Wk 3 Heart And Peripheral Vascular Flashcards
Which part of the heart is the apex?
Base?
Apex = bottom
Base = Top
Heart wall layers from inner
Endocardium
Myocardium
Pericardium
Atrioventricular valves
Semilunar valves
Tricuspid/ mitral
Pulmonic / aortic
Question: What is the “S1” heart sound?
Answer: “first heart sound” or “lub,” marks the beginning of systole and is associated with the closure of the atrioventricular (AV) valves.
Which valves are responsible for the “S1” heart sound?
Closure of the AV valves, specifically the Mitral valve and the Tricuspid valve.
The 2nd heart sound
Which valves closure is responsible
Sound made
Pulmonic and aortic
Dubb
1st heart sound
What makes the noise
Where can we ausculate
Bicuspid (Mitral) & Tricuspid
Tricuspid = 4th intercostal space,Left side, sternal border
Mitral (bicuspid) = 5th intercostal space, left side, midcavicular
3rd heart sound
Describe sound
Cause
Who it maybe normal for
Lub du bub
Rapid filling of the ventricles
<40
4th heart sound
Describe
Cause / disease associated
Be lub duplicate
Stuff ventricle due to Hypertension
Ventricle cannot fill properly and thus has a reduced volume of blood to expel
With pericarditis, there is often an abnormal heart sound called _________. This sound is created when the inflamed pericardial layers rub against each other
pericardial friction rub
Murmur
An extra noise heard when examining the heart.
Maybe innocent or caused by heart disease
Stenosis is…
When a valve doesn’t open properly
Regurgitation is….
When a valve doesn’t close properly
How is the Jugglar veins “Pulse” felt as….
A wave
A stool softener may be given to a heart attack victim
True or False
True
With heart failure there maybe Cyanosis & Pallor
Which is Chronic and which is Acute
Cyanosis= Acute
Pallor = Chronic
Where is edema usually first seen
Legs
Qualify edema
1+ ….
2+ ….
3 + ……
1+ = 2mm
2+ = 4mm
3+ = 6mm
Nocturia is often seen with heart or lung problems
Heart
High BP, Smoking, High LDL, obesity, DM are all risk factors for…
Cardiac problems
Give examples of Primary & Secondary prevention for heart problems
Primary. Exercise, Healthy Diet, No smoking/ Drinking
Secondary: Screening for hypertension
Objective Data: Physical Exam
Palpate the carotid arteries…..
How?
One at a time
Objective Data: Physical Exam
When auscultating the Carotid artery with the Bell, what abnormal sound are you looking for.
Describe it / what is its cause
Bruit
Swishing sound.
Narrowing of artery
early systole, and is loudest near the apex of the heart. Describes this heart sound
S¹
Carotid Doppler to estimate if it is narrowed. If so…
Stent is placed inside the artery
Inspect Jugglar vein for……
Which is associated with Heart Failure
Distention
This lung sound is associated with Heart Failure
Fine crackles
AFib causes _____ solution is to give an anticoagulant
What can happen if not treated
Clots
Stroke
Any rare findings what is the first thing to do in an assessment
POLDCARTS
History of Present Illness
FAST is for which disease
Stroke
Face, arms, speech, time
Sever valve disease is….
A murmur
Which is the best posistion to hear S³ (Kentucky)
Left lateral
Give a reason valves may not close properly
Stiffening from Old Age
Arteriosclerosis
Loss of flexibility
Atherosclerosis is a type of arteriosclerosis
Describe Atherosclerosis
Plaque build up
Lymph nodes get smaller or larger with age
Smaller
Modeling
Spotty skin
Edema +1 pitting (2mm) is a ___% increase of fluid
30
What is the maximum level of edema that is so sever it doesn’t have pitting
Brawny Edema
A positive Allen’s test signifies what
The paitent has sufficient blood supply to upper extremities
When auscultating a AV shunt or fistula access for Bruit & Thrill.
These are normal/ healthy findings?
Yes or No
Yes
Arteriovenous fistula
An abnormal connection between an artery and a vein.
Arteriovenous (AV) fistulas usually occur in the legs.
An AV fistula is a connection that’s made between an artery and a vein for….
dialysis access
Bruit is this type of sound
Swishing
Thrill can be inspected how?
Palpate. Palmer surface of hand and feel vibrations
Is lack of popteal pulse normal
If you use a doppler to find this pulse, how do you chart this?
Yes
Positive with doppler
Pulsus bigeminus is…..
cardiovascular phenomenon characterized by groups of two heartbeats close together followed by a longer pause
Raynauds Syndrome is an autoimmune disease that reacts to____
Treat with steroids
Cold weather
1 cause of preventable death in hospitals….
Pulmonary embolism from DVT
Leathery skin, swelling lower legs, Nee varicose veins, statis ulcer…
Describe this disease
Chronic Venus Disease
To help Venus disease place legs in this posistion
Elevated
To help Arterial Disease put legs in this position
Dangling
An Unna boot is a compression dressing made by wrapping layers of gauze around your leg and foot.
The Unna boot is used for (Venus Status Ulcers or peripheral Artery Disease)
The compression of the dressing helps improve blood flow in your lower leg.
Venus Status Ulcers
Use a unaboot for (Venus or Artery)
Venus
Venus ablation seals veins from the inside to improve blood flow from these two vein disease
from varicose veins or chronic venous insufficiency
Perferial Artery Disease PAD lower extremity problem.
Poor wound healing, burning/ tingling, cramps, slow nail growth and Claudication
Describe teachings to help
Beware falls, injury to foot, wear shoes
Rubor
Flushed Red
Claudication, Pain with exercise, low pulses, Thin shiny hairless skin, Cool Temps, ulcers on pressure points in feet
Describes (Arterial or Venus)
Arterial
Pain increases when legs dependent, lower extremities edema, Brown discoloration of skin, Ankel Ulcerations, Skin temp normal, Pulse present but difficult to palpate due to edema
(Arterial or Venus)
Venous
Activation of the sympathetic nervous system (increases/ decreases) heart rate, (constricts / dilates) blood vessels, and (diminish / enhance) the force of heart contractions
Increase
Constricts
Enhances
parasympathetic nervous system (slows/ speeds up) the heart rate, (dilates/ constricts) blood vessels, and (reduces/ increases) the force of heart contractions.
Slows
Dilates
Reduces
Often referred to as “lub,” S1 is the sound of the closing of the ________ valves (tricuspid and mitral) at the beginning of ventricular (systole / diastole)
It marks the start of ventricular contraction and the ejection of blood into the _______ & _______circulation.
atrioventricular
Systole
pulmonary and systemic
is an extra heart sound that occurs during early diastole, typically associated with rapid filling of the ventricles.
can be a sign of heart conditions like ______ & ________
S3
heart failure or volume overload
extra heart sound that occurs in late diastole
It is sometimes called an “atrial gallop” and is associated with stiff or non-compliant ventricles.
Can be a sign of these diseases
S4
hypertensive heart disease or ventricular hypertrophy
Edema swelling occurs when there is an excess of ______
interstitial fluid
Often referred to as “dub,” S2 is the sound of the closing of the_____ valves (aortic and pulmonic) at the end of ventricular systole.
It marks the end of ventricular contraction and the closure of the valves to prevent blood from flowing back into the ventricles.
Semilunar
Negative allen’s test is associated with (veins / arteries) and reduced blood flow.
Arteries
Apex (Bottom) of the heart this is heard better
S¹
Base (Top) of heart this is heard better
S²
membranous partition between two body cavities or two parts of an organ, especially that between the lungs.
mediastinum
membranous partition between two body cavities or two parts of an organ, especially that between the lungs.
mediastinum
The cordiatendian attach to ______ helping to prevent leakage through the AV valves during systole.
Papillary muscles
MI could make the chordate tendonia not open and close valves properly.
Which sound would this be heard as
Murmur
S³ has this “state” sound
S⁴…
Correct
S³ Kentucky
S⁴ Tennessee
A murmur is ….
Correct
When a valve doesn’t open or close properly
Afterload =
Blood pressure
Preload =
Amount of fluid
Does dehydration make heart rate go (up / down)
Up
Parasympathetic involves the stimulation of the ____ nerve which makes heart rate / Blood pressure (increase/ decrease)
Vagus
Decrease
Valsalva maneuver stimulates _____ nerve and decreases heart rate / BP
Valsalva maneuver is similar to the force used when deficating
True or False
Vagus
True
A paitent has pallor associated with anemia
Will heart rate be (elevated / decreased)
Elevated
In attempt to move more blood around
With nocturia the Sympathetic Nervous System is decreased which releases
Water and sodium
Fine crackles associated with Heart Failure is AKA
Rales
Endocarditis: An infection of the heart’s inner lining, usually involving the heart valves
How does this infection usually occur
Causes this type of atypical heart sound
Central Line Catheter
Murmur
____ sound occurs when the atria contract, forcing blood into non-compliant ventricle
S⁴
Lymphatic nodes should be smaller than
1cm
Which have valves (veins/ arteries)
Veins
Pulse
0
1
2
3
4
Correct
0 absent
1 weak
2 normal
3 Bounding
4. Increased
When do we do Allen’s test
When drawing arterial blood
Difference between a fistula and a shunt.
Fistula uses graft material to attach an artery to a vein
Shunt connects them without the graft material
Manual compression test is for…
- Compress vein
- Feel for wave
A. No wave felt
B. Wave felt
No wave
Vein function
A. No wave felt = Competent valve
B. Wave felt = incompetent valve
Homan’s sign: Test for what
Supine, flex foot towards tibia, PAIN = (possible disease)
Valves in veins not functioning
Deep vein thrombosis
Tendinitis
Muscle injury
Pulse amplitude
1+
2+
3+
4+
1+ = Weak Thready
2+ = Normal
3+ = Full
4 + = Bounding
Problems with lymph nodes can cause this. Unilateral, near lymph nodes
Lymphedema
Raynaud’s syndrome is an autoimmune disorder that is aggrevated by the cold.
What kind of symptom does it present
Decreased circulation in hands / fingers
Swollen and red leg is associated with this disease
DVT
Does DVT always have swelling and redness associated with it?
No, sometimes only a fever is present
Symptoms: Arterial or Venous
Claudication
(Pain, commonly in the legs, caused by too little blood flow, usually during exercise)
Arterial
Symptom: Arterial or Venous
Pain increases when legs are dependent (standing or sitting)
Venous
Symptom: Arterial or Venous
Pain with exercise or at rest
Arterial
Symptom: Arterial or Venous
Lower extremity edema
Venous
Symptom: Arterial or Venous
Lower or absent pulse
Arterial
Symptom: Arterial or Venous
Brown discoloration of skin
Venous
Symptom: Arterial or Venous
Thin, shiny, hairless skin
Arterial
Symptom: Arterial or Venous
Ankle ulcerations
Venous
Symptom: Arterial or Venous
Cool skin temperature
Arterial
Symptom: Arterial or Venous
Skin temperature normal
Venous
Symptom: Arterial or Venous on pressure points of feet
Arterial
Symptom: Arterial or Venous
Pulse present but difficult to palpate due to edema
Venous
What do compression socks / unaboots do to venous return?
Increases it
In arterial disease
Foot elevated = (Pallor/ Rubor)
Foot Dependent = (Pallor/ Rubor)
Foot elevated = Pallor
Foot Dependent = Rubor
Lub de bub is the sound associated with this extra heart sound
S³ (Kentucky)
Extra heart sound
Results from increased atrial pressure leading to increased flow rates.
CHF
MOST COMMON CAUSE OF THIS EXTRA HEART SOUND
S³
Extra heart sound
Low frequency sound in presystolic portion of diastole
Belub dup
S⁴
Starling law: The more the heart is filled during diastole the more forcefully it contracts
Is associated with (Afterload / Preload)
Preload
Stimulates Adrenal Medulla to secrete Catecholamines to interact with adrenergic receptors in heart and blood vessels
(Sympathetic/ Parasympathetic)
Sympathetic
______ represents ventricular filling, and ____ represents ventricular contraction/ejection
Diastole / systole
Carotid artery pulse coincides with (S¹ or S²)
S¹
Harsh, blowing, musical, rumbling describe the quality of which heart sound
Murmur
Ejection murmur (due to blood flow through a narrowed vessel or irregular valve)
Regurgitation murmurs
happen when
Systolic murmur
These murmurs happen when the heart muscle relaxes between beats
Due to narrowing (stenosis) of the mitral or Tricuspid valve
Or
Regurgitation of the aortic or pulmonary arteries
Diastolic
Murmurs caused by valvular defects
Midsystolic ejection murmurs
Semilunar valves stenosis
Aortic & pulmonic
Murmurs caused by valvular defects
Diastolic rumbles of av valves
Av valves stenosis
Murmurs caused by valvular defects
Pansystolic regurgitation murmurs
Semilunar Valve regurgitation
Murmurs caused by valvular defects
Early diastolic murmurs
Semilunar Valve regurgitation
Aortic & Pulmonic
Diaphragmatic excursion less than 3-5 cm may indicate which diseases
Pneumonia
Pneumothorax
Bronchial vesicular sound heard over
Tracheal, high pitched, loud
Brochvesicular heard where
1 & 2nd ICS at sternal boarder
Post: to T4
Medium intensity
Vesicular sounds are heard in most of the lung fields
True or False
True
Which condition is associated with Marfans syndrome
Pectus excavatum
Pleural Rub
Because these sounds occur whenever the patient’s chest wall moves, they appearon inspiration and expiration
Name diseases associated with it
pneumonia, pulmonary embolism, and pleurisy
rhonchi aka wheezes are (Continuous/ Discontinuous)
Continous
A (positive / negative) Allen’s test is when the blood returns in less than 6 seconds.
It is a good sign
Positive
Stethoscope Use
Diaphragm (Wide Part) is used to listen to (Low / High) Pitched sounds (S1,S2,S3,S4)
Bell (small part) is used to listen to (Low / High) pitched sounds (S1,S2,S3,S4)
Diaphragm = High Pitched S1 & S2
Bell = Low S3, S4
