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53 Cards in this Set
- Front
- Back
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Where is the heart positioned in the body?
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The heart lies behind the sternum and above the diaphragm in the mediastinum- angled so right vent is most of anterior surface, left vent lies to left posteriorly.
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What is the basic anatomy of the heart?
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Each side has two chambers - upper atrium and lower ventricles. The top is the base and the bottom is the apex.
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What is the right side of the heart responsible for?
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Right side receives blood from the Sup and Inferior Venae Cavae - pumps through pulmonary arteries/circulation
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What is the left side of the heart responsible for?
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Left side receives blood from pulmonary veins and pumps it through the aorta to the systemic circulation
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Name the four valves of the Heart.
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atrioventricular - tricuspid and mitral
semilunar - aortic and pulmonic |
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Describe Diastole.
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VENTRICULAR RELAXATION
Blood flows into atria from systemic/pulmonary circulation When pressure exceed ventricular pressure AV valves open Ventricles fill with blood 80% of ventricular filling is passive Atrial contraction accounts for 20% of ventricular filling ATRIAL KICK |
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Describe Systole.
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VENTRICULAR CONTRACTION
As blood fills ventricles, eventually ventricular pressure exceed atrial pressure AV valves close = first heart sound (S1) = LUBB As ventricles continue to empty, pressure in the aorta/pulmonary artery exceeds ventricular pressure Semilunar valves close = second heart sound (S2) = DUBB |
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What sound is heard when the AV valves close?
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S1 or Lubb
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What sound is heard when the semilunar valves close?
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S2 or Dubb
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What are common risk factors in Hypertension and Coronary Artery Disease?
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Family history, gender, age, race. Modifiable factors include weight, diet, smoking, alcohol and physical activity.
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When obtaining a present health history what important factors relate to the cardiac system?
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Chronic illness, medications (OTC and prescriptions), physical activity, stress and coping, eating habits, excessive alcohol, caffeine and smoking.
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What are related factors when asking for past medical history?
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Childhood issues, rheumatic fever, heart murmur, any surgery, previous tests such as ECG or stress test?
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What related family history is relevant?
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Diabetes
Heart disease Hyperlipidemia HTN Sudden death syndrome |
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Problem based history -
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Chest pain, cough, shortness of breath, Nocturia, fatigue, fainting, swelling of feet and legs, leg cramps or pain.
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What type of analysis is required of a problem based history?
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OLD CARTS - onset, location, duration, characteristics, alleviating/aggravating, related symptoms, treatments, severity.
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Chest pain
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Need to determine if immediate treatment is necessary.
Pain description When started (intermittent or constant) Other symptoms What precedes, makes worse or better, what relieves |
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Shortness of Breath (SOB)
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Need to determine if Cardiac or Pulmonary.
Interfere with ADL, walk how many blocks (now or 6 months ago) Other symptoms What makes worse, how many pillows to sleep (orthopnia) What makes breathing easier |
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What is Nocturia and how is it related to possible cardiac issues?
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Urination during the night -Nocturia occurs with heart failure in persons who are
ambulatory during the day. Fluid shifts at night promote reabsorbtion/excretion |
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What are some indicating factors a cough is related to a cardiac problem?
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Coughing up blood or frothy sputum may indicate problem.
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Why is fatigue and indication of cardiovascular problems?
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If cardiac output is decreased, fatigue results -generally worse in the evening.
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What is syncope and how is it related to cardiovascular issues?
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Syncope is fainting, it can be a sigh of hypotension (inadequate blood flow to the brain). Need to rule out if neuro or possible inner ear issue.
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Peripheral edema can be a sign of cardiovascular problems, what should you look for?
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Localized compared to both legs, does it increase during the day and decrease at night, shortness of breath, is there pain r/t the edema?
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Arterial insufficiency can cause leg pain, where is it mostly noted?
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In the calf, but may occur in other locations. Leg pain that occurs while walking but is relieved w/rest is called intermittent claudication -occurs when artery is about 50% blocked.
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What is orthostatic or postural hypotension?
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Blood pressure falls suddenly when a person stands up, typically more than 20mm/Hg.
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What do we inspect during a cardiac exam?
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Skin color
Nailbeds (color, angle) Capillary refill Turgor Edema Temperature Moisture Precordium |
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What do you look for when palpating pulses?
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Rate and rhythm and amplitude.
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What is the amplitude scale?
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0 - absent
1 - diminished 2- normal 3- full volume 4 - bounding |
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Why is it important to check all 8 pulse points?
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For symmetry and blood flow.
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What are bruits and what do they signify?
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Low pitched blowing sound heard during systole that indicate narrowing of the vessel by atherosclerosis.
Use bell of stethescope- Ask client to hold breath. |
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What is tenting and what does it indicate?
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when skin does not fall back into place, sign of reduced fluid in the interstitial space.
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What is edema and what does it indicate?
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Edema is excess fluid in interstitial space.
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What is the measurement for Edema?
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1+ = barely perceptible pit = 2mm
2+ = deeper pit, rebounds few sec. = 4mm 3+ = deep pit, rebounds 10-20 sec. = 6mm 4+ = deeper pit, rebounds >30 sec. = 8mm |
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Cardiac inspection - anterior
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Inspect Anterior Chest Wall- Contour, pulsations, lifts, heaves
Palpate Apical pulse for location PMI = 4th or 5th ICS MCL = LV apex Precordium for pulsations, thrills, lifts, heaves Auscultate S1-S2 heart sounds for rate, rhythm, pitch, splitting |
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What causes heart sounds and where are they best heard?
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The closing of valves causes heart sounds and they are best heard where blood flows away from the valve.
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What are the 5 areas of cardiac auscultation?
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Aortic = 2nd RICS
Pulmonic = 2nd LICS Erb’s point = 3rd LICS Tricuspid = 4th LICS Mitral = 5th LMCL |
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Describe the characteristics of the S1 heart beat.
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Caused by closure of mitral/tricuspid valves
“Lubb” Marks the beginning of systole Loudest at apex Lower pitch than S2 Almost synchronous with carotid pulse |
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Describe the characteristics of the S2 heart beat.
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Caused by closure of aortic/pulmonic valves
“Dubb” Marks the beginning of diastole Loudest at the base Higher pitch than S1 Physiologic split on inspiration normal in young adults |
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What are abnormal heart sounds and when are they heard?
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S3 and S4 are abnormal sounds. S3 is heard after S2 and S4 is before S1.
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What does S3 sound like and what does it tell us about the condition of the heart?
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S3 is a sloshing sound and is an indication of fluid volume overload and Congestive heart failure.
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What does S4 sound like and what information does it tell us about the heart?
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S4 is a stiff sound and represents a stiff or non compliant wall.
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What is a heart murmur?
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Prolonged heart sound heard during systole or
diastole Produced by abnormal blood flow |
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What are some age related issues when considering an older adult heart?
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As age increases heart size decreases
Output decreases 30% to 40% Decreased heart rate, contractility Response to stress, increased O2 demand is less efficient, longer return to baseline Arterial walls less compliant • Increased BP (systolic/diastolic) from increased peripheral resistance • Fibrosis or sclerosis of SA node or mitral and aortic valves causes altered cardiac function |
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Main factors in difference with older adult exam to note.
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Variations in heart rate is more common and S4 sound is more likely to be heard.
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Valvular Heart Disease
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• Acquired or congenital disorder of valve
• Stenosis (obstruction) • Regurgitation - incompetent closure • Rheumatic fever or endocarditis causes most acquired VHD |
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Ventricular Hypertrophy
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• Aortic stenosis
• HTN Palpable lift during systole; apical pulse displaced laterally • Pulmonary HTN: increases resistance that R ventricle must overcome Lift along L sternal border, 3rd or 4th ICS |
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Angina Pectoris: chest pain from
ischemia |
• Atherosclerosis common cause: occurs during
activity, stress, cold (increased demand on heart); at rest from coronary artery spasm • May occur without atherosclerosis: (hypertrophy, Aortic stenosis, increased metabolic demands) • Incidence: 6.6 million |
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Myocardial Infarction
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Unrelieved ischemia progresses to tissue
necrosis (infarction) MI from coronary artery disease: single leading cause of death in United States (1 in 5 deaths) 1.1 million new or recurrent cases each year; 44% die L ventricle most common; may affect R ventricle |
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Heart Failure
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Failure of ventricles to pump blood efficiently
Can be left side, right side, or bi-ventricular o Left = pulmonary congestion/edema o Right = peripheral edema, ascites, hepatic congestion Precordial lift or heave, displaced apical pulse, palpable thrill, S3, systolic murmur Bilateral pulmonary crackles |
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Endocarditis
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• Infection of endothelial layer / valves
• Associated with valve disease, congenital lesions, prosthetic valves, normal valve with IV drug abuse)) • Microorganisms attach to endothelium, becoming infective vegetation |
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Pericarditis
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• Inflammation of pericardium
• Idiopathic or from infarction, uremia, cancer trauma, infection, surgery, autoimmune reaction • Pericardial rub: inflamed layers rub against each other (2nd, 3rd, 4th ICS, LSB during inspiration) • Pain: pleuritic, increases with deep breathing, supine cough |
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Hypertension
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Based on mean of 2 or more, BP readings on
each of 2 or more occasions o Normal values: <120 systolic, <80 diastolic o www.nhlbi.nih.gov/guidelines o No specific symptoms |
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Venous Thrombosis & Thrombophlebitis
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• Development of clot in vein or inflammation without
clot Stasis, vein damage, hypercoagulability predispose to thrombosis or thrombophlebitis Dilated, superficial veins, edema redness, circumference of leg Upper extremity: superficial veins Redness, warmth tenderness; may be visible or palpable Lower extremity: deep veins Tenderness, pain, edema, worst case = embolic |
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Aneurysm
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• Dilation of artery from weakness in arterial wall (aorta,
iliac vessels) RISK = RUPTURE • Thoracic: asymptomatic; some report deep, diffuse chest pain • Aortic or arc: hoarseness (pressure on laryngeal nerve); dysphagia (esophageal pressure) • Abdominal aortic: most common; asymptomatic, discovered on routine exam/ultrasound, CAT scan o Pulsatile mass in periumbilical area with thrill or bruit |
