test 1 module 4 cardiac Flashcards
What is the location and shape of the mediastinum
behind and left of the sternum, above the diaphragm, between the lungs (where the heart is); cone shaped
Where is the base and apex of the heart
upper portion- base;
lower portion-apex
what are the 4 layers surrounding the heart?
1 pericardium: outer sac
2 epicardium: outer surface
3 myocardium: muscle layer
4 endocardium: inner lining
What are the atrioventricular valves of the heart
tricuspid and mitral
4 chambers of the heart
Right atria, left atria, right ventricle, left ventricle
what are the semilunar valves of the heart
pulmonic and aortic
What is the cardiac cycle
sa node > atria contraction > AV junction > His-purkinje > ventricular contraction > S1 > systole > s2 > diastole > s3, s4
what is the electrical activation of the heart?
Sa node > AV node > Bundle of His > Left and right bundle branches > Purkinje fibers
What does the p-wave indicate on EKG?
atrial depolarization
what does the PR interval indicate on EKG?
Atrioventricular conduction
what does the QRS complex indicate on EKG?
ventricular depolarization
what does the ST segment & T wave indicate on EKG?
ventricular repolarization
What does the U wave indicate on ekg?
final phase of ventricular repolarization
what is the blood flow order through the heart?
R atrium > R ventricle > lungs > L atrium > L ventricle > body
Does the blood flow through the lungs in fetusus?
no
Is the apex of the heart higher or lower in infants?
higher (apex = bottom of heart)
What does the ductus venosus shunt blood through in a fetus? and when should it close?
Diverts blood from the right ventricle > aorta > body > fetal gas exchanger. closes within 12-14 hours of birth
What is the foramen ovale and how does it close?
It allows deoxygenated blood to flow from the RA (where it came from the placenta) and oxygenated blood to flow through the LA ;closes due to shifting pressure in right and left side of heart
what does the ductus arteriosis shunt blood to in a fetus?
Allows maternal blood flow from the placenta to fetus IVC
How many hours should the shunts close after birth?
24-48 hours
4 things that happen to circulation in pregnancy
1 blood volume increases
2 HR increases
3 BP increases
4 ankle edema
(all because the heart is working harder)
What 5 things happen to our hearts as we age?
1 heart size decreases
2 L ventricle thickens
3 Valves calcify
4 decreases in pacing
5 delayed myocardium contractility
Normal order of cardiac exam
Inspection, palpation, auscultation
what age range should you change order or exam to inspection, auscultation, palpation?
infant > 3 years; because of anxiety and fearfulness
Where is the expected apical pulse located in adults and children?
MCL (midclavicular line) & 5th ICS (intercostal space) in adults and medial to nipple and 4th ICS in children
What are the appropriate ranges of normal respiratory rate for a 0-3 month old?
35-55 breaths/min
What are the appropriate ranges of normal respiratory rate for a 3-6 month old?
30-45 breaths/min
What are the appropriate ranges of normal respiratory rate for a 6-12 month old?
22-38 breaths/min
What are the appropriate ranges of normal respiratory rate for a 1-3 year old?
22-30 breaths/min
What are the appropriate ranges of normal respiratory rate for a 3-6 year old?
20-24 breaths/min
What are the appropriate ranges of normal respiratory rate for a 6-12 year old?
16-22 breaths/min
Where is S1 heard? and what pulse does it coincide with?
S1 is heard at the apex of the heart and coincides with the rise of the carotid pulse
What kind of pitch does the sound of S1 have? S2?
S1 has a lower pitch and S2 has a higher pitch
Is the sound of S1 or S2 longer in duration?
S1 is longer than S2
Where is S2 heard?
S2 is heard in the aortic and pulmonic area > base of heart
What is the name of S3 and what characteristics does it have?
S3 is a ventricular gallop and is quiet, low pitched, heard at apex. Pathologic in adults > 40, but normal in children.
What is the name of S4 and what characteristics does it have?
S4 is an atrial gallop, low pitched and best heard at apex. If heard, its pathologic
When do systolic murmurs start and end?
Begin with or after S1 and end before S2
When do diastolic murmurs start and end?
Begin with or after S2 and end at or before S1
What are the 6 systolic murmurs?
1 Mitral valve regurgitation 2 tricuspid valve regurgitation 3 aortic stenosis 4 pulmonic stenosis 5 ventral septal defect (VSD) 6 mitral valve prolapse (MVP)
What are the 4 diastolic murmurs?
1 aortic regurgitation 2 pulmonic regurgitation 3 mitral valve stenosis 4 tricuspid valve stenosis
Signs of venous insufficiency
pale bluish change in skin color, ulcers, varicosity
Signs of arterial insufficiency
shiny skin on legs, skin color change, slow nail and hair growth, non healing wounds
vascular changes in pregnancy
palmar erythema, spider telangiectasis, decrease in SBP, dependent edema, varicose veins
What are the three components of virchow’s triad?
Stasis, Vascular damage, hypercoagulability
Ventricular septal defect (VSD) in children objective and subjective s/s
Subjective: recurrent respiratory infections, rapid breathing, poor growth s/s CHF. Objective: arterial pulse is small, jugular venous pulse not affected
Tetralogy of Fallot in children subjective and objective s/s:
subjective: dyspnea with feeding, poor growth, exercise intolerance. objective: parasternal heave, precordial prominence, can have clubbing of finger/toes
Patent Ductus Arteriosis in children subjective and objective s/s:
subjective: small = asymptomatic, large = dyspnea on exertion. objective: dilated and pulsatile neck vessels, wide pulse pressure
Atrial septal defect (ASD) subjective and objective s/s
subjective: asymptomatic, heart failure can occur in adults. objective: systolic thrill, palpable parasternal thrust
coarctation of the aorta objective and subjective s/s:
subjective: can be asymptomatic, HTN or s/s of heat failure and vascular insufficiency. objective: differences in systolic BP between arm and leg; femoral pulses are weaker than radial pulses or absent
Rheumatic fever subjective and objective s/s:
subjective: fever, inflamed swollen joints, erythema marginatum, chorea, small painless nodules under the skin, chest pain, palpitations, fatigue, shortness of breath. objective: murmurs of mitral regurgitation and aortic insufficiency, cardiomegaly, pericarditis friction rub, signs of CHF
Kawasaki Disease subjective and objective s/s:
subjective: fever 5+ days, weight loss, fatigue, myalgias, arthritis. objective: fever, conjunctival infection, strawberry tongue, edema in hands and feet, lymphadenopathy, polymorphous non -vesicular rashes
what does systole mean
the period of ventricular contraction
what does diastole mean
the period of ventricular filling and relaxation
When does S1 sound occur
when the mitral and tricuspid valves are closed from the pressure generated by ventricular contraction. (lub)
when does S2 sound occur
when the aortic and pulmonic valves close following ventricular contraction. (dub)
what can an S3 sound in adults indicate?
ventricular failure or myocardial ischemia
What can S4 indicate in adults? and when is S4 heard?
ventricular dysfunction (usually stiffness) and is heard right before S1
What 3 high cardiac output states can a BENIGN murmur happen that is unalarming?
pregnancy, fever, and anemia
is a murmur in a child alarming?
No, nearly all murmurs in children are benign and they will grow out of them as they get olderw
what are the two types of mumurs?
stenosis and regurgitation
Where are aortic valve murmurs heard normally?
at the cardiac base and right second intercostal space
Where are mitral valve murmurs normally heard?
near cardiac apex
where are tricuspid valve murmurs usually heard?
lower aspect of the left sternal border
where are pulmonary valve murmurs usually heard?
left second intercostal space
