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Advanced Health Assessment > Quiz 2- Cardiac > Flashcards

Quiz 2- Cardiac Flashcards

1
Q

pathway of blood

A

SVC/IVC

RA

tricuspid valve

RV

pulmonic valve

pulmonary arteries

lungs

pulmonary veins

LA

mitral valve

LV

aortic valve

aorta

body

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2
Q

normal CXR

A

curved ribs/diaphragm

HEART pushing towards L SIDE; normal size

clear lungs

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3
Q

cardiac cycle (rest to rest)

A

SYSTOLE- ventricular contraction

DIASTOLE- ventricular relaxation (need for ventricular filling)

S1- closing of mitral/tricuspid (end of diastole/beginning of systole)

S2- closing of aortic/pulmonic (end of systole/beginning of diastole)

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4
Q

conduction (coordination of muscle contraction)

A

assessment of rate/rhythm/ECG

SINUS NODE- normal pacer, autonomic, 60-100 bpm

AV NODE- at atrial septum, impulse delayed then passes (allows for filling)

bundle of His/bundle branches/perkinje fibers- impulse travels to both ventricles

if muscle damage- will not contract effectively

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5
Q

EKG

A

P WAVE- atrial depolarization (atria contract)

P-R INTERVAL- filling of ventricles

QRS- traveling of impulse thru bundle of His to R/L perkinje fibers; ventricular depolarization (ventricles contract)

T- WAVE- repolarization of ventricles

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6
Q

abnormal QRS

A

wide QRS with left ventricular hypertrophy

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7
Q

cardiac landmarks

A

AORTIC- 2nd ICS RSB, S2>S1

PULMONIC- 2nd ICS LSB, S2>S1

ERB’s- 3rd to 4th ICS LSB, S2=S1; helpful to listen for baseline

TRICUSPID- 5th ICS LSB, S1>S2

MITRAL- 5th ICS L MCL, S1>S2

line from aortic to pulmonic= BASE OF HEART (top)

line from tricuspid to mitral= APEX OF HEART (bottom)

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8
Q

cardiac health history cues

A

SOB

chest pain

syncope- possible dysrhythmia

fatigue

palpitations- consider caffeine intake

claudication- time of ischemia

early satiety/abdominal fullness- CHF

need to obtain a full HPI of CC and rule out cardiac cause with history and physcial exam

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9
Q

child cardiac cues

A

WOB

pallor/cyanosis

limited activity

change in HR

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10
Q

past medical history for cardiac

A

CHILDHOOD ILLNESS- heart murmurs, congenital heart disease, rheumatic fever

surgery- CABG

vaccines

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11
Q

cardiac family history

A

age of onset is very important!

cardiac

endocrine

neuro

vascular

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12
Q

common cardiac presenting symptoms

A

fatigue/activity intolerance

chest pain

shortness of breath

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13
Q

fatigue/activity intolerance

A

most prevalent cardiac symptom

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14
Q

chest pain

A

symptom analysis

stable angina

unstable angina- chest pain at rest; random pattern; no provoking activities

other causes- GERD, coughing trauma, pulmonary

calssifications: CLASS I= angina with strenuous acitvity
CLASS II= angina with ordinary activity, mild limitation of activities
CLASS III= angina with low level of activity, marked restriction of activity
CLASS IV= angina at rest (unstable)

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15
Q

stable angina

A

predictable pattern

rate pressure product (RPP): amount of activity they can do before pain/symptoms; educate pt to stay below this threshold

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16
Q

shortness of breath

A

DOE (how much activity?)

orthopnea

paroxysmal nocturnal dyspnea (wake from sleep with SOB)

talk test- singe happy birthday without SOB

heart failure classification:
CLASS I= no limitation of activity
CLASS II= slight limitation of activity, comfortable at rest but ordinary activity results in fatigue/SOB/palpitations
CLASS III= moderate limitation, comfortable at rest but less than ordinary activity causes fatigue/SOB/palpitation
CLASS IV= unable to carry out any activity without discomfort, symptoms present at rest

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17
Q

non modifiable cardiac risk factors

A

risk reduction

age, gender, genetics (family hx)

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18
Q

modifiable cardiac risk factos

A

can modify/medicate/change

HTN, HLD, DM

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19
Q

lifestyle cardiac risk factors

A

patient must modify/change

smoking, sedentary lifestyle, diet, obesity, hostility prone behavior

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20
Q

coronary artery calcium score

A

calcium in coronary arteries is a sign of plaque buildup

based on the amount of calcium observed on special CT scan

pts whose 10 year risk is between 5-20% should be tested

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21
Q

ASCVD risk estimator for coronary artery calcium score

A

includes age, gender, race, total/HDL cholesterol, SBP/DBP, HTN, DM, and smoking status to determine 10 year risk

also provides benefits of starting statin/ASA/BP meds

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22
Q

hyperhomocysteinemia

A

high serum homocysteine levels (amino acid from meats) creates a pro coagulaable state

discussed as a risk factor for ATHEROSCLEROSIS, associated with INCREASED RISK OF MI, and linked to higher risk of VTE

associated with low levels of B6, B12, folate, and renal disease

cannot use as a biomarker b/c levels can decrease with B6/B12/folate supplementation, but pt can still have atherosclerosis

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23
Q

CRP

A

reflects ongoing inflammation (not specific to cardiac disease)

inflammation is a known factor in the development of atheroschlerosis and subsequent CVD events- increases vulnerability of an atherosclerotic lesion to erosion/rupture

CRP is not routinely done, but is widely available

scores <1= LOW RISK, 1-2.9= MODERATE RISK, >3= HIGH RISK

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24
Q

CHADS/chads2-vasc

A

model to determine if anticoagulation therapy is needed based on risk

SCORE OF 0= now risk, no anticoags needed

SCORE OF 1= low/moderate risk, consider anticoags

SCORE 2 OR MORE= moderate/high risk, should otherwise be an anticoag candidate (still need to consider the whole patient)

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25
infant cardiac risk factors
family history/siblings with congenital heart disease premature birth, perinatal/prenatal fetal distress MATERNAL EXPOSURE- ETOH, coxsackie B, CMV, influenza, lithium, mumps, rubella, x-rays, drugs, smoking CHROMOSAMAL ABNORMALITIES- trisomy 21, 13, 18 maternal age over 40 years
26
cardiac inspection
face, overall color, WOB CHEST SHAPE AND SIZE- AP/transverse ratio, barrel chest, convex/concave sternum CHEST MARKINGS- vessel dilation, varicose veins, visible retractions, lesions VISIBLE PULSATIONS- usually abnormal, but may see aortic pulsation on abdomen of very thin pt
27
extra-cardiac inspection
NAILS- capillary refill, clubbing (low perfusion; smokers/COPD/CHF), shape changes, splinter hemorrhages (endocardititis, vasculitis, micro emboli; can be normal in patient who works a lot with hands) MOUTH- dental hygiene, piercings; high arch in palate often seen with MVP BMI/PROPORTIONS- waist circumfereance >40 in males of >35 in females; apple vs pear shape= central vs peripheral obesity; higher risk of CVD with apple shape JANEWAY LESION- seen in acute bacterial andocarditis; flat, on palms/soles, PAINLESS** OSLER'S NODE- associated with infective endocarditis; PAINFUL** erythametous nodules MARFAN SYNDROME- often missed; cardiac issues including incompetent valves; tall and slender, long legs/arms/toes, arachnodactyly (long/slender fingers) XANTHOMAS- lumps containing lipids in periphery; common in older adults and people with high blood lipids; if around the eyes, call XANTHELASMA ARCUS SENILIS- ring around eye that is lipid deposit; common/normal in older adult, sign of high cholesterol in young adult
28
cardiac palpation
symmetrical pattern at all landmarks PMI 5th intercostal MCL (should be about the size of fingertip/contained, gentle tapping) THRILL- fine vibration, indicates turbulence in the blood flow (abnormal) HEAVE- strong outward thrust at PMI, ventricle contracting up into hand (abnormal) VITAL SIGNS- HR/RHYTHM, strength (weak vs bounding), sites (should assess bilateral pulses), skin temp warm/cold
29
location of thrill
aortic area during systole (aortic stenosis), apex during systole (mitral regurgitation), pulmonic area during systole (pulmonic stenosis), LSB 4
30
what may a heave indicate?
ventricular hypertrophy
31
pulses
check **temporal, carotid, brachial, radial, femoral, popliteal, post tib, dorsalis pedis** present, grade, symmetry TWO SCALES (need to indicate which scale you are using) ABNORMAL PULSES ALLEN TEST: test for occlusion of the radial/ulnar artery AORTA PALPATION BLOOD PRESSURE
32
two scales for pulses
3+- 3/3= bounding; 2/3=normal, 1/3=weak, 0/3=absent 4+- 4/4=bounding, 3/4=normal, 2/4=weak, 1/4= thready, 0/4=absent
33
abnormal pulses
pulsus magnus- bounding pulsus parvus- weak pulsus alterans- alternating pulsus paradoxus- r/t blood pressure
34
pulsus paradoxus
abnormally large decrease in SBP/pulse wave amplitude during inspiration NORMAL FALL IS <10 MMHG excessive decline can indicate tamponade, adhesive pericarditits, severe lung disease, advanced heart failure, and other conditions
35
allen test
pressure applied to ulnar/radial to occlude both, have pt elevate arm and make fist for 30 seconds, then open (hand should be blanched), release ulnar side **color should return to hand within 7 seconds= +ALLEN (adequate blood flow)**
36
aorta palpation
identify pulsation if visible press deeply on either side of the aorta- midline abd, above umbilicus NORMAL SIZE- 3 cm or less, average 2.5 cm; if >5.5 cm may need surgery **risk factors for AAA***- >65 yo, smoking, male gender, 1st degree relative with AAA, auscultated bruit
37
edema
RATE THE DEGREE- 0=no pitting, +1= mild, +2= moderate, +3= severe; +4=severe also record **where edema is located**
38
ankle brachial index (ABI)
predicts **severity of peripheral arterial disease** measurable with doppler ultrasound; perform on each side **right ankle SBP/right arm SBP**=ABI (complete bilaterally)
39
right ankle SBP/right arm SBP=ABI
normal= 1 or > at risk= 0.9 borderline ischemia= 0.6-0.8 severe ischemia= <0.5
40
what is the significance of JVP?
it is an indication of function of the R side of heart should see no engorgement of EJ **high level of engorgement=higher RA pressure**
41
how to examine R EJ
right side of pt, HOB at 45 degrees, pt turn head to left identify top of venous pulsation in neck (inward pulsation, not palpable), then measure distance **between top of pulsation and sternal angle** angle of louis (sternal angle) down to RA= approx 5 cm **your result +5cm=JVP**
42
if you get >9cm above RA when examining right EJ, what does this mean?
**increased RA pressure** right side HF is the most common constrictive pericarditis, tricuspid stenosis, SVC obstruction, valsalva phenomenon (laughing, coughing)
43
HJR- hepatic jugular reflux
apply firm pressure to liver border for 30 seconds **positive test**= >4cm JVP risk for >10 seconds
44
what does a positive HJR (hepatic jugular reflux) suggest?
suggests CHF falsely positive if valsalva (pt bearing down, abdominal guarding)
45
normal heart sounds
best heard with **diaphragm of stethoscope** S1 "LUB"- closing of mitral/tricuspid valves (end of diastole/beginning of systole), loudest at apex (mitral/tricuspid areas), upstroke of pulse/rise of QRS S2 "DUB"- closing of aortic/pulmonic valves (end of systole/beginning of diastole), loudest at base (aortic/pulmonic areas)
46
abnormal heart sounds
best heard with **bell of stethoscope** split S2 "lub-d dub" S3" lub-dub-d" or "ken-tuc-KY" S4 "d-lub-dub" or "ten-ne-see" rubs bruits
47
split s2 "lub-d dub" sound
RESPIRATORY EFFECT: **normal/physiologic**- r/t respirations b/c of volume changes; if and when pt holds breath, stutter goes away= physiological PARADOXICAL: **abnormal/pathologic**; sound doesn't go away with breath hold; seen with LBBB b/c impulse takes longer to get to L ventricle FIXED: **abnormal/pathologic**; always there and doesn't vary; seen with atrial-septal defect and RHF
48
S3 "lub-dub-d" or "ken-tuc-ky"
ventricular gallop, best heard at apex (bottom) during early systole (just after s2) result of blood splashing into ventricles PATHOLOGIC: seen in CHF, sign of being "wet" PHYSIOLOGIC: increased flow state in someone under 30, pregnancy
49
s4 "d-lub-dub" or "ten-ne-see"
**always pathologic**, atrial gallop, occurs with atrial contraction at the end of diastole (just before s1), found in stiff heart (recent MI, HTN)
50
rubs
caused by movement of inflammatory adhesions between visceral/parietal pericardial layers high pitched/squeaking sound like rubbing leather together may be systolic or diastolic and systolic heard at different times depending on cause components: atrial contraction, ventricular filling, ventricular contraction best heard with **patient leaning forward/breath held on expiration**- brings heart closer to chest wall
51
bruits (abnormal vascular sound)
caused by turbulent flow in blood vessels listen for carotid, aortic, renal, iliac, and femoral bruits biggest risk: HTN hard to differentiate between carotid bruit and aortic stenosis radiating into neck
52
murmurs
sound created by **turbulent flow in heart** (in periphery=bruit) TIMING- diastolic (between S2 and S1)= heart disease; systolic (between S1 and S2)= heart disease or can be normal SHAPE- intensity over time (crescendo, decrescendo, or crescendo-decrescendo) LOCATION- site of max intensity/loudest (aortic and mitral most common) RADIATION- can you hear it elsewhere? PITCH- high, medium, low QUALITY- blowing, harsh, rumbling, musical INTENSITY- graded on 1-6 scale
53
intensity of murmur
graded on 1-6 scale: 1/6- faint, only heard if you know it's there 2/6- quiet, but heard immediately 3/6- moderately loud 4/6- loud with PALPABLE THRILL 5/6- very loud, heard with stethoscope partially off of chest wall, PALPABLE THRILL 6/6- loudest, heard with stethoscope completely off of chest wall, PALPABLE THRILL
54
questions to identify valvular disorders
where is the loudest? when does the murmur occur? what is the valve doing during the cardiac cycle when you hear it? does it radiate? possible cause of valve dysfunction?
55
what is the valve doing during the cardiac cycle when you hear the murmur? *systole vs. diastole**
systole- tricuspid/mitral CLOSED (regurg); aortic/pulm OPEN (stenosis) diastole- tricuspid/mitral OPEN (stenosis); aortic/pulm CLOSED (regurg)
56
mid-systolic murmur
heard between S1 and S2 loudest during mid systole (crescendo-decrescendo)
57
holosystolic murmur
heard between S1 and S2, does not get louder or softer
58
aortic murmurs
radiates into neck STENOSIS***- mid-systolic, heard in aortic area (2nd ICS-RSB) INSUFFICIENCY***- diastolic decrescendo, heard in aortic area (2nd ICS-RSB)
59
mitral murmurs
radiates into axillary area STENOSIS***- diastolic murmur, heard in mitral area/apex (5th ICS-MCL) REGURGITATION ***- systolic murmur, heard in mitral area/apex (5th ICS-MCL)
60
common systolic murmurs: MR PASS MVP
Mitral Regurg Physiologic Aortic Stenosis Systolic Mitral Valve Prolapse
61
common diastolic murmurs: MS ARD
Mitral Steosis Aortic Regurg Diastolic
62
mitral valve prolapse
MID-SYSTOLIC CLICK (from leaflet opening back up)+ LATE MURMUR (2nd half of systole; when valve should be closed) PRIMARY: familial/non-familial, marfans, or other connective tissue diseases SECONDARY: CAD, rheumatic heart disease, vegetation, ASD, anorexia, dehydration, straight-back syndrome/pectus excavatum
63
general population aged 60 years or older (recommendations)
initiate pharmacologic treatment to lower blood pressure if SBP>150 mmHg or DBP >90 mmHg treat to a goal of <150/90 older patients with other perfusion issues, can't lower blood pressure too much or have other issues such as syncope
64
general population <60 years (recommendations)
initiate pharmacologic treatment to lower blood pressure if DBP>90 mmHg treat to goal of DBP <90 mmHg special recommendations for black and non black patient groups, kidney disease and diabetes black patients do not do as well on ACE/ARBS- start on CCB/thiazide

Advanced Health Assessment (7 decks)

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