Heart/neck vessels ch 19 Flashcards
Precordium
anterior chest area directly overlying the heart and great vessels connected to heart.
Mediastinum
houses the heart, between the lungs in the middle third of thoracic cage, from the 2nd to fifth intercostal space.
Apex of the heart
the bottom/left area (left ventricle) which beats against chest wall during contraction.
Base of the heart
the top, broad part of the heart
Superior and Inferior vena cavas
largest veins in the body, return unoxygenated blood to the right atrium
Pulmonary artery
carries unoxygenated blood, pumped from the right atrium, to the lungs
Pulmonary veins
return newly oxygenated blood to left atrium of heart (from lungs)
Aorta
largest artery in the body, carries oxygenated blood to systemic arteries.
Pericardium
tough, fibrous, dbl-walled sac surrounding the heart. It contains pericardial fluid to ensure smooth contraction of the heart
Myocardium
muscular, middle layer of heart responsible for contractions
Endocardium
endothelial tissue lining the inner surface of heart.
Tricuspid valve
the right atrioventricular valve; separates RA from RV. Closed during systole, open during diastole
Mitral valve
bicuspid or Left AV valve; seperates LA from LV. Closed during systole, open during diastole.
Chordae Tendinae
collagenous fibers on the papillary muscles that attach to the AV valves. Papillary muscles contract during systole to close valves.
Semilunar Valves
valves that separate the ventricles and arteries.
Pulmonic SL valve
between the right ventricle and pulmonary artery, Open during systole to allow blood flow to the lungs
Aortic SL valve
seperates the left ventricle and the aorta. Opens during systole to allow systemic circulation.
Diastole
2/3 of cardiac cycle. Where AV valves are open and ventricles are filling with blood.
Atrial kick
presystole or atrial systole, occurs during ventricular diastole and is the active filling phase where atria contract to push about 25%/ last amt of blood into ventricles
Systole
the contraction phase (1/3 of cardiac cycle) where the filled ventricles close the AV valves and then contract, causing the SL valves to open and eject blood into the arteries.
S1 (sound)
1st Sound heard during the beginning of systole where the AV valves close as a result of high ventricular pressure. Heard loudest over apex
Isometric contraction
the contraction of the ventricles when all valves are closed, causing a highly pressured, rapid ejection of blood into arteries
S2 (sound)
2nd sound that signals the end of systole and heard when the semilunar valves close due to backflow of blood in the arteries. Heard loudest at the base.
Isometric relaxation
The brief period upon diastole where all four valves are closed and atrial pressure is rising
Split S2 (sound)
Where the aortic valve closes significantly earlier than the pulmonary valve and both distinct sounds are heard due to unequal stroke volume b/w ventricles caused by respiration.
S3
occurs when the ventricles are resistant to filling during protodiastole and they vibrate
S4
vibrations heard just before S1 due to resistant ventricular filling when the atria contract.
Murmur
gentle blowing sound heard due to turbulent blood flow. Can be caused by increased viscosity, decreased viscosity of blood, or defective valves or unusual openings in the chambers.
How are heart sounds further described?
by their frequency (high pitch/low pitch), Intensity (loud or soft), Duration, and Timing (systole or diastole)
Describe the sequence of electrical current in the heart?
The SA node (pacemaker) initiates the impulse, then impulse moves across atria to AV node, then to the bundle of His, the R and L bundle branches, and then through the ventricles.
Cardiac output= ?
Stroke volume SV X Heart rate HR
List the changes of hemodynamics with the aging adult:
increase in systolic pressure due to arteriosclerosis, ventricular wall thickens to accomodate arteriosclerosis, ability to augment CO during exercise decreases.
Angina
chest pain occurring when the hearts blood supply can’t keep up with metabolic demand.
Associated symptoms of Angina?
diaphoresis, pallor, palpitations (skipped beats), dyspnea, fatigue, tachycardia
Dyspnea on exertion
DOE, with this symptom state how much activity causes this.
Paroxysmal nocturnal Dyspnea
PND, occurs with heart failure b/c lying down increases volume of intrathoracic blood and heart can’t accommodate.
Hemoptysis
coughing up blood that usually indicates pulmonary condition but may be due to mitral stenosis
Cardiac Edema
bilateral swelling first in the feet and legs. Usually worse at evening and is a sign of heart failure.
Risk factors for CAD
elevated cholesterol lvls, elevated BP, BS lvls above 130mg/dL or diabetes mellitus, obesity, smoking, low activity level, postmenopausal hormone replacement therapy
Carotid sinus hypersensitivity
where pressure over carotid sinus causes decreased HR and BP, and cerebral ischemia with syncope. occurs with hypertension or occlusion of the carotid artery
The normal strength of the carotid pulse is?
2+ or moderate
Bruit
blowing sound heard when auscultating carotid, indicating turbulent blood flow due to a local vascular cause such as atherosclerotic narrowing.
Describe auscultation of the carotid?
done with bell of stethoscope over 3 areas: angle of lower jaw, midcervical area, base of the neck. Listen after person exhales a deep breath.
Thrill
palpable vibration (purring) usually present with murmurs that indicates turbulent bl flow
Left Ventricular Hypertrophy
Increased volume or thickened heart wall due to HTN, CAD, heart failure, and cardiomyopathy. A sustained impulse will be present.
Pulse Deficit
Difference in apical and radial pulses that occurs with weak ventricular contractions as in heart failure, atrial fib, and premature beats.
Pericardial friction rub
High-pitched, scrathy noise heard over precordium during systole and diastole. Best heard with pat sitting erect and stethoscope over apex.
Murmur
blowing, swooshing sound that occurs with turbulent blood flow. Can be innocent, functional, or pathological
Jugular Venous pressure
Central venous pressure (CVP). estimates right side heart function based on the level of pulsation of internal jugulars. note patients elevation and mx in cm.
Summation Gallop
When both S3 and S4 sounds are heard as one prolonged, loud sound during cardiac stress periods.
Sinus Arrhythmia
A change in rhythm of heart beats due to respiration. Beats increase during inspiration and decrease on expiration. Normal in young adults and children.
apical impulse
pulsation created against chest wall as left ventricle rotates during systole. May or may not be seen.
