Heart and Neck Vessels Flashcards
1
Q
The “top” of the heart is the ________
A
base
2
Q
The “bottom” of the heart is known as the _______
A
apex
3
Q
During contraction, the apex beats against the chest wall, producing ___________
A
an apical IMPULSE
4
Q
Of the heart’s 4 chambers, the ________ forms the greatest area of anterior cardiac surface.
A
right ventricle
5
Q
What makes blood fall into the right atrium? (in class question)
A
Only gravity
6
Q
The __________ leaves the right ventricle, bifurcates, and carries the venous blood to the lungs.
A
Pulmonary artery
7
Q
The __________ return the freshly oxygenated blood to the left side of the heart, and the ________ carries it out to the body.
A
Pulmonary veins/
Aorta
8
Q
The __________ is a tough, fibrous, double-walled sac that surrounds and protects the heart.
A
pericardium
9
Q
___________: this ensures smooth, friction-free movement of the heart muscle.
A
pericardial fluid
10
Q
The ________ is the muscular wall of the heart (it does the pumping).
A
myocardium
11
Q
The __________ is the thin layer of endothelial tissue that lines the inner surface of the heart chambers and valves
A
endocardium
12
Q
The ______ side of the heart pumps blood into the lungs, and the _______ side of the heart simultaneously pumps blood into the body
A
right/
left
13
Q
The _______ is a thin-walled reservoir for holding blood.
A
atrium
14
Q
The thick-walled _________ is the muscular pumping chamber.
A
ventricle
15
Q
The ______ open and close passively in response to pressure gradients in the moving blood.
A
valves
16
Q
The right AV valve is the __________
A
tricuspid
17
Q
The left AV valve is the __________
A
bicuspid or mitral valve
18
Q
The AV valves open during the heart’s ___________, to allow the ventricles to fill with blood
A
the heart’s filling phase, or diastole
19
Q
During ___________, the AV valves close to prevent regurgitation of blood back up into the atria
A
the pumping phase, or systole
20
Q
When the valve leaflets do NOT meet and unite to form a perfect seal you have: ____________ (in class point)
A
murmurs
21
Q
The ___________ open during pumping, or systole, to allow blood to be ejected from the heart.
A
semilunar valves
22
Q
**There are no valves between the vena cava and the right atrium nor between the pulmonary veins and the left atrium. For this reason _______________________________________ occurs on each side. **
A
abnormally high pressure in the Left side of the heart gives a person symptoms of -pulmonary congestion-, and abnormally high pressure in the Right side of the heart shows in the -neck veins and abdomen-
23
Q
Review direction of blood flow if needed (pg 458, fig 19-5)
A
- From liver to right atrium (RA) through inferior vena cava
Superior vena cava drains venous blood from the head and upper extremities
From RA, venous blood travels through tricuspid valve to right ventricle (RV) - From RV, venous blood flows through pulmonic valve to pulmonary artery
Pulmonary artery delivers unoxygenated blood to lungs - Lungs oxygenate blood
Pulmonary veins return fresh blood to left atrium (LA) - From LA, arterial blood travels through mitral valve to left ventricle (LV)
LV ejects blood through aortic valve into aorta - Aorta delivers oxygenated blood to body
** Remember that the circulation is a continuous loop. The blood is kept moving along by continually shifting pressure gradients. The blood flows from an area of higher pressure to one of lower pressure.
24
Q
The rhythmic movement of blood through the heart is the__________. It has two phases: In ________, the ventricles relax and fill with blood. This takes up two thirds of the cardiac cycle. The heart’s contraction is _________. During this phase, blood is pumped from the ventricles and fills the pulmonary and systemic arteries. This is one third of the cardiac cycle
A
cardiac cycle/
diastole/
systole
25
Toward the end of diastole, the atria contract and push the last amount of blood (about 25% of stroke volume) into the ventricles. This active filling phase is called __________, or sometimes the “atrial kick.” It causes a small rise in left ventricular pressure.
presystole, or atrial systole
26
The __________ contributes to the first heart sound (S1) and signals the beginning of systole.
(Note: You can hear S1 over all the precordium, but usually it is loudest at the APEX)
closure of the AV valves
27
This contraction against a closed system works to build pressure inside the ventricles to a high level=________
(isometric contraction)
28
The ___________ causes the second heart sound (S2) and signals the end of systole.
(note : Although it is heard over all the precordium, S2 is loudest at the BASE)
closure of the semilunar valves
29
Now all four valves are closed and the ventricles relax= _______________
(called isometric or isovolumic relaxation)
30
The volume of right and left ventricular systole is just about equal, but this can be affected by respiration. To learn this, consider the phrase:
MoRe to the Right heart,
| Less to the Left
31
When the aortic valve closes significantly earlier than the pulmonic valve, you can hear the two components separately, this is is known as ___________
Split S2
32
Normally, diastole is a silent event. However, in some conditions, ventricular filling creates vibrations that can be heard over the chest. These vibrations are known as ___________
S3
33
________ occurs when the ventricles are resistant to filling during the early rapid filling phase (protodiastole).
S3 (This occurs immediately after S2) **S3 hugs S2
34
________ occurs at the end of diastole, at presystole, when the ventricle is resistant to filling.
S4
35
The atria contract and push blood into a noncompliant ventricle. This creates vibrations that are heard as S4. S4 occurs just before __________.
S1 (S4 holds onto S1)
36
A ___________ is a gentle, blowing, swooshing sound that can be heard on the chest wall. (usually blood circulating through normal cardiac chambers and valves usually makes no noise)
murmur
37
Conditions resulting in a murmur are:
1. Velocity of blood increases (flow murmur) (e.g., in exercise, thyrotoxicosis)
2. Viscosity of blood decreases (e.g., in anemia)
3. Structural defects in the valves (narrowed valve, incompetent valve) or unusual openings occur in the chambers (dilated chamber, wall defect)
38
All heart sounds are described by:
1. Frequency (pitch)—heart sounds are described as high pitched or low pitched, although these terms are relative because all are low-frequency sounds, and you need a good stethoscope to hear them
2. Intensity (loudness)—loud or soft
3. Duration—very short for heart sounds; silent periods are longer
4. Timing—systole or diastole
39
The _________ has an intrinsic rhythm, it is the “pacemaker.”
SA node
40
In the resting adult, the heart normally pumps between __________ of blood per minute throughout the body
4 and 6 L
41
Cardiac output=
the volume of blood in each systole (called the stroke volume) X the number of beats per minute (rate) CO=SV x R
42
__________ is the venous return that builds during diastole. It is the length to which the ventricular muscle is stretched at the end of diastole just before contraction
Preload (page 462)
43
Increased contractility (from the muscle stretching, like during exercise) results= __________________
in an increased volume of blood ejected (increased stroke volume)
44
___________ is the opposing pressure the ventricle must generate to open the aortic valve against the higher aortic pressure. (It is the resistance against which the ventricle must pump its blood)
Afterload
45
The __________ is located in the groove between the trachea and the sternomastoid muscle, medial to and alongside that muscle
carotid artery
46
The ___________ empty unoxygenated blood directly into the superior vena cava
jugular veins
47
Because no cardiac valve exists to separate the superior vena cava from the right atrium, _________ give information about activity on the right side of the heart. (exposes when the right side of the heart is not pumping correctly).
the jugular veins
48
The larger ________ vein lies deep and medial to the sternomastoid muscle. (It is usually not visible)
internal jugular vein
49
The _________ vein is more *superficial*; it lies lateral to the sternomastoid muscle, above the clavicle.
external jugular vein
50
The jugular pulse results from: _______________________________________
a backwash, a waveform moving backward caused by events upstream
51
Specifically,the jugular veins reflect:
filling pressure and volume changes of the right side of the heart
52
With aging, there is an increase in systolic blood pressure (BP). This is due to:
stiffening of the large arteries, which in turn is due to calcification of vessel walls (arteriosclerosis)
53
With age, the heart does not get larger but the ____________increases. This is an adaptive mechanism to accommodate the vascular stiffening mentioned earlier that creates an increased workload on the heart.
left ventricular wall thickness
54
________________ increases sharply with advancing age and accounts for about half of the deaths of older people
Coronary artery disease
55
In the United States, an estimated ____ million people (more than 1 in 3) have one or more forms of cardiovascular heart disease (CVD)
81 mil
56
The current cutpoints for cholesterol risk in adults are the following: total cholesterol levels of _____ mg/dL are high risk; and levels from _______ mg/dL are borderline–high risk
≥240 mg/dL
200 to 239 mg/dL
57
Subj data/questions associated with CHEST PAIN:
1. -Any chest pain or tightness?
* Onset: _________________
* Location: _______________
* Character: ______________
* Onset: When did it start? How long have you had it this time? Had this type of pain before? How often?
* Location: Where did the pain start? Does the pain radiate to any other spot?
* Character: How would you describe it? Crushing, stabbing, burning, viselike? (Allow the person to offer adjectives before you suggest them.) (Note if uses clenched fist to describe pain.)
58
________: is an important cardiac symptom, occurs when the heart's own blood supply cannot keep up with metabolic demand. Chest pain also may have pulmonary, musculoskeletal, or gastrointestinal origin; it is important to differentiate.
-A squeezing “clenched fist” sign is characteristic of this, but the symptoms below may be equivalents in the absence of chest pain
Angina
59
•Any associated symptoms with chest pain?: Sweating, ashen gray or pale skin, heart skips beat, shortness of breath, nausea or vomiting, racing of heart?
Diaphoresis, cold sweats, pallor, grayness.
Palpitations, dyspnea, nausea, tachycardia, fatigue.
60
Goal of this question:
| Pain made worse by moving the arms or neck, breathing, lying flat?
Trying to differentiate pain of cardiac versus noncardiac origin.
61
2. Dyspnea. (subj data)
Any shortness of breath?
* What type of activity and how much brings on shortness of breath? How much activity brought it on 6 months ago?
* Onset: ____________
* Duration: ______________
* Seem to be affected by position:lying down?
* Awaken you from sleep at night?
Does the shortness of breath interfere with activities of daily living?
•Onset: Does the shortness of breath come
on unexpectedly?
* Duration: Constant or does it come and go?
* Seem to be affected by position: Lying down?
* Awaken you from sleep at night?
62
Dyspnea on exertion (DOE) you want to:
quantify exactly (e.g., DOE after walking two level blocks).
63
________________ occurs with heart failure. *Lying down* increases volume of intrathoracic blood, and the weakened heart cannot accommodate the increased load. *Typically, the person awakens after 2 hours of sleep with the perception of needing fresh air.*
Paroxysmal nocturnal dyspnea (PND)
64
3. Orthopnea. (subj data)
| What is an example question asked?
How many pillows do you use when sleeping or lying down?
65
________ is the need to assume a more upright position to breathe. (Note the exact number of pillows used.)
Orthopnea
66
4. Cough.
Do you have a cough?
Example questions:
* Duration: How long have you had it?
* Frequency: Is it related to time of day?
* Type: Dry, hacking, barky, hoarse, or congested?
* Do you cough up mucus? Color? Any odor? Blood tinged? *Note sputum production, mucoid or purulent.*
* Associated with: Activity, position (lying down), anxiety, talking?
* Does activity make it better or worse (sit, walk, exercise)?
* Relieved by rest or medication?
67
_________ is often a pulmonary disorder but also occurs with mitral stenosis.
Hemoptysis (the expectoration of blood)
68
5. Fatigue. (subj data)
Do you seem to tire easily? Able to keep up with your family and co-workers?
* Onset: _______________
* Fatigue related to time of day: All day, morning, evening?
Onset: When did fatigue start? Sudden or gradual? Has any recent change occurred in energy level?
69
Fatigue from decreased cardiac output is worse in the _________, whereas fatigue from anxiety or depression occurs __________.
evening/
| all day or is worse in the morning
70
6. Cyanosis or pallor: (subj data) example question:
Ever noted your facial skin turn blue or ashen?
71
Cyanosis or pallor occurs with myocardial infarction or low cardiac output states as a result of ___________.
decreased tissue perfusion.
72
7. When asking about _______, these questions may be used:
Any swelling of your feet and legs?
* Onset: When did you first notice this?
* Any recent change?
Edema
73
Edema is dependent when caused by ________
heart failure
74
________ is worse at evening and better in morning after elevating legs all night.
Cardiac edema
75
Cardiac edema shows __________ swelling; _________ has a local vein cause.
Cardiac edema is bilateral; unilateral swelling has a local vein cause.
76
8. Do you awaken at night with an urgent need to urinate? How long has this been occurring? Any recent change?
Nocturia
77
__________: this occurs with heart failure in the person who is ambulatory during the day.
Nocturia
78
Risk factors for CAD (coronary artery disease):
- Collect data regarding elevated cholesterol
- elevated blood pressure
- blood sugar levels above 130 mg/dL or known diabetes mellitus
- obesity
- cigarette smoking
- low activity level
- and length of any hormone replacement therapy for postmenopausal women
79
Subjective ?'s for the aging adult
Additional History for the Aging Adult
1. Do you have any known heart or lung disease: Hypertension, CAD, chronic emphysema, or bronchitis?
2. Do you take any medications for your illness such as digitalis? Aware of side effects? Have you recently stopped taking your medication? Why?
3. Environment: Does your home have any stairs? How often do you need to climb them? Does this have any effect on activities of daily living?
80
To evaluate the carotid arteries, the person can be _______. To assess the jugular veins and the precordium, the person should be ____________.
sitting up/
supine with the head and chest slightly elevated
81
Stand on the person's _____ side; this will facilitate your hand placement, viewing of the neck veins, and auscultation of the precordium.
right
82
Ensure the female's privacy by ___________.
keeping her breasts draped
83
The room must be _______
warm—chilling makes the person uncomfortable, and shivering interferes with heart sounds
84
When performing a regional cardiovascular assessment, use this order:
1. Pulse and blood pressure
2. Extremities (see Peripheral Vascular Assessment in Chapter 20)
3. Neck vessels
4. Precordium
(*The logic of this order is that you will begin observations peripherally and move in toward the heart)
85
~Located central to the heart, the _______ yields important information on cardiac function
carotid artery
86
_______________ is the condition in which pressure over the carotid sinus leads to a decreased heart rate, decreased BP, and cerebral ischemia with syncope. This may occur in older adults with hypertension or occlusion of the carotid artery.
Carotid sinus hypersensitivity
87
Make sure to palpate the carotid artery: _______
gently and only one at a time
88
~For persons middle-aged or older or who show symptoms or signs of cardiovascular disease, auscultate each carotid artery for the presence of a __________. *This is a blowing, swishing sound indicating blood flow turbulence; normally none is present.*
bruit
89
A _________ indicates turbulence due to a local vascular cause, such as atherosclerotic narrowing
bruit
90
When auscultating the carotid artery: Keep the neck in a neutral position. Lightly apply the bell of the stethoscope over the carotid artery at three levels: ___________, ___________, ____________
(1) the angle of the jaw, (2) the midcervical area, and (3) the base of the neck (see Fig. 19-17).
91
Avoid compressing the artery because this could: ________________
create an artificial bruit and it could compromise circulation if the carotid artery is already narrowed by atherosclerosis
92
Ask the person to___________________ while you listen so that tracheal breath sounds do not mask or mimic a carotid artery bruit.
take a breath, exhale, and hold it briefly
93
A carotid bruit is audible when the lumen is occluded by ____ to _____.
1/2 to 1/3
94
Bruit loudness increases as the atherosclerosis worsens until the lumen is occluded by ______ . After that, bruit loudness decreases. When the lumen is completely occluded, the bruit disappears. Thus absence of a bruit does not ensure absence of a carotid lesion.
2/3
95
A murmur sounds much the same but is caused by a __________. Some aortic valve murmurs (aortic stenosis) radiate to the neck and must be distinguished from a local bruit.
cardiac disorder
96
~Inspect the: ___________
Jugular Venous Pulse
97
From the jugular veins you can assess the________ and thus judge the heart's efficiency as a pump. Stand on the person's _____ side because the veins there have a direct route to the heart
central venous pressure (CVP)
right side
98
You can see the top of the external jugular vein distention overlying the _________ or the pulsation of the internal jugular vein in the __________.
sternomastoid muscle
sternal notch
99
When inspecting the Jugular Venous Pulse: Position the person ___________, wherever you can best see the top of the vein or pulsations. In general, the higher the venous pressure is, the higher the position you need. Remove the pillow to avoid flexing the neck; the head should be in the same plane as the trunk. Turn the person's head slightly away from the examined side, and direct a strong light tangentially onto the neck to highlight pulsations and shadows.
supine anywhere from a 30- to a 45-degree angle
100
Unilateral distention of external jugular veins is due to local cause (kinking or aneurysm).
Full distended external jugular veins above 45 degrees signify increased CVP as with: _______
CVP as with heart failure.
101
Left-sided systolic failure signs and symptoms (mnemonic)
"Left Systolic Failure Can Have Dialated Heart Cause Of Pulmpnary Backflow":
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Loss of hair on legs
Skin cold and clammy
Fatigue
Crackles
High heart rate
Dyspnea
HTN
Cyanosis
Orthopnea
Pink Sputum
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