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102 Cards in this Set

  • Front
  • Back
Heart
muscular pump
blood vessels
arranged in two continuous loops pulmonary circulation and systemic circulation.
precordium
area on the anterior chest overlying the heart and the great vessels. Creating the major arteries and veins connected with the heart.
mediastinum
where the heart and gret vessels are located between the lungs in the middle third of the thoracic cage.
apex
bottom of the heart and to the left of midline. During contraction it beats against the chest wall producing an apical impulse.
Superior & Inferior Vena Cava
lie bunched above the base of the heart. Return un oxygenated venous blood to right side of heart.
Normal blood flow through the heart:
unoxygenated blood downstream into vena cava swept along with venous blodd flow from liver to RA through inferior vena cava. superior vena cava drains venous blood from head and upper extremities. RA venous blood travels through tricuspid valve to RV to pulmonic valve to pulmonary artery delivers unoxygenated blood to lungs. Lungs then oxygenate the blood in the pulmonary veins return fresh blood to LA which arterial blood travels through the mitral valve to the LV. The LV ejects blood through aortic valve into aorta which delivers oxygenated blood to the body.
Pulmonary artery
leaves the right ventricle, bifurcates, and carries the venous blood to the lungs.
Pulmonary veins
return freshly oxygenated blood to the left side of the heart.
Aorta
carries freshly oxygenated blood to the body.
Pericardium
tough fiberous double-walled sac that surrounds and protects the heart. Has two layers containfew mL of serous pericardial fluid. It is adherent to the great vessels, esophagus, sternum, & pleural anchored to the diaphragm.
Pericardial fluid
ensures smooth, friction free movement of the heart muscle.
myocardium
is the muscular wall of the heart. Does th pumping. Cardiac muscle cells and connective tissue. Responsible for cardiac contraction.
endocardium
thin layer of endothelial tissue that lines the inner surface of the heart chambers and valves. Thin delicate inner layer.
Four Chambers of the heart:
Right Atrium (RA); Left Atrium (LA); Right Ventricle (RV); and Left Ventricle (LV).
Right Atrium (RA)
thin walled chamber or reservoir for holding blood, pressure of 0-8mmHg, located at top of the body, 80% of venous blood return flows passively from RA to RV. 20% remaining blood occurs at end of diastolic filling (atrial kick), no valves are located here.
Atrial systole "kick"
End of diastole atria contract and push the last amount of blood ~25% of stroke volume into ventricles. Active phase is presystole. Causes small rise in LV pressure. Occurs in the RA when the 20% of remaining venous blood is pushed by the heart contracting at end of diastolic filling.
Right Ventricle (RV)
muscle pumping chamber, thin walled, pressures low systolic 15-25 mmHg and diastolic 0-8 mmHg, recieves unoxygenated blood from RA pumps into pulmonary circuit.
Left Atrium (LA)
thin walled, low pressure 4-12 mmHg, recieves oxygenated blood from lungs through pulmonary veins.
Left Ventricle (LV)
thick powerful muscle, normal systolic pressure is 110-130 mmHg, normal diastolic pressure is 4-12 mmHg, ejects 70-80 cc of blood/contraction (= stroke volume), 60-70% of normal LV end diastolic volume called EF ejection faction. ~30%of blood remains
Pressure of Heart
Atrium have higher pressure than ventricles. Causing blood to pour rapidly into ventricles. AV valves are open.
Atrioventricular Valves
AV Valves
Seperate the atria & the 2 ventricles.
the right valve is the tricuspid, has three cusps. & the left valve is the mitral or bicuspid valves, has two cusps.
Valves of the heart
main purpose is to prevent backflow of blood. Unidirectional open/close passively due to pressure gradient. Allow flow of blood between chambers and into blood vessels.
Diastole
ventricles relax, fill with blood, takes up 2/3rds of cardiac cycle.
AV are open during the heart's filling phase allowing ventricles to fill with blood because pressure in the atria is higher than the pressure in the ventricles.
Systole
heart's contraction, blood is pumped from the ventricles and fills the pulmonary and systemic arteries. 1/3 of cardiac cycle. Ventricular pressure is higher than that in atria. Mitral, tricuspid valves close and prevent backflow into atrai during contraction. Creating S1 sounds. The Systole process begins. Ventricular walls contract building pressure inside ventricles to high pressure exceeds pressure in aorta causes aortic valve to open and ejects blood rapidly.
The pumping phase, AV valves close to prevent regurgitation of blood into atria.
Pulmonary Circulation
the right side of the heart pressures are less than the the left side of the heart pressures. Less energy is needed to pump blood on right side. Also the actions that take place on the right side of the heart happen later than the actions that take place on the left side of the heart due to myocardial depolarization.
Semilunar Valves
Seperate between the ventricles and the arteries each valve has three cusps. They look like half moons.
Pulmonic Valve
on the right side, 3 cusps between RV and main pulmonary artery. Open during pumping, or systole, to allow blood to be ejected from the heart.
Aortic Valve
on the left side, 3 cusps between LV and aorta. Open during pumping, systole, to allow blood to be ejected from the heart.
Heart Sounds
when vlaves close you get heart sounds created.
S1
1st heart sound. Signals start of systole, closure of the AV valves. Sounds are heard as one sound, can hear over the precordium, loudest in the apex. Mitral closes first, tricuspid closes next, M1 and T1 close within in 0.2 seconds of one another. Usually hear as one sound.
S2
2nd heart sound. Signals end of systole, closure of semilunar valves. Can hear sound over the precordium, loudest at base of heart. Aortic valve A2 and pulmonic valve PS close within 0.02 seconds from each other. Usually hear as one sound.
Extra heart sounds
Normally diastole is silent. Ventricullar fillings create vibrations that creates these sounds. S3 and S4.
S3
Extra heart sound. "ken tuck y" is what it sounds like. Ventricullar fillings create vibrations that can be heard over the chest. Occurs when ventricles are resistant to filling during early rapid phase. Occurs immediately after S2.
S4
Extra heart sound. "tenn e see" is what it sounds like. Ventricle is resistant to filling. Atria contract, push the blood into noncompliant ventricle. Creates the vibrations heard. Occurs right before S1.
Murmurs
blood circulating through normal cardiac chambers and valves are usually silent. Turbulent blood flow and collision currents create murmurs. Produce a gentle, swooshing, sound that can be heard on the chest wall. Can be caused by thyrotoxicosis, anemia, structural valve defects.
Thyrotoxicosis
velocity of blood flow increases with exercise usually.
Anemia
viscosity of blood decreases
Structural valve defects
narrowed valves, or wall defect can effect blood flow causing murmur sounds to occur.
Apical impulse
Point of Maximal Impulse (PMI)
short gentle tap, 1 cm to 2 cm normally. Specifically for the apex beat. Pulsation created as the LV rotates against the chest wall during systole. Visible in 4th or 5th intercostal space inside the midclavicular line. Used to be called point of maximal impulse. Some abdominal condtions may cause a maximal impulse to be felt elsewhere on chest. Palpable in 1/2 of adults. Increases with anxiety, fear, anemia, hyperthyroidism.
Angle of Louis
where the sternum and the manubrium form a slight indentation where the 2nd ribs line up parallel.
Hypertension
systolic is greater than 140mmHg. diastolic is less than 90 mmHg. Increases with age, heart failure, lifestyle habits, and physical activity.
Intermittent claudication
is the number of blocks walked or stairs climbed to produce pain. Note a sudden decrease in claudication distance or pain not relieved by rest. Caused by PVD or night leg pain.
SA node
60-100 bm. Results in atrial contraction. Specialized cells in the sinoatrial (SA) node near the superior vena cava initiate an electrical impulse. Because the SA node has an intrinsic rhythum it is the "pacemaker."
AV node
40-60 bm. Stimulates ventricles to contract. The current flows across the atria to the AV node low in the atrial septum then to the Bundle of His the right and left bundle branches through ventricles stimulates heart to do its work, contract, sm amount spreads to heart of body which is what is read on ECG waves (PQRST).
Central Venous Pressure (CVP)
assess the jugular veins judge efficiency of the heart as a pump. Internal jugular vein attached to superior vena cava more reliable for assessment. Can't see it, can see it's pulsation. Head and trunk of the body need to be on the same place to evaluate properly. Turn head away and direct a strong light tangentially onto the neck. Look for pulsations in area of suprasternal notch or around origin of sternamastoid muscle around clavicle. Unilateral distention of external jugular veins is due to local cause -kinking or aneurysm. Full distended external juguklar veins above 45 degrees signify increased CVP as in heart failure.
Jugular Vein Distention
in supine positioned pt 30-45 degree angle look at neck. Same plane head/trunk. Turn head away look for pulsations. Use Hepatojugular reflex if think venous pressure is elevated. Look for jugular veins to rise for a few seconds then recede back. In heart failure the jugular veins will rise and stay elevated as long as you push in on the liver.
Profile Sign
look at profile of index finger identify angle of nail base. Normally should be 160 degrees. Look for clubbing, flattening, cyanotic heart disease.
Capillary Refill
near heart level depress and blanch nail beds, release, look for color to return. Normal refill within a fraction of a second will return to finger. A cold room, decreased body temperature, cigarette smoking, pleripheral edema, and anemia could skew these results. If lasts more than 1-2 seconds could be vasoconstriction, hyporolemia, shock, or heart failure.
Vasoconstriction
if capillary refill takes longer than 1-2 seconds for color to return to finger.
Hyprolemia
decreased cardiac output.
Homan's sign
calf pain occurs ~35% of cases with deep vein thrombosis, also with superficial phlebitis, Achilles tendnitis, gastrovenemius, plantar muscle injury.
Cardiomyopathy
An enlarged heart. Place stationary finger in the pt's 5th intercostal space over to the left side of the chest near the anterior axillary line. Slide your stationary hand toward yourself, percussing as you go, and note the change of sound from resonance over the ling to dull over the heart. Normally the left border of cardiac dullness is at the midclavicular line in the 5th intercostal space and slopes in toward the sternum as you progress upward, so that by the 2nd intercostal space the border of dulness coincides with the left sternal border. The right border normally matches with the sternal border.
Hepatojugular reflux
makes transmitted pulsations more apparent. Pathologic states will cause blood that has pooled in the liver to flow in retrograde fusion out the IJ. Apply gentle pressure to the right upper quadrant of the abdomen for 5-10 seconds. Make sure to visualize the correct location. When push to detect any change in the height of this column or blood immediately after you apply hepatic pressure. If elevated could be in heart failure= JV will elevate and stay elevated as long as you push.
Stethoscope listen to vessels
earpieces angled forward to match auditory meatus. Use bell and diaphragm.
Stethoscope Diaphragm
filter out low pitched sounds. Detect high pitch sounds. Use to analyze the 2nd heart sound (DUB), ejection, mid systolic clicks, and soft but high pitched early diastolic murmur of aortic regurgitation.
Stethoscope Bell
best for detecting low pitched sounds. Use for mid-diastolic murmur of mitral stenosis or S3 in heart failure
Stethoscope Assessing Carotid Arteries
listen at the angel of the jaw. Midclervical area. Back of head with bell and diaphragm. Come in two pieces.
Carotid Arteries
for middle aged or older show signs of cardiovascular disease. Auscultate each carotid artery for presence of a bruit. One is under the angle of the jaw along the neck, the next is right on the thyroid areas, the last is parallel to the first but closer to the shoulders.
Heart Assessment
"All Practioners Earn Their Money"
The areas that are examined are:
Aortic, Pulmonic, Erb's Point, Tricuspid, and Mitral.
Heart Assessment
Inspection
carefully look for apical impulse; inspect the Jugular veins in the neck; hepatojugular reflex.
Heart Assessment
Palpate
make a z; from apex of heart at ~5th intercostal space lay hand parallel to rib; then lay hand pointing up toward head along the sternal border; then again parallel at the intercostal space this time at about the 2nd space or at the base of the heart. Feel for any abnormal vibrations, thrills, pulsations. Normally should not feel anything.
Heart Assessment
Auscultate
Listen to rate, rhythum, S1 & S2 heart sounds, extra heart sounds, and murmurs. Start at aortic area, then pulmonic area, then erb's point, then tricuspid, and mitral valve areas.
Heave/Lift
sustained forceful thrusting of the ventricule during systole. Occurs with ventricular hypertrophy as a result of increased workload. Right ventricular heave is seen at the sternal border. Left ventricular heave is seen at the apex.
Pulmonic Valve disease
right ventricular hypertrophy.
Pulmonic Hypertension
chronic lung disease.
Thrill
palpable vibration (cat purring) signifies turbulent blood flow and accompanies loud murmurs. Absence doesn't mean no murmur is present. Accentuated S1 & S2 heart sounds and extra heart sounds S3 & S4 also may cause abnormal pulsations.
Thrill in 2nd and 3rd intercostal spaces on the right hand side
aortic stenosis and systemic hypertension.
Thrill in 2nd and 3rd intercostal spaces on the left hand side
pulmonic stenosis and pulmonic hypertension.
Heart failure
heart fails as a pump, circulation backs up and congested. Inability to pump enough blood to meet demands of metabolic body. Kidneys compensate mechanisms of abnormal rention of sodium and water to compensate for decreased cardiac output. Increases blood volume and venous return causes further congestion.
Acute Heart failure (onset)
following myocardial infarction when direct damage to heart's contracting ability has occured.
Chronic Heart failure (onset)
hypertenstion, ventricles must pump against chronically increased pressure.
Heart Failure Causes
myocardial infarctions, hypertension, and pulmonary congenstion (SQBOE)
Heart failure findings during an assessment
dialed pupils; pale, cyanotic, or grey skin; Dyspnea; orthopnea; crackles; wheeze; cough; decreassed bp; nausea; vomiting; ascites; dependent pitting edema; anxiety; falling O2 saturation; confusion; jugular vein distention; infarct, fatique; S3 gallop; tachycardia; enlarged spleen; liver; decreased urine output; weak pulse; cool; moist skin.
Major Arteries
High pressure system, touch, strong, tense, artery walls, withguard pressure. Have a true pulse you can palpate. Fx to supply O2 and essential nutrients to tissues of the body.
Temporal Arteries
Found in the front of the ear toward papillary fissure of the eye. It kind of a groove in the skull there.
Carotid Arteries
paplated in groove between sternomastoid muscle and trachea, corner of the jaw.
Brachial Arteries
major arteries supplying the arm below the elbow bifurcates into Ulnar arteries and Radial arteries that supply the thumb. Usually palpate the RADIAL which is medial to radius @ wrist near the thumb. The ulnar is harder to palpate because it is medial to the ulnar and deeper on the pinkie finger side.
Femoral Arteries
major arteries supplying the leg. Under the inguinal ligament down the thigh forms into POPLITEAL artery under the knee. Here the artery bifurcates into anterior tibial artery for the front of the leg onto the dorsum of the foot which leads to the DORSALIS PEDIS for the top of the foot. POSTERIOR TIBIAL artery for down the back of leg into the foot to the Plantar arteries for medial to bulbar of ankle.
Pulse
each heart beat creates a pressure wave makes arteries expand and recoil. Recoil propels blood through like a wave. Can only feel at sites in the body where arteries lie close to skin and over a bone.
Weak thready pulse
hard to palpate, need to search for it, may fade in and out, easily obliterated by pressure. Ex. Decreased cardiac output, peripheral artery disease, aortic valve stenosis.
Full bounding pulse
easily palpable, pounds under fingertips. Ex. hyperkinetic states, exercise, anxiety, fever, anemia, and hyperthyroidism.
Veins
drain the deoxygenated blood and its waste products from the tissues in the body and return it to the heart. Low pressure system. No pump to generate blood flow. 1. Contract skeletal muscles to milk the blood proximally back to the heart. 2. Pressure gradient caused by breathing. 3. Intra luminal valves ensure unidirectional flow of the blood. Thinner walls, larger in diameter, more distensible, stretchier).
Vein Problems
need efficient contracting skeletal muscles; need competant valves; need patent lumen. If any of these are problematic can get venous stasis, venous disease, hypercoagulable states, vein wall trama, varicose veins, deep vein thrombophlebitis (DVT), venous stasis, ulcers, etc.
Edema
fluid accumulating in intercellular spaces. Abnormal. Check for by imprinting thumbs against the ankle malloulus or tibia. Normal skin stays smooth. If pressure leaves a dent=pitting is present shows edema is present.
Bilateral
when caused by a systemic problem such as heart failure.
Unilateral
when caused by a result of a local obstruction or inflammation caused by infection, malignancies, immumologic diseases, or surgeries.
Modified Allen Test
is used to evaluate the adequacy of collateral circulation prior to cannulating the radial artery. Crude test subjective to error. Depress radial and ulnar arteries at same time with 11 pds of pressure. Pt makes a fist. Release one of the arteries and observe normal blood flow return. Must occlude both arteries with 11 lbs of pressure to get accurate test. Abnormal would be no blood return=occluded or blockage located there.
Pulmonary Embolism
undissolved materials originating in legs or pelvis. Detach and travel through the venous system returning blood to the right side of the heart and lodge to occlude pulmonary vessels.
Pulmonary Embolism Causes
deep vein thrombi (DVT) in lower legs as a result of stasis of blood, vessel injury, hypercoaguability, pulmonary occlusion results in ischemia, increased pulmonary artery pressure, decreased cardiac output, hypoxia.
Pulmonary Embolism Clinical Manidestations
chest pain, worse or deep inspiration, dyspnea.
Pulmonary Embolism Prevention
getting up and walking after surgeries, moving around every 2-3 hours for seated trips of elderly.
Arteriosclerosis Ischemic Ulcer
build up of fatty plaqued on intima plus hardening and calcification of arterial walls. Ilcers occur at toes, metatarsals, heels, lateral ankle, characterized by pale ischemic base, well defined edges, no bleeding, common with diabetic pts.
Venous Stasis Ulcer
after acute deep vein thrombosis or chronic incompetent valves in deep veins. Ulcers occur at medial malleolus and are characterized by bleeding, and uneven edges.
Bruit
occurs with turbulent blood flow indicating partial occlusion in that area.
Deep Vein Thrombophlebitis DVT
deep vein occluded by a thrombus causing infalmmation, blocked venous return, cyanosis, edema. Cause may be prolonged by bed rest, vericose vein history, trama, infection, cancer, younger women use of oral contraceptives more common, Requires immediate emergency referral could cause pulmonary embolism.
Venous Stasis
causes increaded venous pressure which causes red blood cells to leak out of veins into the skin. RBC break down leave hemosiderin (iron deposits) behind which are brown pigment deposits.
Raynaud's syndrome
episodes of red, white, blue fingers in response to cold, vibration, or stress.
Lymphedema
removal of lymph nodes usually mastectomy for breast cancer. Impeded lymph drainage. Chronic swelling, unilaterally, non pitting, brawny edema, cancer reminder.
Arteriosclerosis
peripheral blood vessels grow more rigid with age. Causes systolic bp to increase. Plus hardening and calcifiaction of arterial walls. Occurs with aging.
Atherosclerosis
Occurs with aging. Deposition of fatty plaques on intima of arteries.
Aging and Lymph Nodes
also lose lymphatic tissue leads to fewer numbers of lymph nodes. Decrease in size of remaining lymph nodes.