Term
major risk factors for heart disease |
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Definition
smoking
hypertension
obesity
diabetes
high cholesterol |
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Term
heart
structure and function |
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Definition
position and landmarks
-precordium
--pericardial fluid
--between 2 thin layers
-mediastinum
--middle third of thoracic cage
-heart wall-pericardium, myocardium, endocardium
-chambers-right and left atria and ventricles
-valves-
--atrioventricular-tricuspid, mitral
--semilunar- pulmonic, aortic
-- |
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Term
diastolic rumbles of atrioventricular valves |
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Definition
mitral stenosis- left atria hypertrophy
tricuspid stenosis |
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Term
midsystolic ejection murmurs |
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Definition
aortic stenosis- left ventricular hypertrophy
pulmonic stenosis |
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Term
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Definition
complete S1 and S2
-diastole
-systole
heart sounds
-first-closing of AV valves
-second-clsoing of SL valves
S3-protodiastole-ventricular filling vibrations-common in children and preg
S4-presystole-atrial kick-common in older adults 40-50 especially after exercise
valves close slightly later in the right side of the heart
-sometimes heard separately
-mitral closes right before tricuspid
effects of respiration
-normal: split S2 on inspiration
-fixed split if on inspiration and expiration |
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Term
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Definition
all 4 valves are closed and ventricles relax-isometric or isovolumic relaxation
protodiastolic filling-first passive filling
presystole-"atrial kick" atria contract and push last amount of blood out (25% of SV) |
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Term
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Definition
| briefly all 4 valves close again and pressure builds in ventricles-isometric contraction |
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Term
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Definition
turbulent blood flow-blowing and swooshing sounds
-increased velocity of blood
-decreased viscosity of blood
-structural defects in the valves
timing-diastolic always indicates heart disease
loudness:
grade i- barely audible
grade ii- clearly audible, but faint
grade iii-moderately loud, easy to hear
grade iv-loud, thrill palpable
grade v-very loud, heard with one corner of steth off chest
grade vi-loudest, hear with steth off of chest wall
pitch
pattern
quality-mitral stenosis-rumbling, aortic-harsh
location
radiation
posture-innocent, functional
change position |
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Term
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Definition
SA node-sinoatrial "pacemaker"
Av node
bundle of His
right and left bundle branches
through ventricles
p wave-depolarization of atria
PR interval-atrial depolarization and time for the impulse to travel through AV node to the ventricles
QRS complex- depolarization of the ventricles
T wave repolarization of ventricles |
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Term
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Definition
cardiac output (4-6 L per min)
-SV x rate (co=sv x r)
preload-venous return that builds during diastole
afterload- pressure ventricles generate to open aortic valve |
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Term
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Definition
-wave like pulse
-varies with respiration
-supine-see pulsation over sternomastoid muscle |
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Term
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Definition
Chest pain: Any chest pain or tightness? Edition Change: diaphoresis, pallor, palpitations, dyspnea, nausea, tachycardia, or fatigue should be considered to be equivalent to angina.
Dyspnea: Any shortness of breath?
Orthopnea: How many pillows do you use when sleeping or lying down?
Cough: Do you have a cough?
Fatigue: Do you seem to tire easily? Able to keep up with your family and co-workers?
Cyanosis or pallor: Ever noted your facial skin to turn blue or ashen?
Edema: Any swelling of your feet and legs?
Nocturia: Do you awaken at night with an urgent need to urinate? How long has this been occurring? Any recent change?
Cardiac history: Any history of hypertension, elevated blood cholesterol or triglycerides, heart murmur, congenital heart disease, rheumatic fever or unexplained joint pains as child or youth, recurrent tonsillitis, anemia?
Family cardiac history: Any family history of hypertension, obesity, diabetes, coronary artery disease (CAD), sudden death at younger age? |
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Term
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Definition
chest pain-OLDCAAARTS
dyspnea
orthopnea
cough
fatigue
cyanosis or pallor
edema
nocturia
paroxysmal nocturnal dyspnea
cardiac history
family cardiac history
personal habits-cardiac risk factors |
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Term
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Definition
perform regional cardiovascular assessment in this order
-pulse and BP
-extremities
-neck vessels
-precordium |
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Term
objective: sitting position |
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Definition
-inspect
--skin-neck and precordium
--pulsations-neck and precordium
-palpate
--carotid artery
-auscultate
--carotid artery-bruit indicates occlusion |
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Term
objective: supine
inspection |
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Definition
heave or lift
-seen at apex
-forceful thrusting of ventricle during systole
-increased workload, ventricular hypertrophy
jugular venous pulsations -central venous pressure |
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Term
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Definition
-apical impulse
--point of maximal impulse
--heart size
--5th intercostal space
--1cm x 2cm, short gentle tap
--exhale and hold
-pericardium
--thrills-feels like a purring cat, indicates turbulent blood flow |
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Term
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Definition
-left ventricular dilatation-volume overload-displaces impulse down and to the left, increases size more than one space
-left ventricular hypertrophy and no dilatation-increased force and duration but no change in location |
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Term
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Definition
supine
-cardiac borders/dull
--5th intercostal space mid-clavicular line and slopes toward sternum to left sternal border at 2nd left ics
--determines size of heart |
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Term
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Definition
cardiac-each location in Z pattern
-bell: low pitch
-diaphragm: high pitch
-aortic, pulmonic, erb's point, tricuspid, mitral (apex)
-rate and rhythm of mitral valve
-identify S1(apex) S2 (base)
-listen for extra heart sounds (S3, S4, etc)
-listen for murmurs |
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Term
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Definition
inspiration-lub-T-dub
paradoxical split is on expiration |
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Term
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Definition
| associated with mitral valve prolapse, common extra heart sound |
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Term
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Definition
S3-pathologic-ventricular gallop-occurs with heart failure and volume overload
S4-pathologic-atrial gallop-occurs with CAD |
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Term
summary checklist:
heart and neck vessels exam |
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Definition
-neck
carotid pulse-observe and palpate
observe jugular venous pulse
estimate jugular venous pulse
-precordium-inspect and palpate
describe location of apical impulse
note any heave(lift) or thrill
--auscultation
identify anatomic areas where you listen
note rate and rhythm of heartbeat
identify S1 and S2 and note any variation
listen in systole and diastole for any extra heart sounds
listen in systole and diastole for any murmurs
repeat sequence with bell
listen at the apex with the person in left lateral posistion
listen at the base with the person in sitting position |
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Term
clinical portrait of heart failure |
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Definition
dilated pupils
skin pail gray or cyanotic
anxiety
falling o2 sat
confusion
jugular vein distension from venous congestion
dyspnea
orthopnea
crackles, wheeze
cough-frothy pink or white
decreased BP
infarct
fatigue
S3 gallop-tachycardia
enlarged spleen, liver from venous congestion
decreased urine output
nausea vomitting
ascites
weak pulse, cool, moist skin
dependent, pitting edema |
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