N362 Heart & Neck Vessels & Peripheral Vascular Sys & Lymphatic Sys

Front 1

Precordium

Back 1

Area on anterior chest overlying the heart & great vessels

Front 2

Mediastinum

Back 2

B/n the lungs in the middle third of thoracic cage; location of heart & great vessels

Front 3

Location of the heart

Back 3

2nd to 5th intercostal space & from R border of sternum to L midclavicular line

Front 4

Pericardium

Back 4

Tough, fibrous, double-walled sac that surrounds & protects heart; has 2 layers that contain a few ml of serous pericardial fluid to ensure smooth, friction-free movement of heart muscle; adheres to great vessels, esophagus, sternum, & pleurae & is anchored to diaphragm

Front 5

Myocardium

Back 5

Muscular wall of the heart; does the pumping

Front 6

Endocardium

Back 6

Thin layer of endothelial tissue that lines inner surface of heart chambers & valves

Front 7

Cardiac output

Back 7

Stroke volume (volume of blood in ea. systole) X rate (number of beats/min), CO = SV x R; normally b/n 4-6 L/min in resting adult

Front 8

Preload

Back 8

Venous return that builds during diastole; length to which ventricular muscle is stretched at end of diastole just before contraction

Front 9

Frank-Starling Law

Back 9

The greater the stretch, the stronger is the heart's contraction

Front 10

Afterload

Back 10

Opposing pressure the ventricle must generate to open aortic valve against higher aortic pressure; resistance against which the ventricle must pump its blood

Front 11

Systolic BP changes w/aging

Back 11

From ages 20 to 60 yrs, systolic BP increases by ~20 mm Hg; from ages 60 to 80 yrs, systolic BP increases by another 20 mm Hg; due to stiffening of large arteries, which creates increase in pulse wave velocity b/c less compliant arteries cannot store volume ejected

Front 12

Pregnant female - hemodynamics

Back 12

Blood volume increases by 30-40% during pregnancy, w/most rapid expansion occurring during 2nd trimester; arterial blood pressure decreases in pregnancy as result of peripheral vasodilation, blood pressure drops to lowest point during 2nd trimester, then rises

Front 13

Cross-cultural diff - heart disease

Back 13

Black & Mexican-American women have higher cardiovascular risk factors than do white women; blacks have higher incidence of hypertension

Front 14

Central venous pressure

Back 14

Inspect internal & external jugular veins for pulsations to assess CVP --> judge heart's efficiency as pump

Front 15

Bruit

Back 15

Blowing, swishing sound indicating blood flow turbulence due to local vascular cause (e.g. atherosclerotic narrowing); normal = none present

Front 16

Heave/lift

Back 16

Sustained forceful thrusting of the ventricle during systole; occurs w/ventricular hypertrophy as a result of increased workload; R ventricular heave seen at sternal border, L ventricular heave seen at apex

Front 17

Apical impulse

Back 17

Point of maximal impulse; use 1 fingerpad, ask person to exhale and hold it; 4th or 5th interspace, at or medial to midclavicular line; palpable in about half of adults

Front 18

Aortic valve area

Back 18

Auscultatory areas - 2nd R interspace

Front 19

Pulmonic valve area

Back 19

Auscultatory areas - 2nd L interspace

Front 20

Tricuspid valve area

Back 20

Auscultatory areas - L lower sternal border

Front 21

Mitral valve area

Back 21

Auscultatory areas - 5th interspace at around L midclavicular line

Front 22

Murmurs

Back 22

Gentle, blowing, swooshing sound that can be heard on the chest wall; conditions resulting in murmur: velocity of blood increases (e.g. exercise), viscosity of blood decreases (e.g. anemia), structural defects in valves or unusual openings occur in the chambers; sound characteristics: loudness, duration, timing

Front 23

Murmur grades

Back 23

i: barely audible; ii: clearly audible but faint; iii: moderately loud, easy to hear; iv: Loud, associated w/thrill; v: very loud, heard w/1 corner of steth lifted off chest wall, thrill; vi: loudest, still heard w/entire steth lifted just off chest wall

Front 24

Murmur description

Back 24

Pitch: high, medium, low; pattern: crescendo (getting louder), decrescendo (tapering off), crescendo-decrescendo; quality: musical, blowing, harsh, rumbling; location: describe area of maximum intensity noting valve area/intercostal spaces; radiation: may be transmitted in another place on precordium, neck, back, axilla; posture: some disappear/enhanced by posture (innocent murmur - no valvular/pathological cause; functional murmur - increased blood flow to heart, i.e. anemia, fever, pregnancy)

Front 25

Change position after auscultating in supine position

Back 25

Roll person to L side, listen w/bell at apex for presence of any diastolic filling sounds (e.g. S3, S4)

Front 26

Thrill

Back 26

Palpable vibration, feels like throat of purring cat; signifies turbulent blood flow & accompanies loud murmurs

Front 27

Heart sounds - S1

Back 27

Occurs w/closure of AV valves & signals beginning of diastole; usu. loudest at the apex, louder than S2 at apex; coincides with carotid artery pulse; coincides w/R wave if person is on ECG monitor

Front 28

Heart sounds - split S1

Back 28

Occurs rarely; means you are hearing mitral & tricuspid components separately; audible in tricuspid valve area (L lower sternal border)

Front 29

Heart sounds - S2

Back 29

Occurs w/closure of semilunar valves & signals end of systole; aortic component of 2nd sound (A2) slightly precedes pulmonic component (P2); loudest at the base, S2 louder than S1 at base

Front 30

Heart sounds - split S2

Back 30

When aortic valve closes significantly (0.06 sec) earlier than pulmonic valve, A2 & P2 are heard separately; heard only in pulmonic valve area (2nd L interspace); normal phenomenon that occurs toward end of inspiration in some ppl; don't ask person to hold breath b/c this will equalize ejection times in R & L sides of heart; occurs about every 4th heartbeat, fading in w/inhalation & fading out w/exhalation

Front 31

Heart sounds - S3

Back 31

Occurs when ventricles are resistant to filling during early rapid filling phase; occurs immediately after S2; heard best at apex w/person in L lateral position; doesn't vary in timing w/resp.; dull, soft sound, lower-pitched; found in high cardiac output states in absence of heart disease: hyperthyroidism, anemia, pregnancy; ventricular gallop; "Kentucky"

Front 32

Heart sounds - S4

Back 32

Occurs at end of diastole when ventricles are resistant to filling; very soft sound, very low pitch; heard best at apex w/person in L lateral position; atria contract & push blood into noncompliant ventricle; occurs just before S1; "Tennessee"

Front 33

P wave

Back 33

Depolarization of atria

Front 34

PR interval

Back 34

From the beginning of P wave to beginning of QRS complex (time necessary for atrial depol. plus time for impulse to travel through AV node to ventricles

Front 35

QRS complex

Back 35

Depolarization of ventricles

Front 36

T wave

Back 36

Repolarization of ventricles

Front 37

Heart failure pt

Back 37

Crackles, wheeze - adventitious breath sounds; ascites - fluid in peritoneal cavity; dependent, pitting edema - in sacrum, legs; jugular vein distention (JVD) - from venous congestion; S3 gallop, tachycardia; Enlarged spleen & liver - from venous congestion, which causes pressure on breathing

Front 38

Patent Ductus Arteriosus (PDA)

Back 38

Persistence of channel joining L pulmonary artery to aorta; usu. closes spontaneously w/in hrs of birth; subj: growth/development normal; obj: wide pulse pressure, bounding peripheral pulses from rapid runoff of blood into low-resistance pulm. bed during diastole; machinery murmur - continuous murmur heard in systole & diastole

Front 39

Atrial Septal Defect (ASD)

Back 39

Abnormal opening in atrial septum, resuling usu. in L-to-R shunt, large increase in pulmn. blood flow; subj: mild fatigue, DOE; obj: S2 has fixed split; murmur systolic (increased blood flow thru pulm. valve), best heard at base in 2nd L interspace