- Angina- decreased blood flow to coronary arteries - May have pulmonary, GI, musculoskeletal origin

Heart and blood vessels Flashcards by Alison O'Malley

DC: Infants: how is fetal blood rerouted to maternal supply

Two thirds is shunted through an opening in the atrial septum, foramen ovale into the left side of the heart-> pumped into aorta

Rest of oxygenated blood is pumped by the right side of the heart out through the pulmonary arteries, detoured through ductus arterioles to the aorta

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DC:Infants: When does the mass of the left ventricle surpass the right reaching a 2:1 ratio

By 1 years old

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DC: infants: Heart position

heart is more horizontal, apex is higher located at fourth intercostal space.
Reaches adult position at 7 years old

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DC: Aging adults: hemodynamic changes

Increase in systolic BP
- thickening and stiffening of large arteries–> collagen and calcium deposits in vessel & loss of elastic fibers

Stiffening (arteriosclerosis) creates and increase in pulse wave velocity bc less compliant arteries can’t store blood volume
Size of heart does not increase
Left ventricles does enlarge though
Diastolic BP may decrease after 6th decade
Rise of systolic and decline in diastolic= larger pulse pressure
No change in resting heart rate, or CO
Decreased ability of heart to augment CO with exercise

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Non-cardiac factors that affect exercise performance in aging adult

Decrease in skeletal muscle performance
Increase in muscular fatigue
Increased sense of dyspnea

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DC: Aging adult: Dysrhythmias

PSVT, ventricular dysrhythmias increases
Ectopic beats
-Tachydysrythmias less tolerated d/t thicker less compliant myocardium, and shortened diastole

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DC: Aging adult ECG changes

Prolonged PR, QT intervals
QRS is unchanged
Left axis deviation from age related mild LV hypertrophy and fibrosis in LBB
Increased risk of BB block

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Leading cause of death in those over 65 years?

CVD

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Stage 1 hypertension

Systolic > 140 mmhg

Diastolic>90 mmhg

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Factors that play a significant role in acquisition of heart disease

Obesity
Alcohol use
Smoking
Lack of exercise 
Diet

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Which racial group has highest prevalence of HTN

Blacks

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Leading cause of death of women

CVD

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Chest pain signifies

Angina- decreased blood flow to coronary arteries

- May have pulmonary, GI, musculoskeletal origin

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Paroxysmal nocturnal dyspnea

Occurs with heart failure
Lying down increases volume of intrathoracic blood, and weakened heart cannot accommodate the increased load

Typically the person wakes up w/ 2 hours

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Hemoptysis

Occurs with pulmonary disorders and mitral stenosis

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Prodromal symptom in women for MI

Unusual fatigue

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Fatigue from reduced CO

worse in the evening

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Fatigue from anxiety

Worse in morning or all day

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Cyanosis or pallor

occurs with MI, low CO as a result of decreased tissue perfusion

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Cardiac edema

Worse in the evening and better in morning after elevating legs

B/L

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Unilateral edema

Local vein occlusion or other problem

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Risk factors for CAD

Cholesterol
Elevate BP
Blood glucsose> 100 mg/dl
DM
Hormonal replacement (collect length in assessment)

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Vitamin D deficiency increases risk for?

HTN
CVD
Diabetes
Metabolic syndrome
LV hypertrophy
Chronic vascular inflammation

Carotid sinus hypersensitivity

Pressure over the carotid sinus leads to a decrease hr, decreased bp, and cerebral ischemia w/ syncope

Carotid sinus hypersensitivy causes

HTN or occlusion of the carotid artery

Central Venous Pressure

Assessment of jugular vein pressure and therefore the heart's efficiency as a pump and intravascular volume status

how should you stand for testing CVP?

On patient's right side

What should occur to jugular veins when a person is raised from supine to a 45 degree angle?

The external jugular veins should flatten and disappear

Where can you inspect the internal jugular veins?

Suprasternal notch or around the origin of sternocleidomastoid

Estimating the Jugular Venous Pressure

Normal is 2cm or less | State person's angle at which jugular pulsations stop

What should you perform when venous pressure is elevated or if you suspect heart failure?

abdominojugular test (hepatojugular reflux)

Abdominojuglar test results

4 cm or greater indicates heart failure

Heave or lift indicates?

ventricular hypertrophy as a result of increased workload It is a sustained forceful thrusting of ventricles during systole

What states cause an increase in CO that increases apical pulse amplitude and duration?

Anxiety, fever, hyperthyroidism, anemia

How to perform an apical pulse?

Use one finger pad Patient exhales and holds breath Sustained impulse w/ increased force and duration but no change in location occurs with LV hypertrophy and no dilation (pressure overload)

Carotid bruit

Audible when lumen is occluded to 1/2-1/3

Thrill

Palpable vibration Signifies turbulent blood flow and can help locate the origin of murmurs Absence of thrill does not rule out murmurs Accentuated 1st and 2nd heart sounds also may cause abnormal pulsations

Aortic valve area

Second right intercostal space

Pulmonic valve area

Second left intercostal space

Tricuspid valve area

Left lower sternal border

Mitral valve area

5th intercostal space around left midclavicular space

Pulse deficit

Auscultate the apical beat while simultaneously plating radial pulse

Pulse deficit significance

Signals a weak contraction of the ventricles | Occurs w/ AFib, premature beats, and heart failure

- Louder at the apex - Coincides with the carotid artery pulse - Coincides with the R wave - Caused by closure of the AV valves and signals beginning of systole - Audible in any position, and inspiration and expiration

Split S1

associated with closure of the semilunar valves

Split S2

Normal phenomenon that occurs toward the end of inspiration in some people Only heart in the pulmonic valve area at second left intercostal space

Do the aortic and pulmonic valves close at the same time?

No, aortic closes 0.06 seconds before pulmonic

ventricular gallop occurs with heart failure and volume overload

atrial gallop occurs with CAD

mid systolic gap occurs with

mitral valve prolapse | most common extra sound

Murmur

blowing sound

What characteristics to document a murmur

Timing- systole or diastole Loudness- 6 different grades Pitch- high, medium, low Pattern- grow louder w/ cardiac cycle or tapers etc Quality- musical, blowing, harsh, rumbling Location- Where it is best heard Radiation Posture- some enhance or disappear w/ different positions

Innocent murmurs

Indicates no valvar problems - Soft (grade 2) - midsystolic - short - cresendo-descendo - Vibratory or musical - heard in 2nd-3rd intercostal space - Disappears with sitting

Functional murmur

Caused by increase blood flow in the heart - anemia - pregnancy - fever - hyperthryodism

How do childhood murmurs sound

Louder than adults d/t smaller chest and increase in blood velocity

S3 and S4 murmur of mitral stenosis

May only be heard on left side

Diastolic murmer of aortic regurgitation

May only be heard when person is leaning forward