Week 4/5 Cardio Flashcards
What are the layers of the heart and their functions?
Epicardium- visceral
Myocardium- muscle portion
Endocardium- where blood vessels are
Where is the location of the base of the heart and what is heard here?
Near the 2nd and 3rd intercostal and S2 is best hear here.
Where is the PMI and where is it heard
Apical pulse at the bottom of the heart
Where is S2 heart sound heard?
The base of the heart
What is the order of blood flow through the heart?
Rt atria, tricuspid, rt ventricle, pulmonic valve,
Lt atria, mitral/bicuspid, lt ventricle, aortic
What do you call the valves that lead into the ventricles?
AV valves, tricuspid and mitral
What are the valves that lead out of the heart?
Semilunar valves, pulmonic and aortic
What makes the S1 sound?
Tricuspid and mitral closing “lub”, or the beginning of systole
What structures makes the S2 sound?
pulmonic and aortic closing “dub”, or the end of systole/beginning of diastole
What is the difference between S3 and S4?
The s3 is after S2 and S4 comes before
What sounds do S1 and S2 make?
Lub and dub
What is the condition for S3 sounds called?
Ventricular gallop
What is the condition for S4 sounds called?
Atrial gallop
What is systole?
Phase of ventricular contraction
What is diastole?
Phase of ventricular relaxation
What makes the “lub” sound of the heart?
Tricuspid and mitral closing
What makes the “dub” sound of the heart?
pulmonic and aortic closing
When does S3 occur?
After S2 in early diastole
When does S4 occur?
Before S1in late diastole
What extra heart sound is sometimes normal?
S3
What extra heart sound is heard in pregnant women? Why?
S3 because the heart is pumping harder
What might S3 and S4 be a sign of?
CHF
What does a heart murmur sound like and what causes it?
Turbulent blood flow, which causes a harsh blowing sound
What is a regurgitation
When the valves doesn’t close all the way the blood leaks backwards
What are the grades of murmurs?
The intensity of a murmur
What is a stenosis?
When the valve doesn’t open all the way for blood passage and the valve is narrowed
What is another word for thrust and what does it sound like?
heave
Grade one murmur sound
Barely audible with stethoscope
Grade two murmur
Very soft but distinctly audible
Grade three murmur
Moderately loud, but no thrill or thrusting
Grade four murmur
Distinctly loud with a palpable thrill
Grade five murmur
Very loud and can hear with part of diaphragm of stethoscope off chest with palpable thrust and thrill
Grade six murmur
Loudest and can hear w/o stethoscope visible thrill and thrust (heave)
What is happening in an aortic stenosis?
Aortic valve is narrowed
What is happening in a mitral regurgitation?
Blood flow of mitral valve is backflowing
What does an aortic stenosis sound like?
Usually harsh, coarse sound
What does a pulmonary stenosis mean?
Pulmonary valve is not opening all the way
What is the flow of cardiac electrical conduction?
SA, AV, Bundle of His, Rt/Lt bundle branches, Purkinje.
What does each section of a deflection mean?
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
When does the atria depolarize?
p-wave
When does the ventricle repolarize?
T-wave
What should the ST segment look like, and what does it mean the heart is doing?
Beginning of ventricle repolarization and should be flat
When does the ventricles depolarize?
QRS
What allows for the delaying of AV node to allow filling of ventricles?
PR interval delays a bit
What does a sinus brady and sinus tachy look like?
Brady is less than 60 but even, and tach is faster than 100, but even
What does a-fib look like?
Irregular and inconsistent QRS wave like the ocean some are taller and some are shorter
What does an atrial flutter look like?
Low somewhat even and regular P-r waves and ORS peaks
What does v-tach look like?
Depressed Q waves and high RST, or wide fast fluctuations
What does v-fib look like?
An irregular iceberg; no regularities
What are some areas to assess when doing a cardio assessment?
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
How do you palpate the carotid arteries?
- Palpate one at a time
- Auscultate with the bell for bruits (swooshing sound for arterial sclerosis
- Palate the wrist and auscultate carotid or API to see if the same rate for a pulse deficit
Use the diaphragm and bell
How do you assess for JVD? What does it signal?
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
What is a normal jugular vein?
If it measures less than 3 cm
What is a splinter hemorrhage indicative of?
Endocarditis, lupus, rheumatoid arthritis, psoriatic nails, trauma
What landmarks should you place your stethoscope for precordial assessment?
RSB, 2nd ICS- aortic
LSB, 2nd ICS- pulmonic
LSB, 3rd ICS- Erb’s
LSB, 4th ICS, tricuspid
LMCL, 5th ICS- mitral
What are bruits and what causes them?
Blowing sounds that might signal arterial sclerosis from plaque buildup.
When do you use the diaphragm and the bell for precordial assessment?
Use the diaphragm for aortic and pulmonic, the bell for Erb’s and mitral/apex, and either for tricuspid
What heart sound should S2 sound louder than S1?
Aortic and pulmonic
What heart sound should S1 and S2 sound equal
Erb’s should sound equal
What heart sound should S1 sound louder than S2?
Tricuspid and mitral or at the apex
What kinds of things do you listen for in a cardiac assessment?
Bruits, arterial sclerosis
What kinds of things do you palpate for?
Heaves, thrills, and vibrations.
What do you percuss?
Rt/lt sternal border and superior and inferior surfaces of A the chest walls
What kind of blood vessels don’t pulsate, and why?
Veins because there is less pressure and in a vacuum.
Fluid that bathes tissue and drains into the blood stream?
Lymphatics
What are some general things to assess for?
Pulse, BP, orthostatic hypotension, cap refill, less than 2-3 seconds, palpate pulse, and Allens’ test
What is the definition of orthostatic hypotension?
If switching positions makes BP drop more than 10
What are things/ of a pulse you should document?
Rate, rhythm, quality, and peripheral pulses that are assessed simultaneously
What is the Allen’s test and what does it look for?
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
What would you do if the peripheral pulses were at a 0?
Try again with a doppler
What is a bounding pulse grade?
4
What is a weak pulse grade?
1
What is a normal pulse grade?
2
How would you test for Homans’ sign and what does it look for?
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.
What are some signs of arterial insufficiency?
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
What are some signs of venous insufficiency?
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
What complication does arterial insufficiency cause?
Claudication in the butt or legs
What is arterial insufficiency caused by?
Inadequate circulation in the arterial system from fatty plaques
What end up happening with right sided heart failure?
The right side of the heart is too weak to push the blood out into pulmonary circulation, so it backs up in the body
What are the symptoms of right sided heart failure?
Fatigue upon exertion, JVD from fluid overload, dependent edema, hepatomegaly, and splenomegaly,
What type of swelling happens in right-sided heart failure?
Increased peripheral venous pressure, ascites, dependent edema, and swelling in hands and fingers
What are symptoms of left sided heart failure?
Fatigue at rest, Productive cough, frothy sputum with blood tinged, hacking cough
What type of dyspnea happens in left sided?
Exertional, or during physical movement
What type of coughing happens in left-sided HF?
Blood tinged or frothy from productive coughing
What are some cognitive changes in left-sided HF?
Restlessness and confusion because there is a lack of oxygenated blood getting out into the systemic circulation
What are two abdominal findings of right sided HF?
Anorexia and GI distress with enlarged liver and spleen LAGS
What is the difference between myocardial ischemia and infarction.
Ischemia has a temporary blood supply block from plaques and an infarction is where heart muscle tissue die
What is the intervention for infarction?
Give aspirin
What is a major difference in s/s of infarction and ischemia/
There is a feeling of impending doom in an infarction
What are some interventions with chest pain?
Have the patient sit, put them on O2
What are some s/s of infarction and ischemia?
SOB, pain, nausea, diaphoretic, pallor, EKG changes
What happens in mitral and aortic regurgitation?
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
What do stenoses look like?
They have narrowing of the valves
What happens with a tricuspid stenosis?
The tricuspid fails to open fully so there is backflow of blood from right atrium into the system circulation
What happens with an aortic regurgitation?
The aortic valves doesn’t close all the way so there is backflow from the pulmonary circulation into the right ventricle
What happens in an atrial septal defect?
There is an opening in the wall between the atria so the oxygenated and deoxygenated blood mixes, causing low oxygen in the systemic circulation
What happens in coarctation of the aorta?
The aorta is narrowed or pinched so it restricts blood flow from the heart to systemic circulation and you typically need surgery
What happens in patent ductus arteriosus?
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
What are the four abnormalities of tetralogy of fallot?
Stenotic pulmonary valve
Overriding aortic valve
Interventricular septal defect
Hypertrophied right ventricle
Blue babies are a sign of what?
Some heart defect because there is poor oxygenation
Patent ductus arteriosus
the ductus arteriosus fails to close after they are born and they may or may not need any surgery
Which congenital heart defect is the most serious?
Tetralogy of Fallot and the baby may need a shunt or some other stent or surgical intervention
What is artifact?
If the electrode is off the chest, sweaty patient, or portable monitor
What does a-fib look like?
Inconsistent
What does ventricular tachycardia look like?
elves
Very tall and fast waves like a 6.5 earthquake
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
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
What does v-fib look like and mean?
dwarves
Total absence of regular heart rhythm that is irregular, but not that tall and R-R rates are not equal
What does an atrial fibrillation mean and what does it look like?
No p wave and fibrillation flopping
Dandelions or weeds
There are irregular distance R waves from the different foci of the electrical field.
No regularity or pattern
No p wave
What does a grayish undertone in the skin indicate possibly?
Coronary artery disease or shock
Polycythemia or Cushing syndrome can manifest how on the skin?
A ruddy red color
Hyperthyroidism can result in what type of cardiac problem?
Tachycardia and then CHF
Marfan syndrome is what and can be seen as what?
Blue color in the sclera affected by connective tissue degeneration
What can Noonan syndrome be manifest as?
Wide-set eyes in a child who may have pulmonic stenosis
What might the xanthelasma manifest as?
Yellowish cholesterol deposits on the eyelids may indicate premature atherosclerosis.
What cardiac issues can Paget disease lead to?
Bone disease characterized by localized loss of calcium from the bone can be characterized by high cardiac output and can lead to heart failure
Where is the jugular vein in relation to the carotid?
The jugular is over the sternocleidomastoid muscle and the internal jugular is behind and the carotid is right nest to the trachea.
Where is the best indicator of central venous pressure?
The internal jugular vein
What side of the stethoscope do you listen for bruits on the jugular veins?
The bell
What should you see when inspecting the carotids?
They should be visible bilaterally
What is the best way to assess the carotids on an obese patient?
Sit them upright because they may have trouble breathing
What do splinter hemorrhages indicate?
Possible infective endocarditis
What may yellow fingernails and tips indicate?
Atherosclerosis from smoking
What might dilated distended chest veins indicate?
Obstruction of the superior vena cava
What positions should you observe the patient’s chest at?
30 degrees and then upright
What is patchy hair distribution a sign of ?
Circulatory compromise
How would you auscultate the carotids?
Listen with the diaphragm and the bell by holding their breath
Compare the apical pulse with a carotid and compare
What are objective findings of right sided heart failure?
Peripheral edema
Liver congestion
Hypertension
JVD
What are subjective findings of left-sided heart failure?
Dyspnea and SOB
What are objective findings of left-sided heart failure?
Frothy sputum, adventitious breath sounds, such as rhonchi or rales, decreased O2 saturaton and productive cough
What are subjective findings of right-sided heart failure?
Fatigue, weakness, confusion, and loss of appetite
What is the average time for each cardiac cycle to be completed?
0.8 seconds
What is the atrial kick?
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
How long does the P wave last usually?
0.08 seconds
How long does the PR interval last?
0.12-0.20 second
How long does the QRS complex last?
0.08 to 0.11 second
Where is the atrial repolarization in a deflection?
Hidden behind the QRS complex
What is normal adult cardiac output?
4-8 L/min
What is the Frank-Starling law?
The greater the stretch, the greater the contractile force and the greater the volume of blood ejected with each contraction
How does stress increase cardiac workload?
They experience longer period of sympathetic stimulation, increasing systemic vascular resistance
What kind of drug use can cause coronary artery spasm in addition to myocardial injury and ischemia?
Cocaine and other substances
Which insufficiency pain will be relieved when elevated?
venous
What are varicose veins?
They have increased intravenous pressure and have dilated vessels and diminished rate of blood flow
Which condition has red, white and blue skin?
Raynaud- spasms
What symptom has unilateral swelling?
Occlusion that means lymph node disease
What is lymphedema caused by?
Obstruction in the lymph nodes from causes like cancer which makes the lymph fluid build up.
What causes Raynaud disease?
Cold temperatures or stress constrict small blood vessels near the skin and causes a chameleon effect.
Which peripheral disease can have pain relieve when lowering feet?
arterial
What peripheral disease would you have to elevate the feet to relieve pain?
Venous
What are some s/s of varicose veins?
Aching and burning
Skin changes, scaly, dry, and shiny
