, they may compromise cardiac output and BP when disease is present.
Ectopic
___ may not be tolerated as well in older people.
Tachydysrhythmias
Electrocardiogram changes:
Prolonged P-T interval and prolonged Q-T interval, but the QRS interval is unchanged.
Left axis deviation form age/related mild LV hypertrophy and fibrosis in left bundle branch
Increased incidence of bundle branch book
___ most common underlying cause of death globally
CVD
Culture and Geneteics. CVD Risk factors:
High BP smoking Serum Cholestrol Physical Activity Sex and Gender Differences
Dyspnea
Difficulty breathing
To evaluate the carotid arteries, the person can be ___
sitting up
To access the jugular veins and the precordium, the person should be ___.
Supine with the head and chest elevated between 30-45 degrees
When performing a regional CV assessment use this order:
Pulse and BP
Extremities
Neck Vessels
Precordium
Palpating carotid artery:
Only one at a time to avoid compromising arterial blood to the brain
Feel contour and amplitude of pulse, normal strength 2+
findings should be same bilaterally
Auscultate the carotid artery:
Assess for prescence of carotid bruit
- avoid compressing the artery which can create an artificial bruit
Keep neck in neutral position and lightly apply stethoscope at
- angle of jaw, midcervical area, and base of neck
From the jugular veins you can assess the ____, and thus judge the hearts efficiency as a pump and the intravascular volume status.
Central venous pressure (CVP)
How should a person be when inspecting jugular venous pulse?
Supine anywhere from a 30-45 degree angle, wherever you can best see pulsations.
Characteristics of jugular versus carotid pulsations:
differentiate between: location, quality, respiration, palpable, pressure, and position of patient
Identify auscultatory areas associated with valves. Sound radiates with blood flow direction; valve areas are:
Second right interspace: aortic valve area
Second left interspace: pulmonic valve area
Left lower sternal border: tricuspid valve area
Fifth interspace at around left midclavicular line: mitral valve area
Precordium Auscultation. Identify ___ and ___. and listen for ___ and ___.
S1 and S2
extra heart sounds; describe them
murmurs; describe them
Heart rate may range from ___ to ___ beats per minute immediately after birth.
100 to 180
murmurs in the immediate newborn ___ necessarily indicate congenital heart disease seen due to shunt closure.
do not
Heart Failure symptoms:
Dilated pupils, skin pale/gray/ or cuantoic, dyspnea, orthopnea, crackles (wheeze), cough, decreased BP, nausea/vomiting, ascites, dependent pitting edema, anxiety, falling O2 saturation, confusion, jugular vein distention, infarct, fatigue, S3 gallop (tachycardia), enlarged spleen and liver, decreased urine output, cool moist skin, and weak pulse.
signs and symptoms of heart failure come from :
- the hearts inability to pump enough blood to meet the metabolic demands of the body
- the kidneys compensatory mechanisms of abnormal retention of sodium and water to compensate for the decreased cardiac output.
the heart cannot contract properly
systolic dysfunction
a failure of the heart to fully relax between heartbeats
diastolic dysfunction
S1 sound
loud
faint
varying intensity
split
S2 sound
Accentuated
Diminished
Normal splitting
- fixed split, paradoxical split, and wide split
What abnormal sounds are these: Ejection click, aortic prosthetic valve sounds, and midsystolic click
systolic
What abnormal sounds are these: opening snap, mitral prosthetic valve sound, third heart sound, fourth heart sound, summation sound, and pericardial friction rub.
Diastolic
Persistence of the channel joining left pulmonary artery to aorta
Patent Ductus Arteriosus
Severe narrowing of descending aorta, usually at the junction of the ductus arteriosus and the aortic arch, just distal to the origin of the left subclavian artery.
Coarctation of the Aorta
