Cardiovascular Assessment Chapter 12

Front 1

What does the Cardiovascular system do?

Back 1

transports oxygen, nutrients, and other substances to body's tissue and carries metabolic waste product to kidneys and lungs

Front 2

How many chambers in the heart?

Back 2

4; 2 chambers on each side, atrium and ventricle

Front 3

Right side of heart

Back 3

receives blood from superior and inferior venae cava and pumps it through pulmonary arteries to pulmonary circulation

Front 4

Left side of heart

Back 4

receives blood from pulmonary veins and pumps it through aorta into systemic circulation

Front 5

Three layers of the heart wall

Back 5

pericardium, myocardium and endocardium

Front 6

Pericardium

Back 6

heart encased in pericardium, which has a fibrous later and two serous layers

Front 7

Myocardium

Back 7

middle layer, thick muscular tissue that contracts to eject blood from ventricles

Front 8

Endocardium

Back 8

lines inner chambers and valves

Front 9

Tricuspid valve

Back 9

right side of heart

Front 10

Mitral valve

Back 10

left side of heart; atrioventricular (AV) valves -separate atria from ventricles

Front 11

Aortic valve

Back 11

opens from left ventricle into aorta (semilunar valve)

Front 12

Pulmonic valve

Back 12

opens from right ventricle into pulmonary artery (semilunar valve)

Front 13

Diastole

Back 13

ventricles relax and fill with blood from left and right atria; higher atrial pressures passively open AV valves, allowing blood to fill ventricles (80% of blood from atria flows into relaxed ventricles) Contraction forces remaining 20% through (atrial kick) at the end, ventricles are filled with blood

Front 14

Systole

Back 14

ventricles contract creating pressure to close AV valves (prevents backflow into the atria); semilunar valves open, eject blood to aorta (left) and pulmonary arteries (right). As blood is ejected, ventricular pressure decreases causing semilunar valves to close; ventricles relax...diastole

Front 15

Electronic Conduction

Back 15

SA (cardiac pacemaker) node through internodal tracts to AV node travel through branches and Purkinje fibers in myocardium which results in ventricular contraction.

Front 16

AV node compensation

Back 16

If SA node fails to discharge, AV node can generate ventricular contraction at slower rate of 40 to 60 impulses per minute.

Front 17

Bundle branches compensation

Back 17

If both SA and AV nodes are ineffective, bundle branches may contract, but at very slow rate of 20 to 40 impulses per minute.

Front 18

Ventricular systole
1st phase of Cardiac cycle

Back 18

(S1 -"lub") closing of MV and TV

Front 19

Ventricular diastole

Back 19

(S2 -"dub") closing of the AV and PV

Front 20

Factors that affect the heart

Back 20

Aging, Lifestyle, Disease

Front 21

5 points of Auscultation in Heart Assessment

Back 21

1. 2nd Right ICS (aortic valve)
2. 2nd Left ICS (pulmonic valve)
3. 3rd Left ICS (Erb's point)
4. 4th Left ICS (Tricuspid valve)
5. 5th Left Midclavicular Line (Mitral valve) -Apical

Front 22

Murmur Intensity Grades

Back 22

Grade I barely audible in a quiet room
Grade II quiet but clearly audible
Grade III moderately loud
Grade IV loud and associated with a thrill
Grade V very loud; thrill easily palpable
Grade VI very loud; thrill palpable and visible

Front 23

Aortic stenosis (Systolic) [heard over aortic valve area; radiates to neck, down left sternal border]
S1-III-S2

Back 23

(heard between normal heart sounds) -medium pitch, coarse with crescendo-decrescendo pattern; pitch low

Front 24

Pulmonic stenosis (Systolic) [heard over pulmonic valve; radiates left to neck; thrill at 2nd & 3rd ICS]
S1-III-S2

Back 24

heard over pulmonic valve; (heard between normal heart sounds) medium pitch, coarse with crescendo-decrescendo pattern

Front 25

Aortic regurgitation (Diastolic) [patient sitting and leaning forward, 2nd R ICS, radiates to L sternal border]
S1 S2 III---

Back 25

Blowing in early diastole; pitch high

Front 26

Pulmonic regurgitation (Diastolic) [patient sitting or leaning forward; 3rd & 4th ICS]
S1 S2 III---

Back 26

Blowing; pitch high or low

Front 27

Mitral Stenosis (Diastolic) [bell at apex with pt in L lateral decubitus position]
S1 S2

Back 27

Low rumble more intense in early and late diastole; pitch low

Front 28

Tricuspid Stenosis (Diastolic) [Bell over tricuspid area]
S1 S2

Back 28

Similar to mitral stenosis but louder on inspiration; pitch low

Front 29

Mitral regurgitation (Holosystolic) [diaphragm at apex, radiates to left axilla or base]
S1 IIIII S2

Back 29

Harsh blowing quality; pitch high

Front 30

Tricuspid regurgitation (Holosystolic) [5th ICS, left sternal border]
S1 IIIII S2

Back 30

Blowing; pitch high

Front 31

P

Back 31

Atrial depolarization and contraction

Front 32

QS

Back 32

Ventricular depolarization and contraction

Front 33

T

Back 33

Ventricular repolarization and relaxation

Front 34

Ken-tuck-y
S1 S2 S3

Back 34

Ten-ness-ee
S4 S1 S2

Front 35

Pulse Amplitude Ratings

Back 35

0+ Absent
1+ Diminished, barely palpable
2+ Normal
3+ Full volume
4+ Full volume, bounding hyperkinetic

Front 36

What is "Bruit"?

Back 36

a rushing, blowing sound created by the blood passing through the narrowed section of the vessel. (Carotid pulse)

Front 37

Normal findings on Auscultation

Back 37

S1 loudest at mitral area
S2 loudest at pulmonic area

Front 38

Abnormal findings

Back 38

Splitting (valves aren't synchronized) S1 or S2
Third heart sound (S3) -CHF, fluid overload
Fourth heart sound (S4) -CAD, cardiomyopathy
Opening snap
Summation gallop
Midsystolic click
Pericardial friction rubs
Murmurs

Front 39

Inspect upper and lower extremities for

Back 39

Symmetry
Skin integrity
Color and temperature
Capillary refill
Hair distribution
Sores
Varicose veins

Front 40

Peripheral Edema chart

Back 40

1+ barely perceptible pit - 2mm
2+ Deeper pit; rebounds in a few seconds - 4mm
3+ Deep pit; rebounds in 10 -20 seconds - 6mm
4+ Deeper pit; rebounds in >30 seconds - 8mm