Week 9: Cardiac & Peripheral Vascular Assessment Flashcards
Definition: Arteriosclerosis
A vascular disease that causes arteries to harden and thicken, which can restrict blood flow
Definition: Bradycardia
A slow heart rate, less than 60 in adults (sinus brady = slow normal sinus rhythm)
Definition: Cardiac dysrhythmia
Abnormal heart rhythm (problem with conduction systems)
Definition: Cardiac output
The amount of blood the heart pumps in 1 minute.
Definition: Claudication
Muscle pain due to lack of oxygen that’s triggered by activity and relieved by rest.
Definition: Diastole
The phase of the heartbeat when the heart muscle relaxes and allows the chambers to fill with blood.
Definition: Edema
Swelling caused by fluid building up in body tissues
Definition: Ischemia
An inadequate blood supply to an organ or part of the body, especially the heart muscles.
Definition: Pallor
An unhealthy, pale appearance
Definition: Perfusion
The process of fluids, like blood, passing through the body’s circulatory system to organs and tissues.
Definition: Precordium
The region or the thorax immediately in front of the heart
Definition: Stroke volume
The difference between the end-diastolic volume (EDV) and the end-systolic volume (ESV)
Definition: Symmetry
When it has two matching halves; same on both sides.
Definition: Systole
Period of contraction of the ventricles of the heart that occurs between the first and second heart sounds of the cardiac cycle.
Definition: Tachycardia
A fast heart rate, greater than 100 in adults (sinus tachy= fast normal sinus rhythm)
Definition Thorax
The area of the body between the neck and the abdomen.
Definition: Varicose veins
A medical condition in which superficial veins become enlarged and twisted.
What are the 3 main functions of the heart?
- Delivering oxygen & nutrients
to the body - Removing metabolic waste
- Maintaining adequate
perfusion of the organs and
tissues
How many RBCs are lost and replaced every second?
2.5-3 million
How much blood is continuously travelling through a human body?
5 litres
Where is the heart located?
Between 2th and 5th intercostal space
What part of the heart is the “base”?
The top
What part of the heart makes up the “apex”?
The bottom, it points down and to the left
What causes the apical pulse?
The apex beating against the chest wall
Where can the apical pulse be felt?
Can be felt at the 5th intercostal space, 7-9 cm
from midsternal line)
Starting in the lungs with OXYGENATED blood, describe the flow of blood through the heart/body.
Leaves the lungs to the left atrium, left ventricle, to the body, then circles back DEOXYGENATED to the right atrium, right ventricle, then back to the lungs for oxygenation
What causes the First Heart Sound (S1)?
Closure of AV Valve (tricuspid, between the R atrium and
ventricle, and mitral, between the L atrium and ventricle)
What is the S1 sound mean?
The beginning of systole
Where is the S1 heart sound loudest?
At the aortic and pulmonary valves points
What causes the Second heart sound (S2)?
Closure of semilunar valves (aortic – between the L
ventricle and aorta, and pulmonic – between the R ventricle and pulmonary
artery)
What is the S2 sound mean?
The end of systole
Where is the S2 heart sound loudest?
At the tricuspid and mitral valve points
What are murmurs?
Turbulence in blood flow and collision currents (gentle, blowing, swooshing sound)
What causes Murmurs?
- Increases in velocity (speed) of bloodflow
- Decreases in viscosity (thickness) of blood
- Structural deficits in the valves or unusual openings in
the chambers.
When does S3 occur?
Early ventricular filling; “Sloshing in”
What is S3 associated with?
Normal in children; in adults,
associated with ventricular
dilation and fluid backing up (ex.Heart failure)
When does S4 occur?
Atrial contraction; “A stiff wall”
What is S4 associated with?
Associated with stiff, low
compliant ventricle (ex. ventricular hypertrophy; ischemic ventricle, MI)
What is the Sinoatrial (SA) node?
“The pacemaker” near superior vena cava; initiates electrical impulse
Where does the impulse made by the SA node flow to?
Impulse flows across atria to the AV node low in the atrial septum
Why is the impulse delayed at the AV node?
So the atria have time to contract
What is the Bundle of His?
A collection of heart muscle cells that transmits electrical impulses to the Left and Right Bundle Branches
Where does the impulse flow after the Bundle of His?
Impulse is transmitted to the ventricles
What is the result after the impulse leave the Bundle of His?
The ventricles contract
What are common clinical presentations of Coronary Artery Disease (CAD)?
Will often see hypertension, normal heart rate and rhythm, normal O2 saturations and normal respiratory rate and rhythm.
What are common clinical presentations of Myocardial Infarction (MI)?
During an evolving MI you will often see hypertension, higher
than heart rate normal rate +/-
irregular rhythm, reduced O2
saturation, increased respiratory rate.
What are common clinical presentations of Congestive Heart Failure (CHF)?
- Will often see hypotension,
normal heart rate and
rhythm, normal to reduced
O2 saturations depending
on the severity of disease - Reduced temperature
- Hear an S3 on auscultation
What are common clinical presentations of Atrial Fibrillation?
Normal heart rate to
tachycardia with an irregular
rhythm, +/- reduced O2
saturation and increased
respiratory rate dependent on
the heart rate. The higher the
heart rate the greater
likelihood of respiratory
compromise.
What is Atherosclerosis?
Accumulation of plaque in cardiac arteries that can lead to MI.
What are some signs of Heart Failure to recognize?
- Dilated pupils
- Pallor, grey, or cyanotic skin
- Dyspnea
- Orthopnea (can only breath while sitting up)
- Cough/Crackles/wheeze
- Low BP
- Nausea and vomiting
- Dependent, pitting edema
- Anxiety
- Falling O2
- Confusion
- Fatigue
What sort of questions should you ask for a cardiac assessment?
- Chest pain
- Dyspnea
- Orthopnea
- Cough
- Fatigue
- Cyanosis/pallor
- Edema
- Nocturia
- Cardiac history
- Family history
- Risk factors
What sort of preparations should be done before a cardiac assessment?
- Warmth/comfort
- Quiet
- Privacy
- Infection control
- Organization
- Reassurance
What is an important thing to remember about draping when doing a cardiac assessment?
Expose only as much of the
body as is needed while draping the other areas to provide as much privacy as possible
Why do you never assess through clothing or sheets?
- Inspection will not be possible
- Auscultation will be dulled and sounds will be missed and
misheard - Palpation: small things may be missed, tactile fremitus will
be dulled
What are the 3 steps to a cardiac assessment?
Inspection
Palpation
Auscultation
What do you look for upon inspection during a cardiac assessment?
Skin colour and condition, chest wall pulsations, heaves and lifts
What are heaves or lifts?
Sustained or forceful thrusting of the ventricle during
systole; Occurs with ventricular hypertrophy as a result of increased workload.
Where do you palpate during a cardiac assessment?
Across the precordium (using palmar aspect of 4 fingers) along the apex, left sternal border, and base of the heart
What is a thrill?
A palpable vibration indicating
turbulent blood flow; like a cat purring
What are some things to remember to do before you auscultate during a cardiac assessment?
- Palpate IC spaces to landmark
- Z pattern from base to apex
- Identify valve areas
- Listen with the bell and diaphragm
Which valve area is found in the 2nd R IC space?
Aortic valve
Which valve area is found in the 2nd L IC space?
Pulmonic valve
Which valve area is found in the 3rd L IC space?
Erbs point
Which valve area is found in the 5th L IC space?
Tricuspid valve
Which valve area is found in the 5th L IC space, approximately midclavical?
Mitral valve
Which heart sounds are best heard with the diaphragm of the stethoscope?
S1 & S2
Which heart sounds are best heard with the bell of the stethoscope?
Murmurs, S3, & S4
What do you expect to hear during auscultation of a cardiac assessment?
- 60 to 100 beats
- Any premature beats (a beat is early)
- Sinus arrhythmia with children occasionally
- Irregularly irregular (no pattern)
How do you calculate a pulse deficit?
If you note an irregularity palpate the radial pulse and listening to apical pulse simultaneously; Count serial measurement and subtract radial pulse from apical pulse.
When would you hear S4 in relation to S1 and S2?
Before S1
When would you hear S3 in relation to S1 and S2?
After S2
What are the 3 arteries in the arm?
Radial
Ulnar
Brachial
What are the 4 arteries of the legs?
Femoral
Politeal
Dorsalis pedis
Posterior tibial
What is the function of the lymphatic system?
Retrieves excess fluid from tissue spaces and returns it to the bloodstream
What are the 2 main trunks of the lymphatic system?
Right lymphatic duct (right arm, right side of heart & liver)
Thoracic duct (rest of the body)
What are lymph nodes?
Clumps of lymphatic tissue along the vessels that filter fluid before it is returned to the
bloodstream (they filter out microorganisms)
What are the 4 superficial lymph nodes?
Cervical
Axillary
Epittrochlear
Inguinal
What is Nitroglycerin?
Medication used to relieve cardiac pain by relaxing and widening blood vessels so blood can flow more easily to the heart.
What is Angina (chest tightness)?
An important cardiac symptom that occurs when the heart’s vascular supply cannot keep up with metabolic demand; A squeezing “clenched fist” sign is characteristic
What is Hemoptysis?
Coughing up blood-tinged mucus
What is an ECG?
An electrocardiogram
