Module 8 - Cardiovascular Assessment Flashcards
What is the function of the heart?
The heart is a muscular pump
- Pumps blood to the lungs to become oxygenated
- The oxygenated blood is then pumped to the organs of the body (skin, liver, kidney etc)
What does the cardiovascular system consist of?
- Heart
- Blood vessels
- Precordium (area on the anterior chest overlying the heart and great veins)
What are the great vessels?
Major arteries and veins connecting to the heart
What is the mediastinum?
It is the location of the heart and the great vessels between the lungs in the thoracic cage
How many chambers does the heart contain?
4 chambers
- Two Atriums
- Two Ventricles
What are the 2 main continuous loops called? - For circulation
- Pulmonary circulation
- System circulation
What is Pulmonary circulation?
Circulation of blood to the lungs to become oxygenated
- Oxygenated blood travels via Pulmonary arteries
- Oxygenated blood travels back via Pulmonary veins
What is Systemic circulation?
Circulation of blood to vital organs and other organs of the body
- Oxygenated blood travels via systemic arteries to body
- Returns unoxygenated to heart via system veins
What is the function of the Superior and Inferior venae cavae?
Return unoxygenated blood venous blood to the right side of the heart
What does the Pulmonary artery do?
Transports unoxygenated blood via the right ventricle and carries the unoxygenated (venous) blood to the lungs
What are the functions of the Pulmonary veins?
Return oxygenated blood to the left side of the heart (left atrium)
What is the function of the aorta?
Carries the blood out to the body via Systemic Circulation
What are the layers of the heart wall?
- Pericardium (outside layer) - tough and fibrous - Protects the heart -contains pericardial fluid which prevents friction
- Myocardium (middle layer) - muscle of the heart - pump
- Endocardium (inner layer) - contains a thin layer of endothelial tissue that lines the surface of heart chambers/valves
- Septum - separates the heart into right and left
How many valves does the heart have?
4
- Pulmonic Valve
- Aortic Valve
- Tricuspid valve - right AV
- Mitral valve (Bicuspid valve) - left AV
Name the two semi-lunar valves and their function
- Pulmonic valve - right side
- Aortic valve - left side
- They open during pumping (systole) to allow blood to eject from the heart
What are the two phases and function of the cardiac cycle?
1) Diastolic - Ventricles relax and fill with blood
2) Systolic - Heart is contracted, blood pumps from ventricles and fills the pulmonary/aortic arteries
What is the structure and function of the peripheral vascular system?
- Part of the circulatory system
- Consists of veins and arteries not in the chest/abdomen ex) arms, legs, hands and feet
- Peripheral arteries supply oxygenated blood to the body
- Peripheral veins direct unoxygenated blood from capillaries to the heart
What is the structure of the lymphatic system?
- Part of the circulatory system and immune system
- Network of lymphatic vessels, lymphatic fluid ad lymphoid organs/tissues
- Vessels carry lymph fluid towards the heart
What are the two main functions of the lymphatic system?
1) Providing a route for the surplus of blood back to the heart from the interstitial fluid
2) Immune defense - lymphocytes
Name the main organs that are part of the lymphatic system
- Lymph nodes - highest concentration of lymphocytes
- Spleen
- Thymus
- Tonsils
What is the function of the Spleen?
- Filter and store blood
- Recycles RBC’s - turns globin into amino acids and metabolizes heme into bilirubin (liver)
- Contains antibodies to fight infection in its white pulp
What is the function of the Thymus?
- Immunity
- Allows T cells to mature
What is the function of tonsils?
First line defense for immunity of ingested or inhaled pathogens
- Provide immune response against the common cold
Health History questions for Cardiac system
- Chest pain - onset, location, character
- Dyspnea (SOB) - onset, duration, interference
- Orthopnea - pillows
- Cough - duration, frequency, type (dry, hacking), position, treatment
- Fatigue - onset
- Cyanosis/pallor
- Edema - onset, changes
- Nocturia
- Cardiac history
- Family cardiac history
- Personal habits (smoking, alcohol, diet, activity level)
Health history questions for the Peripheral and Lymphatic system
- Leg pains/cramps - Pain assessment
- Skin changes on arms/legs - temperature, ulcers, sores
- Swelling in arms/legs - edema
- Lymph node enlargement - swollen glands
- Medications
What is isometric contraction?
Contraction to build high pressure inside the ventricles
What are the two normal heart sounds?
1) S1 - closure of AV valves - beginning of systole - loudest in apex
2) S2 - closure of semi-lunar valves - end of systole - loudest at base
“Lub-Dub” Sound
What are the four auscultating areas for listening to heart valves?
- Aortic valve area - Second right intercoastal space - Base
- Pulmonic valve area- Second left intercostal space
- Tricusid valve area- Fifth intercostal space at left lower sternal border
- Mitral valve area- Fifth interspace at around left midclavicular line - Apex
What should you note during auscultation of the heart (5)?
1) Rate and rhythm
2) Heart Valves - S1 and S2
3) Assess S1 and S2 - S1 is louder at apex and S2 is louder at base
4) Extra heart sounds
5) Murmurs
What is the normal range for heart rates?
60-100 bpm
What should you listen for when assessing for murmurs?
- Timing
- Loudness
- Pitch
- Pattern
- Quality
- Location
- Radiation
How would you palpate the Precordium?
- Palmars of four fingers
- Gently palpate over apex, left sternal border and base
- Search for pulsations - if none are felt that is normal
- If you feel a pulsation - note timing
On inspection of the Precordium where would you see the Apical Impulse if noted?
When visible, it appears at the level of the 4th or 5th intercostal space at/or inside the midclavicular line - Apex
How would you palpate an Apical Impulse?
- One finger pad
- “exhale and hold”
- Roll client midway to the left
What are the characteristics of sound (4)?
1) Frequency
2) Intensity
3) Duration
4) Timing
How would you take an accurate Apical-Radial pulse?
Auscultate apical beat and simultaneously palpate the radial pulse
- Two counts should be identical
- When different subtract the radial rate from apical rate = pulse deficit
What qualities are you looking for when recording a pulse?
1) Rate
2) Rhythm
3) Force
4) Quality
What is a pulse deficit?
- It signals a weak contraction of the ventricles
- Occurs with atrial fibrillation., premature beats and heart failure
What is the significance of the Jugular Venous distention/pressure?
- When the pressure inside the vena-cava increases and appears as a bulge running down the right side of a person’s neck
- May indicate heart failure
heart
What is the location of the apical pulse?
Left center of the chest at the apex of the heart - 4th/5th intercostal
What is the location of the cartoid pulse?
- On the neck (either side) between trachea and sternomastoid muscle
- Coincides with ventricle systole
- Supplies blood to head, neck and face
What is the location of the brachial pulse?
- Pulse is found on the antecubital foca of elbow
- Brachial artery is the major artery in the arm and runs in the biceps-triceps of the upper arm
What is the location of the radial pulse?
Lateral of the wrist under the base of the thumb
What is the location of the femoral pulse?
Inner thigh - midway between symphysis pubis and anterior superior iliac spine, known as the “Femoral Triangle”
What is the location of the popliteal pulse?
Back of knee - most difficult to find
What is the location of the dorsalis pedis pulse?
Dorsum (top) of the foot
What is the process of palpating the cervical lymph nodes?
- Palpate one side at a time
- Position client’s head forward
- Palpate over carotid arteries
What is the process of palpating the cervical lymph nodes?
- Palpate one side at a time
- Position client’s head forward - protruding nodes
- Palpate over carotid arteries
What is the process of palpating the axillary lymph nodes?
Palpating under the axilla palpating the tissue over the ribs - posterior and anterior of axilla
What is the process of palpating the epitrochlear lymph nodes?
- Cup clients elbow
- Palpate just above the elbow along inside of the arm
What is the process of palpating the inguinal lymph nodes?
- Palpate groin area
- Same as femoral pulse area - femoral triangle
What is the significance of enlarged lymph nodes?
Inflammation has occurred due to immunity response against a pathogen that could cause infection
Signs and Symptoms of enlarged lymph nodes
- Swelling
- Tenderness
- Infection
What is the edema rating scale?
1+ - Mild pitting, slight indentation, no swelling of the leg
2+ - Moderate pitting, indentation subsides rapidly
3+ - Deep pitting, indentation remains for a short time, swelling of leg
4+ - Very deep pitting, indentation lasts a long time, gross swelling and distortion of leg
Normal findings for heart relating to sounds
- Normal valve closures - S1 and S2
- Lub - dub sound
Abnormal findings for the heart relating to sounds
- Bruit
- Murmurs
- Arrhythmia
- JVP
- Variations of S1 and S2
- Thrills (vibrations) on precordium
- Heaves - lifting impulse on systole
Normal findings for peripheral vascular system relating to pulse and palpation
- Normal 2+ rate
- Equal bilateral brachial pulse
- Pulse tap for femoral pulse - should be felt
- Capillary refill
Abnormal findings for peripheral vascular system
- Bruits
- Full and bonding pulse (anemia, hyperthyroidism)
- Weak/thready pulse
- Deep muscle pain on palpation
- Ulcers (diabetes, Ischemia, Stasis)
- Edema
- Varicose veins
- Deep vein thromboses
- Reynauds
- Skin discolouration
- Gangrene
Normal findings for lymphatic system
Normal size, consistency, tenderness and locations of lymph nodes
Abnormal findings for lymphatic system
- Lymph edema
- Cancer - Lymphoma
- Chronic infection
Abnormal sound variations of S1
- Loud
- Faint/diminished
- Varying intensity
- Split S1 (Mitral and Tricuspid heard separate)
Abnormal sound variations of S2
- Accentuated S2
- Diminished S2
- Splitting
- Fixed split (right ventricle failure)
- Wide split (Right bundle branch block)
- Paradoxial Split (Left bundle branch block)
What are some Vascular disorders?
- Thrombosis – blood clots
- Phlebitis – infection
- DVT – Deep vein thrombosis
- Venous Insufficiency - poor wound healing
What is isometric/isovolumic relaxation?
All four valves are closed and ventricles are relaxed
What are some diagnostic tests for the Cardiac system?
- ECG (electrocardiogram)
- ECHO (Echocardiogram)
- Exercise Stress Test
- Doppler
- Cardiac Catheter
What is an ECG?
Measures electrical impulses
What does the P interval on the ECG represent?
Depolarization of the atria
What does the QRS interval on the ECG represent?
Depolarization of the ventricles
What does the T interval on the ECG represent?
Re-polarization of the ventricles
How many liters of blood does the heart normally pump in an adult per minuet?
4-6 L
What is Cardiac Output?
Stroke volume x Rate (CO= SV x Rate), the volume of blood pumped from the ventricles in a minuet
What is Deep Vein Thrombosis (DVT)?
Peripheral vascular disorder and is a blood clot in the deep vein, usually in the legs
What is Varicose veins?
Superficial large veins that are enlarged, twisted and have a blueish colour
Signs and Symptoms of Heart Failure
- Dyspnea
- Decreased BP
- Crackles
- Cough
- falling O2 sat
- Weak Pulse
- JVD
- Fatigue
- Dilated pupils
What is Preload?
Venous return that builds during diastole - “blood coming back to fill the ventricles”
What is Afterload?
Opposing pressure that is needed from the ventricle to open the aortic valve against the aortic pressure
