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Physical Assessment > Week 4/5 Cardio > Flashcards

Week 4/5 Cardio Flashcards

1
Q

What are the layers of the heart and their functions?

A

Epicardium- visceral
Myocardium- muscle portion
Endocardium- where blood vessels are

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2
Q

Where is the location of the base of the heart and what is heard here?

A

Near the 2nd and 3rd intercostal and S2 is best hear here.

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2
Q

Where is the PMI and where is it heard

A

Apical pulse at the bottom of the heart

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3
Q

Where is S2 heart sound heard?

A

The base of the heart

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4
Q

What is the order of blood flow through the heart?

A

Rt atria, tricuspid, rt ventricle, pulmonic valve,
Lt atria, mitral/bicuspid, lt ventricle, aortic

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5
Q

What do you call the valves that lead into the ventricles?

A

AV valves, tricuspid and mitral

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6
Q

What are the valves that lead out of the heart?

A

Semilunar valves, pulmonic and aortic

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7
Q

What makes the S1 sound?

A

Tricuspid and mitral closing “lub”, or the beginning of systole

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8
Q

What structures makes the S2 sound?

A

pulmonic and aortic closing “dub”, or the end of systole/beginning of diastole

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9
Q

What is the difference between S3 and S4?

A

The s3 is after S2 and S4 comes before

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10
Q

What sounds do S1 and S2 make?

A

Lub and dub

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11
Q

What is the condition for S3 sounds called?

A

Ventricular gallop

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12
Q
A
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12
Q
A
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13
Q

What is the condition for S4 sounds called?

A

Atrial gallop

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14
Q

What is systole?

A

Phase of ventricular contraction

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14
Q

What is diastole?

A

Phase of ventricular relaxation

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15
Q

What makes the “lub” sound of the heart?

A

Tricuspid and mitral closing

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16
Q

What makes the “dub” sound of the heart?

A

pulmonic and aortic closing

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17
Q

When does S3 occur?

A

After S2 in early diastole

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18
Q

When does S4 occur?

A

Before S1in late diastole

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19
Q

What extra heart sound is sometimes normal?

A

S3

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20
Q

What extra heart sound is heard in pregnant women? Why?

A

S3 because the heart is pumping harder

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21
Q

What might S3 and S4 be a sign of?

A

CHF

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22
Q

What does a heart murmur sound like and what causes it?

A

Turbulent blood flow, which causes a harsh blowing sound

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23
Q

What is a regurgitation

A

When the valves doesn’t close all the way the blood leaks backwards

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23
Q

What are the grades of murmurs?

A

The intensity of a murmur

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23
Q

What is a stenosis?

A

When the valve doesn’t open all the way for blood passage and the valve is narrowed

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23
Q

What is another word for thrust and what does it sound like?

A

heave

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24
Q

Grade one murmur sound

A

Barely audible with stethoscope

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25
Q

Grade two murmur

A

Very soft but distinctly audible

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26
Q

Grade three murmur

A

Moderately loud, but no thrill or thrusting

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27
Q

Grade four murmur

A

Distinctly loud with a palpable thrill

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28
Q

Grade five murmur

A

Very loud and can hear with part of diaphragm of stethoscope off chest with palpable thrust and thrill

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29
Q

Grade six murmur

A

Loudest and can hear w/o stethoscope visible thrill and thrust (heave)

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30
Q

What is happening in an aortic stenosis?

A

Aortic valve is narrowed

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30
Q

What is happening in a mitral regurgitation?

A

Blood flow of mitral valve is backflowing

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31
Q

What does an aortic stenosis sound like?

A

Usually harsh, coarse sound

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32
Q

What does a pulmonary stenosis mean?

A

Pulmonary valve is not opening all the way

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33
Q

What is the flow of cardiac electrical conduction?

A

SA, AV, Bundle of His, Rt/Lt bundle branches, Purkinje.

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34
Q

What does each section of a deflection mean?

A

P-Wave: Depolarization of the atria
PR Interval: delay of AV node to allow filling of ventricles
QRS Complex: depolarization of the ventricles
ST Segment- beginning of the ventricle repolarization
T-Wave: ventricular repolarization

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35
Q

When does the atria depolarize?

A

p-wave

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36
Q

When does the ventricle repolarize?

A

T-wave

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37
Q

What should the ST segment look like, and what does it mean the heart is doing?

A

Beginning of ventricle repolarization and should be flat

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38
Q

When does the ventricles depolarize?

A

QRS

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39
Q

What allows for the delaying of AV node to allow filling of ventricles?

A

PR interval delays a bit

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39
Q

What does a sinus brady and sinus tachy look like?

A

Brady is less than 60 but even, and tach is faster than 100, but even

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40
Q

What does a-fib look like?

A

Irregular and inconsistent QRS wave like the ocean some are taller and some are shorter

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41
Q

What does an atrial flutter look like?

A

Low somewhat even and regular P-r waves and ORS peaks

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42
Q

What does v-tach look like?

A

Depressed Q waves and high RST, or wide fast fluctuations

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43
Q

What does v-fib look like?

A

An irregular iceberg; no regularities

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44
Q

What are some areas to assess when doing a cardio assessment?

A

Face and lips and ears and scalp for cyanosis and color, bruising and other abnormalities
Neck- jugular and carotid
Hands and fingers for circulation
Chest, abdomen, legs and skeletal

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44
Q

How do you palpate the carotid arteries?

A
  1. Palpate one at a time
  2. Auscultate with the bell for bruits (swooshing sound for arterial sclerosis
  3. Palate the wrist and auscultate carotid or API to see if the same rate for a pulse deficit
    Use the diaphragm and bell
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45
Q

How do you assess for JVD? What does it signal?

A

turn the patient’s neck while they sit at 45 degrees and see if it is more than 3 cm, and if more, then it can signal JVD

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46
Q

What is a normal jugular vein?

A

If it measures less than 3 cm

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47
Q

What is a splinter hemorrhage indicative of?

A

Endocarditis, lupus, rheumatoid arthritis, psoriatic nails, trauma

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48
Q

What landmarks should you place your stethoscope for precordial assessment?

A

RSB, 2nd ICS- aortic
LSB, 2nd ICS- pulmonic
LSB, 3rd ICS- Erb’s
LSB, 4th ICS, tricuspid
LMCL, 5th ICS- mitral

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49
Q

What are bruits and what causes them?

A

Blowing sounds that might signal arterial sclerosis from plaque buildup.

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50
Q

When do you use the diaphragm and the bell for precordial assessment?

A

Use the diaphragm for aortic and pulmonic, the bell for Erb’s and mitral/apex, and either for tricuspid

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51
Q

What heart sound should S2 sound louder than S1?

A

Aortic and pulmonic

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52
Q

What heart sound should S1 and S2 sound equal

A

Erb’s should sound equal

53
Q

What heart sound should S1 sound louder than S2?

A

Tricuspid and mitral or at the apex

54
Q

What kinds of things do you listen for in a cardiac assessment?

A

Bruits, arterial sclerosis

55
Q

What kinds of things do you palpate for?

A

Heaves, thrills, and vibrations.

56
Q

What do you percuss?

A

Rt/lt sternal border and superior and inferior surfaces of A the chest walls

57
Q

What kind of blood vessels don’t pulsate, and why?

A

Veins because there is less pressure and in a vacuum.

58
Q

Fluid that bathes tissue and drains into the blood stream?

A

Lymphatics

59
Q

What are some general things to assess for?

A

Pulse, BP, orthostatic hypotension, cap refill, less than 2-3 seconds, palpate pulse, and Allens’ test

60
Q

What is the definition of orthostatic hypotension?

A

If switching positions makes BP drop more than 10

61
Q

What are things/ of a pulse you should document?

A

Rate, rhythm, quality, and peripheral pulses that are assessed simultaneously

62
Q

What is the Allen’s test and what does it look for?

A

Determines the patency between ulnar and radial arteries
1. Close fist
2. Put pressure on radial and ulnar arteries
3. Open hand and watch them turn back to regular color
- If they don’t return w/in 7 seconds, then there’s something wrong

63
Q

What would you do if the peripheral pulses were at a 0?

A

Try again with a doppler

64
Q

What is a bounding pulse grade?

A

4

65
Q

What is a weak pulse grade?

A

1

66
Q

What is a normal pulse grade?

A

2

67
Q

How would you test for Homans’ sign and what does it look for?

A

Checks for DVT (don’t massage)
1. Supine patient
2. Dorsiflex foot with bent knee at 5 degrees
3. Determine if painful or not
- If pain in lower calf, then may be a sign of DVT.

68
Q

What are some signs of arterial insufficiency?

A

Cool, hairless, shiny and rubor (reddish)
Pain is sharp, stabbing and worsens with activity
Leg pain is relieved when lowered
Ulcers are severely painful with gray base
Pulse- often absent or diminished
Edema- non usually

69
Q

What are some signs of venous insufficiency?

A

Skin- warm, mottled
Pain- achy and cramping relieved by activity
Ulcers- pink base on medial aspect of ankle.
Pulse- usually present
Edema- frequent at end of day and areas of ulceration
Leg pain is relieved when elevated

70
Q

What complication does arterial insufficiency cause?

A

Claudication in the butt or legs

71
Q

What is arterial insufficiency caused by?

A

Inadequate circulation in the arterial system from fatty plaques

72
Q

What end up happening with right sided heart failure?

A

The right side of the heart is too weak to push the blood out into pulmonary circulation, so it backs up in the body

73
Q

What are the symptoms of right sided heart failure?

A

Fatigue upon exertion, JVD from fluid overload, dependent edema, hepatomegaly, and splenomegaly,

74
Q

What type of swelling happens in right-sided heart failure?

A

Increased peripheral venous pressure, ascites, dependent edema, and swelling in hands and fingers

75
Q

What are symptoms of left sided heart failure?

A

Fatigue at rest, Productive cough, frothy sputum with blood tinged, hacking cough

76
Q

What type of dyspnea happens in left sided?

A

Exertional, or during physical movement

77
Q

What type of coughing happens in left-sided HF?

A

Blood tinged or frothy from productive coughing

78
Q

What are some cognitive changes in left-sided HF?

A

Restlessness and confusion because there is a lack of oxygenated blood getting out into the systemic circulation

79
Q

What are two abdominal findings of right sided HF?

A

Anorexia and GI distress with enlarged liver and spleen LAGS

80
Q

What is the difference between myocardial ischemia and infarction.

A

Ischemia has a temporary blood supply block from plaques and an infarction is where heart muscle tissue die

81
Q

What is the intervention for infarction?

A

Give aspirin

82
Q

What is a major difference in s/s of infarction and ischemia/

A

There is a feeling of impending doom in an infarction

83
Q

What are some interventions with chest pain?

A

Have the patient sit, put them on O2

84
Q

What are some s/s of infarction and ischemia?

A

SOB, pain, nausea, diaphoretic, pallor, EKG changes

85
Q

What happens in mitral and aortic regurgitation?

A

Because the valve doesn’t close all the way, the blood will flow backward. From the right pulmonary to the right ventricle for aortic regurgitation and from the left ventricle to the left atrium for mitral regurgitation

86
Q

What do stenoses look like?

A

They have narrowing of the valves

87
Q

What happens with a tricuspid stenosis?

A

The tricuspid fails to open fully so there is backflow of blood from right atrium into the system circulation

88
Q

What happens with an aortic regurgitation?

A

The aortic valves doesn’t close all the way so there is backflow from the pulmonary circulation into the right ventricle

89
Q

What happens in an atrial septal defect?

A

There is an opening in the wall between the atria so the oxygenated and deoxygenated blood mixes, causing low oxygen in the systemic circulation

90
Q

What happens in coarctation of the aorta?

A

The aorta is narrowed or pinched so it restricts blood flow from the heart to systemic circulation and you typically need surgery

91
Q

What happens in patent ductus arteriosus?

A

The ductus arteriosus, which usually closes soon after birth fails to close and the blood from the aorta and pulmonary artery mixes, causing fatigue due to lower oxygen in the systemic circulation

92
Q

What are the four abnormalities of tetralogy of fallot?

A

Stenotic pulmonary valve
Overriding aortic valve
Interventricular septal defect
Hypertrophied right ventricle

93
Q

Blue babies are a sign of what?

A

Some heart defect because there is poor oxygenation

94
Q

Patent ductus arteriosus

A

the ductus arteriosus fails to close after they are born and they may or may not need any surgery

95
Q

Which congenital heart defect is the most serious?

A

Tetralogy of Fallot and the baby may need a shunt or some other stent or surgical intervention

96
Q

What is artifact?

A

If the electrode is off the chest, sweaty patient, or portable monitor

97
Q

What does a-fib look like?

A

Inconsistent

98
Q

What does ventricular tachycardia look like?
elves

A

Very tall and fast waves like a 6.5 earthquake

99
Q

What does an atrial flutter mean and what does it look like?
A flutter= sawtooth like jaws
https://www.youtube.com/watch?v=ppyXFJ-mes4

A

They are very fast rates of beating where the SA node beats in a loop, so there are consistent waves and no p waves, and they are only QRS waves
R-R interval are regular distance apart
300bpm of atria

100
Q

What does v-fib look like and mean?
dwarves

A

Total absence of regular heart rhythm that is irregular, but not that tall and R-R rates are not equal

101
Q

What does an atrial fibrillation mean and what does it look like?
No p wave and fibrillation flopping
Dandelions or weeds

A

There are irregular distance R waves from the different foci of the electrical field.
No regularity or pattern
No p wave

102
Q

What does a grayish undertone in the skin indicate possibly?

A

Coronary artery disease or shock

103
Q

Polycythemia or Cushing syndrome can manifest how on the skin?

A

A ruddy red color

104
Q

Hyperthyroidism can result in what type of cardiac problem?

A

Tachycardia and then CHF

104
Q

Marfan syndrome is what and can be seen as what?

A

Blue color in the sclera affected by connective tissue degeneration

105
Q

What can Noonan syndrome be manifest as?

A

Wide-set eyes in a child who may have pulmonic stenosis

106
Q

What might the xanthelasma manifest as?

A

Yellowish cholesterol deposits on the eyelids may indicate premature atherosclerosis.

107
Q

What cardiac issues can Paget disease lead to?

A

Bone disease characterized by localized loss of calcium from the bone can be characterized by high cardiac output and can lead to heart failure

108
Q

Where is the jugular vein in relation to the carotid?

A

The jugular is over the sternocleidomastoid muscle and the internal jugular is behind and the carotid is right nest to the trachea.

109
Q

Where is the best indicator of central venous pressure?

A

The internal jugular vein

110
Q

What side of the stethoscope do you listen for bruits on the jugular veins?

A

The bell

110
Q

What should you see when inspecting the carotids?

A

They should be visible bilaterally

111
Q

What is the best way to assess the carotids on an obese patient?

A

Sit them upright because they may have trouble breathing

112
Q

What do splinter hemorrhages indicate?

A

Possible infective endocarditis

113
Q

What may yellow fingernails and tips indicate?

A

Atherosclerosis from smoking

114
Q

What might dilated distended chest veins indicate?

A

Obstruction of the superior vena cava

115
Q

What positions should you observe the patient’s chest at?

A

30 degrees and then upright

116
Q

What is patchy hair distribution a sign of ?

A

Circulatory compromise

117
Q

How would you auscultate the carotids?

A

Listen with the diaphragm and the bell by holding their breath
Compare the apical pulse with a carotid and compare

118
Q

What are objective findings of right sided heart failure?

A

Peripheral edema
Liver congestion
Hypertension
JVD

119
Q

What are subjective findings of left-sided heart failure?

A

Dyspnea and SOB

119
Q

What are objective findings of left-sided heart failure?

A

Frothy sputum, adventitious breath sounds, such as rhonchi or rales, decreased O2 saturaton and productive cough

120
Q

What are subjective findings of right-sided heart failure?

A

Fatigue, weakness, confusion, and loss of appetite

121
Q

What is the average time for each cardiac cycle to be completed?

A

0.8 seconds

122
Q

What is the atrial kick?

A

When the blood in the atria are stimulated by the SA node and about 30% of the blood in the atria move into the ventricles not due to the passive ventricular filling

123
Q

How long does the P wave last usually?

A

0.08 seconds

124
Q

How long does the PR interval last?

A

0.12-0.20 second

125
Q

How long does the QRS complex last?

A

0.08 to 0.11 second

126
Q

Where is the atrial repolarization in a deflection?

A

Hidden behind the QRS complex

127
Q

What is normal adult cardiac output?

A

4-8 L/min

128
Q

What is the Frank-Starling law?

A

The greater the stretch, the greater the contractile force and the greater the volume of blood ejected with each contraction

129
Q

How does stress increase cardiac workload?

A

They experience longer period of sympathetic stimulation, increasing systemic vascular resistance

130
Q

What kind of drug use can cause coronary artery spasm in addition to myocardial injury and ischemia?

A

Cocaine and other substances

131
Q

Which insufficiency pain will be relieved when elevated?

A

venous

132
Q

What are varicose veins?

A

They have increased intravenous pressure and have dilated vessels and diminished rate of blood flow

133
Q

Which condition has red, white and blue skin?

A

Raynaud- spasms

134
Q

What symptom has unilateral swelling?

A

Occlusion that means lymph node disease

134
Q

What is lymphedema caused by?

A

Obstruction in the lymph nodes from causes like cancer which makes the lymph fluid build up.

134
Q

What causes Raynaud disease?

A

Cold temperatures or stress constrict small blood vessels near the skin and causes a chameleon effect.

135
Q

Which peripheral disease can have pain relieve when lowering feet?

A

arterial

135
Q

What peripheral disease would you have to elevate the feet to relieve pain?

A

Venous

136
Q

What are some s/s of varicose veins?

A

Aching and burning
Skin changes, scaly, dry, and shiny

Physical Assessment (4 decks)

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