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81 Cards in this Set
- Front
- Back
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Heart Anatomy and Physiology: Position
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Position
In mediastinum Left of midline Above diaphragm Between medial/lower borders of lungs Behind sternum 3rd - 6th intercostal cartilage |
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Heart Anatomy and Physiology: Position variance
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Position variance
Body build Chest configuration Diaphragm level Dextrocardia |
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Heart Anatomy and Physiology: Structure
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Pericardium - encases/protects
Chambers - pumps/reservoirs Valves - directional blood flow |
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Anatomy and Physiology: Pericardium
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fibroserous sac covering heart and roots of great vessels
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Anatomy and Physiology: Epicardium
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heart cover, inner layer of pericardium
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Anatomy and Physiology: Myocardium
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supplies pumping action
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Anatomy and Physiology: Endocardium
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lining of heart chambers and valves
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Anatomy and Physiology: Chambers
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Right/left atria - reservoirs
Right/left ventricle - pumps Septum - divides right/left heart |
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Anatomy and Physiology: Valves
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Tricuspid - separates R atrium & R ventricle
Mitral - L atrium & L ventricle Pulmonic - R ventricle & pulmonary artery Aortic - L ventricle & aorta Pulmonic and aortic: semilunar valves |
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Tricuspid
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separates R atrium & R ventricle
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Mitral
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L atrium & L ventricle
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Pulmonic
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R ventricle & pulmonary artery
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Aortic
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L ventricle & aorta
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semilunar valves
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Pulmonic and aortic
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Cardiac cycle: Systole
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Systole - Ventricular contraction ejects blood
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Cardiac cycle: Diastole
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Diastole - Ventricular relaxation/atria contraction moves blood into ventricle
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Cardiac cycle: Coronary Artery Perfusion
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XXX
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Anatomy and Physiology: electrical activity
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Electrical conduction system stimulates contraction
Impulses coordinated within cardiac cycle ECG - Records electrical activity |
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ECG waves: P wave
U wave |
X
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ECG waves: PR interval
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X
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ECG waves: QRS complex
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X
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ECG waves: ST segment
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X
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ECG waves: T wave
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XX
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ECG waves: U wave
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X
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Anatomy and Physiology:Infants/Children
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Heart assumes adult function early in fetal life
Changes at birth Ductus arteriosus/foramen ovale close R ventricle assumes pulmonary circulation L ventricle assumes systemic circulation Ventricle muscle mass increases over 1st year Heart lies more horizontally/apex higher Adult heart position reached by 7 years old |
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Anatomy and Physiology: Pregnant Women
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Heart works harder
Cardiac/blood volume increases Heart shifts to more horizontal position |
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Anatomy and Physiology:Older Adults
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Heart size decreases
L ventricular wall thickens Valves fibrose/calcify Endocardium thickens Myocardium less elastic |
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Related History: Present Problem: Chest Pain
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Chest pain
Onset/duration Character Location Severity Associated symptoms Treatment Medications Risk Factors Gender Hyperlipidemia Smoking Family History Diabetes Obesity Sendentary Lifestyle Personality |
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Related History: Present Problem: Fatigue
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Inability to keep up with peers
Associated symptoms Medications |
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Related History: Present Problem: Cough
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Onset/duration
Character |
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Related History: Present Problem: Difficulty Breathing
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Aggravated by exertion/lying down
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Related History: Present Problem: Syncope
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Associated symptoms
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Related History:Past Medical History
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Cardiac surgery/hospitalization
Rhythm disorder Acute rheumatic fever/unexplained fever/ swollen joints/inflammatory rheumatism Chronic illness |
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Related History: Family History
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Diabetes
Heart disease Hyperlipidemia HTN Congenital heart defects, VSD Sudden death Family members with cardiac risk factors |
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Related History:Personal/Social History
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Employment
Tobacco use Nutritional status Personality assessment Relaxation Use of alcohol/drugs |
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Related History: Infants
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Tiring easily during feeding
Breathing changes Cyanosis Weight gain as expected Knee-chest position or other favored position Mother’s health during pregnancy |
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Related History: Children
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Tiring during play
Naps Positions at play/rest Headaches Nosebleeds Unexplained fever Expected height/weight gain Expected physical/cognitive development |
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Related History: Pregnant Women
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History of cardiac disease or surgery
Dizziness/faintness on standing Indications of heart disease during pregnancy |
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Related History: Older Adults: Common symptoms of cardiovascular disorder
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Confusion/syncope
Palpitations Coughs/wheezes SOB Chest pain/tightness Incontinence/impotence/heat intolerance Fatigue Leg edema |
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Exam & Findings: Inspection
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Apical impulse
4-5 intercostal space midclavicular line |
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Exam & Findings: Precordial Palpation
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Apex
Left sternal border Base Apical pulse Thrill |
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Exam & Findings: Carotid artery palpation
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XXX
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Exam & Findings: Percussion
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Of limited value in defining borders of heart
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Exam & Findings: Auscultation
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Assess overall rate/rhythm
Frequency Intensity Duration Pathology |
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Exam & Findings: Positions
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Seating
Leaning forward Left lateral recumbent |
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Anatomy and Physiology-Physiology / Auscultation / Systole
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Ventricle Pressure Rise
Mitral/tricuspid valves close 1st heart sound (LUB) Aortic/pulmonic valves open Mitral Regurgitation Aortic/Pulmonic Stenosis Blood ejected into arteries Ventricular Pressure falls |
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Anatomy and Physiology-Physiology / Auscultation / Diastole
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Aortic/pulmonic valves close
2nd heart sound (DUB) Mitral/tricuspid valves open Blood moves from atria to ventricles (S3) Mitral/Tricuspid Stenosis Aortic Regurgitation Atria contract as ventricles almost filled Causes complete emptying of atria (S4) Increased ventricular Resistance (Gallop) Cycle slightly slower on right side of heart Splitting of S1 |
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Exam & Findings: Heart sound auscultation
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Aortic valve area
Pulmonic area Second pulmonic area Tricuspid area Mitral area |
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Exam & Findings: Normal heart sounds
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S1/S2 - most distinct
Splitting S3/S4 - difficult to hear |
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Exam & Findings: Extra Heart Sounds
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Gallops (filling of the ventricles)
Increased S3 – Ken Tuck Y S4 – Tenn Es See Gallop: increased S4, related to resistance to filling of the ventricles. Most common in older adults. S4 is always related to pathology and requires further investigation Mitral Stenosis Opening Snap (beginning of diastole) Ejection clicks Semi lunar stenosis (beginning of systoli) |
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Exam & Findings: Heart: Heart murmurs
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Heart murmurs
Timing/duration Pitch Intensity Pattern Quality Location/radiation Respiratory phase variations |
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Exam & Findings: Heart: Grading (x/VI)
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I: Barely audible
II: Quite by easy to hear III: Moderate loud IV: Loud V: Very Loud with palpable thrill VI: Able to hear without stethoscope |
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Exam & Findings: Infants
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Examine newborn at birth/2-3 days for circulation transition signs
Heart function exam includes skin/lungs/liver Inspect color skin/mucous membranes Look for enlargement of heart/position if dyspneic Heart sounds difficult to assess - vigor and quality indicators of heart function Heart rates vary with eating/sleeping/waking Murmurs common until 48 hours of age Auscultate head/abdomen for bruits if cardiac difficulty evident |
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Exam & Findings: Children
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Bulging precordium if long-standing heart enlargement
Sinus arrhythmia is physiologic event of childhood Other arrhythmias usually ectopic in origin and rarely require investigation Heart rates more variable than adult Sinus arrythmia Expected heart rates vary with child’s age Non physiologic murmurs usually indicate congenital heart disease |
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Child with known heart disease:
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Note weight gain/loss
Developmental delays Cyanosis Clubbing of fingers/toes Subtle Changes Ask parents |
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Exam & Findings: Pregnant Women
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Heart rate gradually increases during pregnancy
Pulse 10 to 30% faster by end of third trimester Heart position shifts as size/position of uterus changes Apical impulse shifts up/lateral Heart sounds change with increased blood volume Audible splitting after 20 weeks |
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Exam & Findings: Older Adults
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Slow down pace of exam as cardiac response may be slowed by demands
Heart rate variable Slower if increased vagal tone Range from low 40s to 100+ Ectopic beats common Apical impulse harder to find with increased AP chest diameter Diaphragm raised/heart transverse in obese adults Exercise may delay age-related changes S4 heart sound more common Presence of physiologic murmurs caused by Aortic lengthening Sclerotic changes |
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Common Abnormalities:Heart Murmurs; Mitral stenosis
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x
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Common Abnormalities:Heart Murmurs; Aortic stenosis
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x
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Common Abnormalities:Heart Murmurs; Subaortic stenosis
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x
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Common Abnormalities:Heart Murmurs; Pulmonic stenosis
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x
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Common Abnormalities:Heart Murmurs; Tricuspid stenosis
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x
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Common Abnormalities:Heart Murmurs; Mitral regurgitation
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x
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Common Abnormalities:Heart Murmurs; Mitral stenosis
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x
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Common Abnormalities:Heart Murmurs; Mitral valve prolapse
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x
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Common Abnormalities:Heart Murmurs; Aortic stenosis
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x
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Common Abnormalities:Heart Murmurs; Aortic regurgitation
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x
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Common Abnormalities:Heart Murmurs; Subaortic stenosis
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x
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Common Abnormalities:Heart Murmurs; Pulmonic regurgitation
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x
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Common Abnormalities:Heart Murmurs; Tricuspid regurgitation
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x
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Common Abnormalities:Heart Murmurs; Pulmonic stenosis
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x
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Common Abnormalities:Heart Murmurs; Tricuspid stenosis
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x
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Common Abnormalities:Heart Murmurs; Mitral regurgitation
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x
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Common Abnormalities:Heart Murmurs; Mitral valve prolapse
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x
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Common Abnormalities:Heart Murmurs; Aortic regurgitation
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x
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Common Abnormalities:Heart Murmurs; Pulmonic regurgitation
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x
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Common Abnormalities:Heart Murmurs; Tricuspid regurgitation
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x
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Chest Pain: Characteristics
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Determine onset, location, duration, quality, quantity, radiation, aggravating/alleviating factors, previous episodes, and history of CAD/Testing
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Chest Pain: Predisposing Factors
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Anxiety, exertion, hypertension, chest trauma, recent ingestion of large meal, hyperlipidemia, and recent URI
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Chest Pain: Associated S&S
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Fatigue, anxiety, palpitations, dizziness, sweating, SOB, edema, N/V, fevers, chills and cough
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Chest Pain: Treatment Modalities
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Medications, activity modifications, diet and oxygen
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