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48 Cards in this Set
- Front
- Back
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Where is apex located?
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5th ICS; MCL
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Where does the heart extend?
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2nd to 5th ICS
From right sternal border to Left midclavicular line |
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What is the base of the heart?
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the portion of the heart opposite the apex. It is superior and medially located. It forms the upper border of the heart, lies just below the second rib, and primarily involves the left atrium, part of the right atrium, and the proximal portions of the great vessels.
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What is direction of blood flow?
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Superior/inferior vena cava to RA; to Tricuspid between RA and RV; valves prevent backflow of blood
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Explain pulmonic valve
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RV to pulmonary artery
semilunar valves |
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Where are no valves
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between vena cava and right atrium; and between pulmonary vein and left atrium;
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Explain aortic valve
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semilunar valves
LV to aorta |
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Explain mitral valve
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between LA/LV; also called bicuspid valve
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Explain reasons for murmurs
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dysfunction chordae tendineae
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Explain abnormally high pressure in right side of heart
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shows in neck veins and abdomen
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Explain abnormally high pressure in left side of body
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shows in symptom of pulmonary congestion
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Explain newborn heart condition
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blood bypasses lungs during gestation so foramen ovale/ductus areteriosis need to close
Heart is more horizontal; Apex at L 4th ICS MCL Moves down to 5th space by age 7 |
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Explain foramen ovale
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newborn 2/3 blood RA to LA through FO; then aorta
closes within 1hour |
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Explain ductus areteriosis
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newborn 1/3 blood RA to pulmonary artery through DA to aorta
closes within 10-15 hours |
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Explain normal aging changes attributed to lifestyle
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Diet, stress, habits,
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Explain normal aging changes not attributed to lifestyle
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- SBP ↑ 20 mm Hg until 60 years
- Another ↑ 20 mm Hg from 60-80 years - No change in DBP & resting HR - ↓ ability to compensate for exercise |
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Explain normal increase in SBP
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stiffening and calcification of vessel walls; arteries less compliant; greater pressure required to push blood through body
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Subjective data/health history questions
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Chest pain/angina
shortness of breath Dyspnea Orthopnea/PND Cough Fatigue Cyanosis or pallor Medications Edema Nocturia Past cardiac history Family cardiac history Cardiac risk factors |
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Explain orthopnea
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more upright position needed to breathe;
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Explain PND
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waking up at night
paroxysmal nocturnal dyspnea |
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Explain dsypnea
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shortness of breath
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Explain nocturia
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excess fluid in lungs
lie down reabsorbed |
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Explain cough observations
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may be associated with cardiac pain; productive/colour/amount/types; congested, dry, barking, musical, odor
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explain fatigue
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what time of day is worse? Fatique from cardiac problems worse in evening; depression fatique worse in morning/all day
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explain cyanosis/pallor
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blue or pale
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explain edema (heart)
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- related to heart = dependent edema
- usu lower limbs/feet gravity - joint edema not cardiac - feet edema = CHF |
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explain non modifiable risk factors
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Gender/age/family history
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explain modifiable risk factors
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- htn
- Physical inactivity/diet/stress - smoking |
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explain smoking intervention
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ask/advise/assist/arrange (4 A’s)
- can't change a person's mind, but can remind |
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explain htn (heart)
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- systolic 140 normal
- 130 diabetics (more periph problems) - diastolic 80 |
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explain carotid artery inspection
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Palpate each carotid artery medial to sternomastoid muscle in the neck
Don’t palpate higher, esp, in older adults; simulate vagus nerve; slow down HR Palpate gently and only do one side at a time Feel contour/amplitude of pusle/ Contour is smooth; 2+ moderate strength Equal bilaterally |
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explain bruit
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- ausciltate
- blowing, swishing turbulent blood flow due to narrowed carotid artery; normally don’t want to hear anything - atheriosclerotic disease - can throw up chunks |
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explain precordium palpation
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Palpate apical impulse; point of maximal impulse; use one finger pad; exhale and hold it
May have to roll to left lateral side; bring heart closer to chest wall Location; occupy only one intercostal space (left 5th) Short, gentle tap Hypertrophy of LV, may occur more than one space; heave or lift May not feel it in obese people or people with thick, muscular chests After locating apical impulse, want to palpate across chest wall with palmar aspects of four fingers Palpate apex, base, left sternal border Search for any other pulsations; normally none occur Thrust is intermittent, palpable sensation, eg when palpating apical impulse |
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Explain precordium
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is the portion of the body over the heart and lower chest (thorax)
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Explain cardiac auscultation
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- supine
- nurse right side - diaphragm to start |
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Explain positions of valves to auscultate
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2 ICS, RSB (aortic)
2 ICS, LSB (pulmonic) 5 ICS, LSB (tricuspid) 5 ICS, LMCL (mitral) - should be at the same time 22 55 |
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ape to man
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aortic, pulmonic, tricuspid, mitral
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explain ergs point
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valve sound same intensity
3 ICS LSB |
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Explain S1
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louder at apex of heart
Beginning of systole -55 tricuspid mitral - LUB - ventricle sound, valves closing |
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Explain S2
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Up on base S2 is louder; end of systole; beginning of diastole
- 22 pulmonic aortic - DUB |
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Explain split S2
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- only pulmonic area
- normal at the end if insp for some people - end of exp problem - DUPDUP |
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Explain heart murmurs
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blood flow
Listen for murmurs Murmur is flowing, swishing sound Something is wrong with valve Functional; pregnancy; fever, hyperthyroidism; increased blood flow Pathological; stenosis, valvular defect regurgitation Floppy, doesn’t close properly frequently found with thrills |
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Heart murmus what to do
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- when? during systole or diastole
- loudness - pitch pattern:louder/get softer quality: musical/harsh/blowing radiation posture location |
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Explain Extra heart sounds
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- bell
- one the right left lower sternal border - on the left apex in left lateral position S3 - sounds of ventrial filling |
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Explain S3
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- just after S2
- early filling of ventricles, not as compliant (CHF) - Can be normal; physiological in children, adults up to age 40; pregnant women Or pathological; vibrations of left ventricle - dup[pa] |
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Explain S4
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- late ventricular filling
- atria contracts against - before S1 - atria contract against resistant ventricles - normal adults after exercise |
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Explain summation gallop
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- hear all
- S4123 - [da]LUB |
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Explain CV assesment sequence
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stopped here
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