Heart and blood vessels Flashcards
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
DC:Infants: When does the mass of the left ventricle surpass the right reaching a 2:1 ratio
By 1 years old
DC: infants: Heart position
heart is more horizontal, apex is higher located at fourth intercostal space.
Reaches adult position at 7 years old
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
Non-cardiac factors that affect exercise performance in aging adult
Decrease in skeletal muscle performance
Increase in muscular fatigue
Increased sense of dyspnea
DC: Aging adult: Dysrhythmias
PSVT, ventricular dysrhythmias increases
Ectopic beats
-Tachydysrythmias less tolerated d/t thicker less compliant myocardium, and shortened diastole
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
Leading cause of death in those over 65 years?
CVD
Stage 1 hypertension
Systolic > 140 mmhg
Diastolic>90 mmhg
Factors that play a significant role in acquisition of heart disease
Obesity Alcohol use Smoking Lack of exercise Diet
Which racial group has highest prevalence of HTN
Blacks
Leading cause of death of women
CVD
Chest pain signifies
- Angina- decreased blood flow to coronary arteries
- May have pulmonary, GI, musculoskeletal origin
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
Hemoptysis
Occurs with pulmonary disorders and mitral stenosis
Prodromal symptom in women for MI
Unusual fatigue
Fatigue from reduced CO
worse in the evening
Fatigue from anxiety
Worse in morning or all day
Cyanosis or pallor
occurs with MI, low CO as a result of decreased tissue perfusion
Cardiac edema
Worse in the evening and better in morning after elevating legs
B/L
Unilateral edema
Local vein occlusion or other problem
Risk factors for CAD
Cholesterol Elevate BP Blood glucsose> 100 mg/dl DM Hormonal replacement (collect length in assessment)
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
S1
- 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
S3
ventricular gallop occurs with heart failure and volume overload
S4
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
