Module 2&3 Flashcards
Interatrial Septum
wall shared by left and right atrium- separates them.
Inferior Vena Cava
Bring deoxygenated blood to the right atrium from the organs and lower extremeties
Superior Vena Cava
Brings deoxygenated blood from the head and upper extremities into the right atrium
Pulmonary Veins
Brings oxygenated blood from the lungs into the left atrium
4 of them-> 2 from each lung
Coronary Sinus
opening in the right atrium that return deoxygenated blood from circulation of the myocardial muscle
Pulmonary Atery
Brings deoxygenated blood from the right ventricle into the lungs.
Bifurcates to left and right sides
Tricuspid Valve
AV valve between right atrium and right ventricle
2 cusped valve preventing backflow from ventricle to atria during RV systole.
Movement controlled by chordae tendinae
Right Ventricle
Pumps deoxygenated blood into pulmonary artery.
Consists of a inflow tract with irregular muscle bridges and a smooth outflow tract.
low pressure with a thing outer wall
Mitral Valve
2 Cusped AV valve between left atrium and ventricle.
prevents backflow during left ventricle systole.
movement is controlled by chordae tendinae (more numerous and stronger than right ventricle)
Parts of the Stethoscope
Bell- low frequency sounds
Diaphragm- high frequency sounds
Left Ventricle
Cone shaped- larger than right ventricle
9-11mm muscular walls, high pressure to overcome high resistance of the aorta.
smooth outflow tract
heavy trabeculated inferior region with more and thicker trabeculae than RV
Interventricular Septum
Wall dividing left and right ventricles. Stiffens to become a fixed fulcrum during systole.
Basic Components of a Cardiovascular exam
1) Identify the patient & take history
2) Blood pressure & pulse
3) Assess jugular venous pressure
4) Palpitation
5) Auscultation
6) Check vitals, chest X-ray, ECG, blood test
Aorta
3 branches- brachiocephalic, left common carotid, left subclavian.
Carries oxygenated blood from LV from body circulation
Why is cardiac history important
Most important diagnostic tool. More than 50% of patient assessment the correct diagnosis can be made after taking a history.
Pulmonary Valve
Semi lunar valve between RV and Pulmonary artery
prevent backflow into RV during diastole
no chordae tendinae or papillary muscles
Right Atrium
recieves deoxygenated blood from the inferior and superior vena cava as well as the coronary sinus.
Atrial Kick
When the atria contract to fill ventricle.
when specific arrhythmias occur atrial kick is used to assess patients ventricular output
How much does the heart pump?
5-30 litres of blood/min
75ml of blood into circulation with each beat
Heart Rate
average adult 60-90 bpm
85000 beats/day
Describe the shape and size of the heart
size of a mans fist
weighs less than 500g
conical in shape
Pericardium
2 layers- Visceral & Parietal with a thin film of pericardial fluid between to minimize friction.
Visceral (epicardium) adheres to the external wall of the heart and reflects back on itself. The second layer lines the outer fibrous layer securing heart to sternum and mediastinal portion of L&R pleurae
Parietal- Second layer between epicardium and fibrous layer
Myocardium
middle layer of cardiac wall
heart muscle- striated skeletal muscle- involuntary
electrical excitations spread quickly through myocardium
can produce self excitation
Subendocardium
tissue containing fibroblasts, elastic & collagen fibres, veins, nerves and branches of conduction system.
Continuous with connective tissue of myocardium
below endocardium
Circumflex Artery
Travels left AV groove
branches to form large obtuse marginal branches to supply lateral and posterior walls of LV
Aortic Valve
3 cusped Semi lunar valve located between LV and Aorta
Prevents backflow into LV during diastole
secured by fibrous ring surrounding valve
Fourth Heart Sound
“atrial gallop”
“extra diastolic heart sound”- pitch best heard at apex
caused when left or right atrium vigorously contract against rigid ventricle. (late diastole)
sign of ischemia or hypertrophy (enlargement of the heart)
a-STIFF-wall S4 S1 S2
Third heart sound
“ventricular gallop”
low frequency, best heard with bell
normal in children and young adults-indicates congestive heart failure in middle aged and elderly or rapid filling of ventricle (tricuspid regurgitation)
heard in early diastole following opening of AV valves
SLOSH’ - ing - in S1 S2 S3
Paradoxical Splitting
Seperation of A2 + P2 during expiration but not inspiration
Indicated LBBB or Aortic stenosis
Fixed splitting
A2 + P2 occur with an abnormally large gap in between throughout cardiac cycle
Indicates atrial septal defect (hole in the septum)
Widened splitting
abnormal heart wound when A2 + P2 are heard as separate sounds even during expiration
Indicates RBBB or pulmonary valve stenosis
Cardiac auscultation
“heart sounds”
process of listening to the heart with a stethoscope
S1- First heart sound- high freq- represent closing of mitral and tricuspid valves
S2- Second hear sound- high freq- closing of semi lunar aortic and fractionally delayed pulmonary valves.
Inspiration- splits in A2 + P2 Expiration- one sound
Assessing palptation
detecting evidence of disease by placing hands and fingers on external surface of body (usually done at apex-5th intercostal space in mid clavicle line)
look for scars indicating surgery
2 apex beats: HEAVING- high afterload THRUSTING- high preload
How to assess jugular venous pressure (JVP)
Patient is reclined at 45 degree angle
JVP= height of waveform in cm above sternal angle
JVP helps identify right heart failure or pulmonary embolism
3 types of abnormal pulses
characteristics and causes
1) pulsus paradox- exaggerated drop in pulse on inspiration. caused by cardiac tamponade or acute asthma
2) Bounding- Large volume. Caused by anemia, hepatic failure or type 2 respiratory failure.
3) Pulsus alternons- alternate high and low pulses. Caused by bigeminy.
Coarction
The narrowing of the aorta
assessed by looking at radial-femoral delay (should occur at same time)
How to determine pulse rate
Count # pulses/sec
sites to measure- carotid, brachial, radial
Aortic dissection screening
check both radial pulses simultaneously
aortic dissection- when a tear is formed in the artery and blood can flow between the layers of the vessels wall.
results in low blood flow (ischemia) to organs or aortic rupture
Describe general inspection of physical appearance
Patients with acute cardiac illness show signs of cyanosis(blueish), pallor, or sweatiness
In more stable patients we look for cachexia (weight loss) because it is a prognostic sign of heart failure
How to calculate BMI
Normal range = 18.5-24.9 (male and female)
BMI = body weight / height in meters squared BMI = kg/m2
Left anterior descending coronary artery (LAD)
Courses anterior Interventricular groove toward apex
Supply anterior 2/3 of Interventricular septum via septal branches
Supply anterior surface of left ventricle via diagonal branches
Right coronary artery (RCA)
courses posteriorly between right atrium and ventricle
branches to from posterior descending artery.
supplies inferior and posterior wall of ventricles and 1/3 interventricular septum.
supply SA node 70% of the time via SA nodal artery
supply posterior descending artery and AV nodal arteries 85% of the time
Left main coronary artery
between pulmonary trunk and left atrium to reach AV groove
bifurcates into left anterior descending coronary artery and circumflex artery
Endocardium
innermost layer of cardiac chambers, valves and vessels
smooth single layer
minimizes trauma to red blood cells and accumulation of platelets
Coronary veins
similar to coronary arteries but the vessels return blood from myocardial capillaries to coronary sinus (RA)
major veins most often lie superficial to the arterial counterpart within epicardial fat
Left Atrium
Forms base of heart, extending around pulmonary artery
receives oxygenated blood from pulmonary veins
2mm walls -> thicker than right atrium
low pressure chamber
