Module 11: Pt. 1 Cardiovascular assessment Flashcards
What are the resting pulse rates of infants like compared to adults
MUCH FASTER
Does blood pressure get higher as we age?
Yes, especially in women
Explain diastole
Ventricles relax, fill with blood
AV valves open
-2/3 of the cycle
Explain Systole
Fills the pulmonary and systemic arteries
-1/3 of the cycle
Where does the first heart sound occur closest to?
Its loudest in the Apex
The second heart sound is loudest where?
the base
How is the heart of an infant postitioned differently
It is more horizontal, the apex is more in the 3rd -4th iICS
by age 7 It’s the same location as an adults
What are you listening for in murmurs?
- Timing
- Loudness
- Pitch
- Quality
- Location
- Radiation
- if posture changes the murmur
Developmental considerations for older adults
Gradual rise in systolic BP
- Orthostatic hypotension
- avoid pressure on carotid
- Difficult to find apical pulse
What is S3?
-Ventircular filling that creates vibrations and sound
What is S4?
End of diastole (Presole)
resistant to filling, atria contract push blood into non compliant ventricle `
What is causing murmurs?
Turbulence of blood
-Increase velocity of blood flow
-If you get the murmur during exercise = thyrotoxicosis
2) decrease in viscosity of blood (anemia)
3) Structural defects in valves/ unusual chamber openings
(narrow or incompetent valve, Dilated chamber wall defect)
How much blood does the heart pump per minute
4-6 L
What is cardiac output
Volume of blood in each systole (stroke volume) times the number of beats per minute (rate)
Where is the carotid artery located
Medial, Between trachea and sternocleidomastoid
central artery
How many jugular veins are there
4
What are the 5 components of a jugular vein pulse
- A Wave: Reflects atrial contraction
- C wave: reflects back flow from the bulging upward of the tricuspid valve
- X Decent: atrial relaxation
- V Wave: passive atrial filling
- Y DEsecnt- reflects passive atrial filling when tricustpid valve opens
When does the fetal heart start
week 3
Developmental considerations for pregnant women
- Blood volume increases
- Most rapid during 2nd trimester
- increased stroke volume, cardiac output, pulse rate
- arterial BP down as a result of peripheral vasodilation
- Arterial BP lowest in second trimester then it rises
- varies with position
Developmental considerations for older adults
Smoking, Diet, alcohol, exercise patterns, stress have an influence on coronary artery disease and cardiovascular disease
-stifferning of larger arteries bc of calcification
increased pulse wave velocity
-Not much diastolic change
-increase ventricular wall thickness
-no change in resting heart rate
-decreased ability to augment cardiac ability, but the output does not change at rest
-Arrhythmias increase with age
-Ectopic beats common in older adults, asymptomatic in older ppp
-tachycardia is not tolerated well by old folks
-decrease in cerebral blood flow so they pass out easier
-S4 is normal
-s3 indicates heart disease after 40
What is arteriosclerosis
Calcifying of vessel walls that occurs with aging
Cultural and social considerations
there are decreased CVD deaths but more CVD
- Primary killer of canadian women
- heart disease and stoke are higher in african
What are the risk factors for CVD
Food insecurity, income, high BP, smoking, high cholesterol, oral contraceptives and post menopause hormones
Who has more hypertension
Women 55+, worse in atlantic provinces
Additional subjective questions for infants
1) maternal health
2) feeding (if any cyanosis)
3) Growth
4) activity (naps? tired? milestones)
additional subjective for children
1) Growth
2) Activity (blue spells, any tiring?)
3) Joint pain and fever
4) Headache and nosebleed
5) Respiratory disease
6) Family history ( sibling with heart defect)
Additional questions for pregnant women
1) any hypertension (bp before and during pregnancy)(Treatment)
2) any hypotension (faint or dizziness)
Additional questions for older adults
1) disease
2) medications
3) environment
how should the patient be positioned to palpate and auscultate carotid arteries
-sit up
How should the patient be for the jugular and precordium
supine with head and chest slightly elevated
What is a innocent murmur
No valvular or other pathological cause, common in children (disappears with different posture)
What is a functional murmur
caused by increased blood flow to the heart
- anemia, fever, pregnancy, hyperthyroid
When do the fetal shunts close
10-15 hr after birth but up to 45
Extracardiac signs that may reflect heart status
liver size, skin, resp status
Are respiratory crackles important in children?
No its mostly just for adults
What happens with cardiac enlargement
heart shifts to the left
what could indicate pneumothorax
heart moves away from affected side
What could indicate a diaphragmatic hernia
shifts usually to the right
what is dextrocardia
heart of right side of chest
What is trachycardia and bradycardia considered in new borns
200+ for T
Less than 90 for B
*HR is best auscultated because the radial pulse is hard to count
*expect sinus arrhythmia
-splitting of S2 is common
-neonatal murmors common for first 2-3 days
Indicators of heart disease in children
poor weight gain, developmental delay, tachycardia, tachypnea, dyspnea on exertion, cyanoisis, clubbing of nails, huge apical impulse, cardiac enlargement
Venous hum
Turbulence of blood flow in jugular venous system, common not back
Considerations for pregnant women
- Higher resting pulse
- lower BP
- mild hyperemia
- apical pulse higher and lateral
- exagerated splitting of s1, increased loudness of s2
- loud S3
- systolic murmur that usually diapers after delivery
ischemia
inadequate delivery of oxygen/nutrients to cells
Embolus
blood clot that breaks loose
