Lecture 6 - Cardiac Flashcards
What is the name for the artery behind the knee?
Popliteal
What is considered hypotention?
<95/60 mm Hg
What is considered hypertension?
> 130/80 mmHg
What is the precordium?
The area between the manubrium and sternal body (1st and 5th rib) where the heart and aortic arch sit.
Where is the base of the heart?
At the 3rd intercostal space
Where is the apex of the heart?
At the 5th intercostal space
What is pulmonary circulation? Which ventricle controls it?
Circulation to the lungs, pumped by right ventricle
What are the heart’s three layers?
Pericardium - serous bilayer
Myocardium - cardiac muscle
Endocardium - endothelial tissue
Which valve separates the pulmonary artery and right ventricle?
The pulmonic valve
Which valve separates the aorta and left ventricle?
The aortic valve
What valve separates the right atrium and ventricle?
The tricuspid
Which valve separates the left atrium and ventricle?
The Mitral valve
What is the name for the short phase where the AV valves are open and ventricles passively fill?
The protodiastolic phase
What is the name for the active filling phase where the atria contract and fill the ventricles with the remaining 25% of their stroke volume?
The presystolic phase
What is isometric contraction?
The period where all four heart valves are closed before systole
Describe the five structures involved in conducting and creating impulses in the heart
- SA node
- Atrium
- AV node
- Bundle of His
- Left + right bundle branch
Purkinje Fibers
Describe what happens during different phases of a sinus rhythm ECG.
P wave - Depolarization of atria
Q-R Interval - Time necessary for the impulse to travel through the AV nodes to the ventricles
QRS Complex - Depolarization of ventricles
T wave -Repolarization of ventricles
What are the two normal heart sounds?
S1 “Lub”
–> Closure of AV valves
S2 “Dub”
–> Closure of semilunar valves
Sometimes there are extra sounds in a heartbeat - what are S3 and S4?
S3 (Ventricular gallop) - heard immediately after S2
–> Ventricles resistant to filling during protodiastole
S4 (Atrial gallop) - Heard just before S1
–> Ventricles resistant to filling during presystole
What are heart murmurs and how should they be documented?
Turbulence in blood flow that creates additional sounds during a heartbeat
When documenting, note frequency, intensity, duration, and timing.
Which three things might lead to heart murmers?
- An increase in blood speed
- A decrease in blood viscosity
- Incompetent heart valve
What is the second leading cause of death in Canadians over 65?
Cardiovascular disease
Which hemodynamic changes occur in older adults?
–> Increase in systolic BP d/t arterosclerosis
–> Decreased diastolic BP
–> Thickening of left ventricle
–> Inability to meet cardiac output needs during exercise
Which electrical conduction system changes occur in older adults?
–> Increase in supraventricular and ventricular arrythmias
–> Increase in ectopic beats
–> ECG changes
What kinds of things should you ask a patient about when you suspect cardiovascular illness?
Angina, dyspnea, Orthopnea, cough, fatigue, cyanosis or pallor, edema, nocturia, cardiac history of both patient and family, personal habits
What might cause angina in someone with a CV disease?
Lack of oxygen to heart
What might cause dyspnea is someone with a CV disease?
Pulmonary edema
–> Indicative of heart failure
What might cause orthopnea in someone with a CV disease?
Fluid around lungs, which indicates heart failure
On top of the regular PQRSTU, what additional question might you ask someone struggling with orthopnea?
How many pillows they require to sleep comfortably.
What might cause a cough in someone with a CV disease?
Mitral stenosis - might also have hemoptysis
What additional questions might you ask to an older adult presenting with a CV disease?
–> History of CV disease
–> Past treatment
–> Changed in medications
–> Home environment + ADLs
When performing an assessment of the cardiovascular system, what is the first step and why?
Auscultation of the carotid artery
–> Bruit indicates atherosclerosis. If a person has this, is can be dangerous to palpate them because you might dislodge a plaque.
In which three places should you bilaterally auscultate the carotid artery?
- The angle of the jaw
- The midcervical area
- The base of the neck
How is the apical impulse palpated?
Locate in 5th intercostal space to the left of the sternum, with pad of one finger.
Ask the patient to exhale and hold it few seconds.
If you cannot find it, ask the patient to roll halfway to the left
How will left ventricle hypertrophy and dilation impact the feeling of the apical pulse?
Dilation
–> Heart will move towards the left
Hypertrophy
–> Palpable pulse will increase in length and strength
Why is the palmar aspect of the fingers used on the apex, left sternal border, and base of the heart?
To check for a thrill
–> Palpable vibration, like a cat purring
–> Signifies turbulent blood and often accompanies murmurs.
List the revised cardiac ausculation areas in clockwise order.
–> Aortic (Upper right sternum)
–> Pulmonic area
–> Left atrium
–> Left ventricle
–> Right Atrium
–> Right Ventricle
Which side of the stethoscope is better to listen to the heart?
Start with diaphragm and flip to bell if you suspect a murmur
In which side of the heart of the heart is an S4 atrial gallop more common?
The left side
What usually causes ventricular gallop?
When there is less compliance of the ventricles, more common in those with heart failure.
Sometimes, a heart valves closes just after its counterpart. This is normal but rare. In which kind of valve is this more common?
Occurs rarely in both, but more common in AV valves.
What is heart valve stenosis?
When a valve (most common in aortic valve) does not fully close or open. Created blowing, or swooshing sound that indicates turbulent blood flow.
What usually causes atrial gallop?
Less compliance of ventricles, more common in those with cardiovascular disease
What is an abnormal jugular venous pressure? What might this indicate?
Any measurement 2 cm greater than the angle of louis (sternal angle)
Indicates a backup of blood in systemic circulation, likely due to heart failure
What is the abdimojugular test?
A test done if patient has abnormally high jugular vein pressure
- Pt supine, breathing through mouth
- Push RUQ for 30 seconds
- If the jugular veins rise for few seconds, but return to normal, this is normal. If they jugular veins stay high, it might indicate heart failure.
What are some special consideration when assessing the CV system of an older adult?
–> Gradual rise in systolic bp paired with constant diastole leads to widening of pulse pressure
–> Careful when palpating carotid artery
–> Chest size increases, which might make it harder to feel the apical impulse or difficulty hearing splitting of S2
Which commonly concerning heart sounds can be normal for older adults?
–> S4 sounds
–> Systolic murmurs are more common
–> Ectopic beats more common
(All still require investigation)
A patient presents with dilated pupils, pallor, SOBOE, edema, and ascites, what might be wrong?
Heart failure
Why does heart failure cause edema?
Activates SNS, which dilates blood vessels. However, heart is not efficient to keep pressure high enough to keep blood moving. Therefore, fluid builds up outside of vasculature.
A patient presents with SOB, fatigue, pallor and dizziness. They have low BP, bradycardia, and a weak thready pulse. S2 is split, the apical pulse has moved left, and a thrill can be felt up into the neck.
What might be wrong?
Aortic Stenosis
–> Calcification of aortic valve that restricts forward flow of blood during systole
–> Results in hypertrophy of LV
What might cause an aortic stenosis?
–> Could be age related, congenital
–> Infective endocarditis
–> Rheumatic fever
A patient presents with SOBOE, fatigue, orthopnea, and a cough. They have pulmonary congestion, an irregular pulse, and a thrill.
What might be wrong?
Mitral Stenosis
–> Calcification of mitral valve, restricts blood flow during diastole
–> Results in enlargement of left atria and increase in its pressure
What might cause mitral stenosis?
Rheumatic fever
What are some symptoms specific to aortic regurgitation?
–> Paroxysmal nocturnal dyspnea
–> Hypertension
–> Displacement of apical impulse due to hypertrophy
–> Murmur in S2 that will radiate down if the patient is sitting upright
Mitral regurgitation results in dilation and hypertrophy of ___
The left ventricle
A thrill in the right 2nd and 3rd interspaces might be due to:
–> Severe aortic stenosis
–> Systemic HTN
A Thrill in the left 2nd and 3rd interspaces might be due to:
–> Pulmonary stenosis
–> Pulmonic HNT
Which five things determine blood pressure?
- Cardiac Output
- Peripheral Vascular Resistance
- Blood Volume
- Viscosity
- Elasticity of Arterial Walls
Which vessels empty directly into the vena cava and right atrium?
The jugular veins, both external and internal
All heart sounds should be described by which four characteristics?
- Frequency (pitch)
- Intensity (loudness)
- Duration
- Timing (systole or diastole)
