Unit 1 - Heart and Neck Flashcards
1
Q
What is the anterior surface portion of the chest which most of our assessment is completed on?
A
Precordium
2
Q
What is the cavity/space called between the lungs?
A
Mediastinum
3
Q
What intercostal space is the base of the heart found?
A
2nd intercostal space
4
Q
What intercostal space is the apex of the heart found?
A
5th intercostal space
5
Q
What is the membrane enclosing the heart, consisting of an outer fibrous layer and an inner double layer of serous membrane?
A
Pericardium
Note: Parietal pericardium is the fibrous outer layer of the heart
Visceral pericardium is the inner layer of the heart
6
Q
The bulk of the heart is made up of this muscular tissue.
A
Myocardium - the heart muscle
7
Q
What is the inner lining of the heart called?
A
Endocardium
8
Q
A reservoir of the heart which receives blood from the body and lungs in a relaxed state is called an __________?
A
Atrium
9
Q
Which atrium receives deoxygenated blood from the body?
A
Right Atrium
10
Q
Which atrium receives oxygenated blood from the lungs?
A
Left Atrium
11
Q
What is the lower portion of the heart that acts like a pump and sends blood away from the body?
A
Ventricles
12
Q
What ventricle contracts to send deoxygenated blood to the lungs?
A
Right Ventricle
13
Q
What ventricle contracts to send oxygenated blood to the body?
A
Left Ventricle
14
Q
What is the unique quality about the pulmonary vein?
A
It is the only vein that carries oxygenated blood. In return, the pulmonary artery is the only artery to carry deoxygenated blood in the heart.
15
Q
What are the thread-like bands of fibrous tissue which attach on one end to the edges of the tricuspid and mitral valves of the heart and on the other end to the papillary muscles, small muscles within the heart that serve to anchor the valves.
A
Chordae Tendineae
16
Q
What does AV valve mean?
A
Atrioventricular - valve open with diastole and close with ventricular systole. These are between the atria’s in the upper chamber and the ventricles in the lower chambers.
17
Q
What does SL Valves mean?
A
Semilunar valves - open with ventricular systole. They are between the ventricles and the Pulmonary artery and aorta. Once it fills with blood it will force the valve shut.
18
Q
What is the AV valve found on the right side of the heart?
A
Tricuspid valve
19
Q
What is the SL valve found on the Left side of the heart?
A
Aortic valve
20
Q
Where is the mitral valve found?
A
On the left side of the heart found between the left atrium and ventricle
21
Q
Where is the pulmonic valve found?
A
On the right side of the heart between the right ventricle and the pulmonary artery.
22
Q
Normally, how much blood can you heart pump through per minute.
A
4-6L of blood
23
Q
Describe the flow of blood from outside the heart, through the heart, and out of the heart.
A
DEOXYGENATED Blood comes from the head and lower body through the superior/inferior vena cave.
It then rushes into the relaxed right atrium, through the tricuspid valves down to the right ventricle.
Then gets pumped through the pulmonic valve to the pulmonary artery which carries it to the lungs to become oxygenated.
OXYGENATED blood then returned through the pulmonary vein to the left atrium, down the mitral valve to the lower left ventricle.
It then is pumped out the aortic valve to the aorta.
Fresh blood is then carried to the head and the rest of the body.
24
Q
What is Systole?
A
Built up pressure in ventricles for ejection.
Systolic = how hard you heart is pumping the blood out.
Note* Pressure is the right side of your heart is much lower due to the main ejection of blood comes from the left side of the heart.
25
What is Diastole?
Relaxed ventricles
| Diastolic = how your heart fills up
26
Where would S1 heart sounds be heard?
First heart sound - would be found at the apex of the heart as it is a result from the AV valves close. It is the lub sound.
27
Where is the S2 heart sounds found?
Second Heart sounds - would be found in the base of the heart as it is a result of the SL valves closing. It is the DUP sound.
28
What sound could occur if the patient where to hold their breath changing the pressure of their heart?
Split S2 (Delayed Pulmonary Valve Closure.
29
When would a S3 heart sound be heard?
Right after S2
30
When would a S4 heart sound be heard?
Just before S1
31
What is the cause of S3 and S4 sounds?
Resistant ventricles
32
Describe some sounds that can be heard if a heart murmur is present?
Gentle blowing
Clicking
Rushing
Gurgling
*It is not specific to one site or noise
33
What is some causes of murmurs in the heart?
Changes in velocity or viscosity of the blood or valve and wall defects within the heart.
34
What is the murmur called if it is heard between S1 and S2 heart sounds?
Systole Murmur
35
What is the murmur called if it is heard after the S2 heart sound?
Diastole murmur
36
List some characteristics that you may use to describe a heart murmur.
Timing - systole or diastole
Loudness/Intensity - 6 grading scale
Frequency - Pitch
Duration (more silence than sound)
37
Grade the following murmur:
| Faint murmur that can only be heard after a few seconds have elapsed
Grade 1
38
Grade the following murmur:
loud murmur, a thrill may be present
*Note a thrill is a palpable vibration over the site of an murmur
Grade 4
39
Grade the following murmur:
| Faint murmur that is heard immediately
Grade 2
40
Grade the following murmur:
| Moderate murmur intensity.
Grade 3
41
Grade the following murmur:
| Loud murmur that can be heard with the chest piece just removed from and not touching the skin, a thrill is present.
Grade 6
42
Grade the following murmur:
| Loud murmur that can be heard if only the edge of the stethoscope is in contact with the skin, a thrill is present.
Grade 5
43
What test shows the conductivity of the heart?
Electrocardiogram - ECG
44
What node is known for being the pacemaker of the heart?
Sinoatrial (SA) node (60/100bmp)
Note* The SA node consists of a cluster of cells that are situated in the upper part of the wall of the right atrium (the right upper chamber of the heart). The electrical impulses are generated there which regulate the heart beat.
45
What is the proper name for the AV node?
Atrioventricular (AV) node (40-60bpm)
Note* The AV node delays cardiac impulses. It ensures that the atria have ejected their blood into the ventricles first before the ventricles contract.
46
What is the T wave in an ECG reading
Repolarization of ventricles
47
What is a Q-T interval in an ECG?
Ventricular contractions
48
In an ECG, what is a QRS complex?
Ventricular depolarization
49
in an ECG, what is a P-R interval?
Arterial contraction
50
What is a P wave in an ECG reading?
Arterial depolarization
51
What is the following equation for?
CO=HRxSV
Pumping ability of the heart.
CO= Cardiac output
HR= Heart rate
SV= Stroke Volume
52
What is preload mean?
Preload is the venous return that builds during diastole. It is the length to which the ventricular muscle is stretched at the end of diastole just before contraction. When the volume of blood returned to the ventricles is increased (as when exercise stimulates skeletal muscles to contract and force more blood back to the heart), the muscle bundles are stretched beyond their normal resting state to accommodate it. The force for this switch is the preload.
(Think of the balloon already filled with air)
53
What does afterload mean?
Afterload is the opposing pressure the ventricle must generate to open aortic valve against the higher aortic pressure. It is the resistance against which the ventricle must pump its blood. Once the ventricle is filled with blood, the ventricular end diastolic pressure is 5 - 10 mm Hg, whereas that in the aorta is 70 - 80 mm Hg. To overcome this difference, the ventricular muscle tenses. After the aortic valve opens, rapid ejections occur.
(Think of your fingers holding air in the balloon)
54
What part of the body dumps blood into the Superior Vena Cava?
Bonus- Is it oxygenated blood or deoxygenated?
Head and neck
Deoxygenation returning to the heart!
55
What part of the body dumps blood into the Inferior vena cava?
Bonus- Is it oxygenated blood or deoxygenated?
The rest of the body (below the neck
Deoxygenated blood returning to the heart!
56
What type of blood is carried through the pulmonary veins?
Oxygenated blood from the lungs to the heart
57
What part of the heart delivers oxygenated blood from the heart to the body?
Aorta
58
What delivers oxygenated blood to the head from the heart?
Carotid arteries
59
What is a vagal response?
Occlusion of the carotid arteries preventing oxygenated blood to reach the head which causes the patient to pass out.
60
What drains the head of deoxygenated blood?
Jugular veins (internal and external)
61
What is another word for chest pain or tightness?
Angina
62
What is Orthopena?
Trouble breathing while laying down.
Do they need or use extra pillows when they sleep?
63
What is the term for shortness of breath?
Dyspena
64
What is nocturia?
frequent urination throughout the night that wakes you from sleep.
65
What are some areas of cardiac history you could collect for subjective data?
HTN, Elevated cholesterol, murmurs, congenital heart disease, rheumatic fever or unexplained joint pains as a child or youth, recurrent tonsillitis, anemia
Family history, diabetes, obesity, CAD
Personal habits, daily diet, smoking, alcohol, amount of exercise, medications
66
How shall you prepare the patient in regards to position and draping?
Sitting up, then supine. Be discrete (not every man is comfortable taking off their shirt, be sensitive to both men and women)
67
What is the order of examination?
After Vitals and Extremities
1. Neck Vessels
2. Precordium
68
What arteries are we inspecting on the neck?
Carotid Arteries
- Auscultate for buit
- then palpate ONE at a time
69
How are you assessing the jugular veins of the neck?
Inspecting the jugular venous pulse (pulsation or wave form) Measure as to where the wave form stops
Estimate the jugular venous pressure by looking at the jugular venous distention
DO NOT palpate for hepatojugular reflux
70
What does the JVD (jugular venous distension) tell us about the heart?
It is a reflection of the Right arterial pressure and possible fluid backing up.
71
Where would you hear the Aortic valve during auscultation?
2nd Intercostal space on the right side of the sternum
72
Where would you auscultate to hear the mitral valve?
5th intercostal space midclavicular on the left side of the sternum
73
Where would you auscultate to hear the Pulmonic valve?
2nd intercostal space on the left side of the sternum
74
Where can you hear the tricuspid valve during auscultation?
5th intercostal space to the left of the sternum.
IT CAN be found also in the 4th on some people.
75
What is erbs point, and where can it be found?
Erbs point is the space for which you can hear what is happening in both parts of the heart. It is found in the 3rd intercostal space to the left of the sternum.
76
In which part of the heart is the S1 louder than S2?
Apex
77
In which part of the heart is the S2 louder than S1?
Base
78
S1 coordinates with which artery?
The carotid.
79
What is a pulse deficit?
The difference of heart rate found between the apical pulse and the radial pulse.
Can show if there is an issue with irregular heart rate as they should be the same.
80
What is the proper term for heart attack?
Myocardial Infarction (MI)
81
What are some signs and symptoms that are shown with heart failure?
Dilated pupils, Skin is pale/grey/cyanotic, Dyspena (SOBOE is early symptom from pulmonary congestion), Decreased BP, Nausea and Vomiting, Ascites (fluid build up in peritoneal cavity), Failing 02 saturation, Confusion, Jugular vein distention, Fatigue, Decreased urine output, Weak pulse, cool moist skin, dependent pitting edema.
82
Which part of the stethoscope should you auscultate for heart sounds first?
You auscultate first with the diaphragm, then you will use the bell.
83
What is PMI?
Point of maximal impulse
84
What normal variation may affect the location of the apical impulse?
Obese, Thick chest wall, Large breast tissue
85
Define apical impulse and describe its normal location, size, and duration.
Apical impulse: point of maximal impulse; pulsation created as the left ventricle rotates against the chest wall during systole
Location: normally at the fifth left intercostal space in the midclavicular line
Duration: systole (short. normally first 1/2 of systole)
Size: normally 1 x 2 cm
86
Which abnormal variations may affect the location of apical impulse?
Cardiac enlargement
L Ventricle dilation (volume overload)
displaces impulse down and to the left and increases size more than one space.
Barrell chest
87
Explain the physiologic mechanism for normal splitting of S2. In what location on the heart would you expect to hear a split S2?
Splitting of the S2 can happen during inspiration. It is heard when the aortic valve closes earlier than the pulmonic valve. Instead of it sounding like "dub" it sounds like "T-Dub". You can hear it only in the pulmonic valve area.
88
Explain the position of the valves during each phase of the cardiac cycle.
Diastole- AV valves (i.e. tricuspid and mitral) are open
Systole- AV valves shut producing S1.
Aortic valves open to eject blood rapidly. then some back flow from psi equalizing b/t aorta and ventricles causes aortic valve to shut
Diastole again- all 4 valves closed, mitral valve opens and diastolic filling begins again
89
Define bruit, and discuss what it indicates.
A bruit is a blowing, swishing sound indicating blood flow turbulence. Indicated turbulence due to a local vascular cause, such as atherosclerosis narrowing.
90
The precordium is:
a) a synonym for the mediastinum
b) the area on the chest where the apical impulse is felt
c) the area on the anterior chest overlying the heart and great vessels.
d) a synonym for the area where the superior and inferior venae cavae return unoxygenated venous blood to the right side of the heart
C) the area on the anterior chest overlying the heart and great vessels.
91
Select the best description of the tricuspid valve.
a) Left semilunar valve
b) Right AV valve
c) Left AV valve
d) Right semilunar valve
b) Right AV valve
92
The function of the pulmonic valve is to:
a) divide the left atrium and left ventricle
b) guard the opening between the right atrium and right ventricle
c) protect the orifice between the right ventricle and the pulmonary artery
d) guard the entrance to the aorta from the left ventricle
c) protect the orifice between the right ventricle and the pulmonary artery
93
Atrial systole occurs:
a) during ventricular systole
b) during ventricular diastole
c) concurrently with ventricular systole
d) independently of ventricular function
b) during ventricular diastole
94
The second heart sound is the result of:
a) opening of the mitral and tricuspid valves
b) closing of the mitral and tricuspid valves
c) opening of the aortic and pulmonic valves
d) closing of the aortic and pulmonic valves.
d) closing of the aortic and pulmonic valves.
95
The examiner is palpating the apical impulse. The normal size of this impulse:
a) is less than 1 cm
b) is about 2 cm
c) is 3 cm
d) varies depending on the size of the person
b) is about 2 cm
96
The examiner wishes to listen in the pulmonic valve area. To do this, the stethoscope would be placed at the:
a) second right interspace
b) second left interspace
c) left lower sternal border
d) fifth interstate, left midclavicular line
b) second left interspace
97
The examiner wishes to listen for a pericardial friction rub. Select the best method of listening.
a) with the diaphragm, patient sitting up and leaning forward, breath held in expiration
b) using the bell with the patient leaning forward.
c) at the base during normal respiration
d) with the diaphragm, patient turned to the left side
a) with the diaphragm, patient sitting up and leaning forward, breath held in expiration
98
When auscultating the heart, your first step is to:
a) identify S1 and S2
b) listen for S3 and S4
c) listen for murmurs
d) identify all four sounds on the first round
a) identify S1 and S2
99
You will hear a split S2 most clearly in what area?
a) Apical
b) Pulmonic
c) Tricuspid
d) Aortic
b) pulmonic
100
The stethoscope bell should be pressed lightly against the skin so that:
a) chest hair does not stimulate crackles
b) high-pitched sounds can be heard better
c) it does not act as a diaphragm
d) it does not interfere with amplification of heart sounds
c) it does not act as a diaphragm
101
A murmur heard after S1 and before S2 is classified as:
a) diastolic (possible benign)
b) diastolic (Always pathological)
c) systolic (possibly benign)
d) systolic (always pathological)
c) systolic (possibly benign)
102
What is mitral stenosis?
Calcified mitral valve impedes forward flow of blood into left ventricle during diastole
103
what is Mitral regurgitation?
mitral insufficient; incompetent mitral valve allows regurgitation of blood back into left atrium during systole.
104
What is pericardial friction rub?
high-pitched scratchy extra cardiac sound heard when the precordium is inflamed.
105
What is pulmonic stenosis?
Calcification of pulmonic valve that restricts forward flow of blood during systole
106
What is pulmonic regurgitation?
Pulmonic insufficiency; back flow of blood through incompetent pulmonic valve into the right ventricle.
