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HA cardiac
| Question | Answer |
|---|---|
| precordium | area overlying the heart and the great vessels |
| mediastinum | entire area of the thoracic cavity including the lungs surrounding heart and great vessels (precordium) |
| apex of heart (where is it located) | bottom of the heart |
| myocardium | heart muscles, site of myocardial infarcts |
| endocardium | inner surface of myocardium |
| epicardium | outer surface of myocardium |
| atria | right/left sides; reservoirs of the heart |
| ventricles | right/left sides; pumps of the heart |
| atrioventricular valves | AV tricuspid and mitral valves |
| Semilunar valves | SL pulmonic and aortic valves |
| tricuspid valve (what does it separate, what type of valve, how many cusps) | separates right atrium and right ventricle, has 3 cusps (TRI-cuspid) atrioventricular valve |
| heart cusps | tissue flaps making up heart valves |
| mitral valve (what does it separate, what type of valve, how many cusps) | separates left atrium and left ventricle, has 2 valves (biscuspid) atrioventricular valves |
| pulmonic valve (what does it separate, what type of valve, how many cusps) | separates right ventricle and pulmonary artery (3 cusps) semilunar valve |
| aortic valve (what does it separate, what type of valve, how many cusps) | separates left ventricle and aorta (3 cusps) semilunar valve |
| right side of heart supplies | deoxygenated blood, from superior/inferior vena cava to pulmonary arteries to lung |
| left side of heart supplies | oxygenated blood, from pulmonary arteries to aorta |
| flow of right side of heart | deoxygenated blood from superior/inferior vena cava => right atria => thru tricuspid valve => right ventricle => thru pulmonary valve => pulmonary ARTERY |
| flow of left side of heart | oxygenated blood from pulmonary VEINS => left atrium => thru mitral valve => left ventricle => thru aortic valve => aorta |
| sinoatrial node | SA located in the right atrium near the top of atria pacemaker of the heart |
| ectopic beats | premature heartbeats |
| pericardium | fibrous/tough double walled sac lining the great vessels, esophagus, sternum, pleura encases and protects heart |
| bundle of his | electrical conductor of heart, split into right/left bundle branches |
| purkinje fibers | lightning shaped fibers lining the right/left ventricles conducting electrical signals |
| atrioventricular node | AV in atrial septum, signal conducts thru right/left bundle branches |
| conduction of electrical signals thru the heart | sinoatrial node => atrioventricular node -> bundle of his (right/left bundle branches) -> purkinje fibers |
| what does diastole involve | relaxation of myocardium ventricular relaxation and open atrioventricular valves (tricuspid/mitral) |
| what does systole involve | myocardial contraction to move blood atrioventricular valves closed with start of systole/S1 (lubb) and end of systole/S2 (dubb) |
| S1 sound | atrioventricular valves (AV) close; basically beginning of systole lubb sound (loudest at apex, but can be heard throughout precordium) |
| S2 sound | semilunar valves (SL) close; basically the end of systole dubb sound (loudest at base) |
| heart murmurs | caused by incompetent valve/hole in septum, basically turbulent blood flow in the heart or great vessels whooshing or blowing sound |
| pulse deficit | difference between apical and radial pulse; differences indicate underlying issue look for weak/irregular pulses |
| pulse pressure | difference between systolic and diastolic BP representing stroke volume or amount of blood ejected per heartbeat |
| Mean arterial pressure | measure flow/resistance/pressure in arteries during ONE heartbeat |
| mnemonic for heart auscultation | All Patients Take Medicine Aortic Pulmonic Erb's point (between pulmonic/tricuspid) Tricuspid Mitral |
| P wave | arterial depolarization (stimulus thru atria) |
| PR interval | initial atrial stimulation to initial ventricular stimulation |
| QRS complex | ventricular depolarization (stimulus thru ventricles) |
| ST segment | vent repolarization (return to rest state) |
| T wave | continued return to rest state |
| U wave | possible small deflection after T wave, final repolarization state |
| S3 sound | low pitch sound like ken-tuck-Y; "ventricular gallop" best heart at apex |
| what can cause S3 sound | possible heart failure |
| S4 sound | low pitched sound like Ten-nes-see |
| what can cause S4 sound | myocardial infarct (MI) HTN arterial stenosis (AS) |
| S3 is normal/abnormal finding in | normal finding in children/young adults (<30) abnormal in adults >30 |
| abnormal S3 heart sound signifies | fluid volume overload to ventricle due to possible heart failure or mitral/tricuspid regurgitation occurs in diastole (usually silent event in healthy individuals) |
| S3 also called by what names | ventricular gallop early diastolic gallop ventricular filling sound protodiastolic gallop |
| how are heart murmurs graded | I- faint/hard to hear II - faint, but heard immediately/clearly III - moderate intensity, easy to hear IV - loud/associated with thrill (palpable) V - very loud w/ thrill, stethoscope on chest wall VI - very loud w/ thrill, stethoscope off chest |
| developmental consideration for fetal circulation | fetal circulation is unique because there is no air in utero, there is no need for blood to go to the lungs, until fetus takes its first breath |
| what causes the lubb dubb sound | AV node's delayed impulse after signal travels from SA node |
| what does S1 sound mean | start of systole, lubb sound physiologically it is the closure of AV valves |
| what does S2 sound mean | end of systole, Dubb sound physiologically the closure of SL valves |
| early diastole is also known as | protodiastole |
| what occurs after early diastole/protodiastole | presystole/atrial kick/atria systole atrial contraction to get all of the blood out |
| point of maximal impulse is | location where the cardiac impulse can be best palpated at same as apical point |
| describe the path of blood in the heart | blood to the right atria from SCV/ICV, thru the AV into right ventricle, thru the pulmonic valve into the pulmonary artery/lungs, pulmonary vein into left atria, thru the mitral valve into left ventricle, thru the aortic valve into aorta |
| do the right and left ventricles contract at the same time | they do not contract at the same time, left side is slightly delayed c/w right side |
| mean arterial pressure formula | diastolic BP + 1/3 (systolic - diastolic) = MAP |
| what is the expected normal range for MAP | good range = 70-100 mmHg |
| why is MAP significant | mean arterial pressure measures pressure necessary for adequate perfusion to organs in the body |
| when does S4 sound occur | end of diastole at presystole |
| why can abnormal S4 occur | atria attempts to contract and push blood into noncompliant ventricle |
| where is S4 best heard at | left sided S4 - best heard at apex right sided S4 - left sternal border with inspiration |
| what can cause cardiac murmur and what it relates to | increased velocity of blood flow (exercise) decreased blood viscosity (anemia) structural valve defect or abnormal openings in chamber (narrow/incompetent valves or wall defect/dilated chamber) |
| where can murmurs be heard from | all over the precordium |
| what is significant about Erb's point and cardiac murmurs | abnormal murmurs in stenosis and regurgitation can be heard at Erb's point |
| characteristics of heart mumurs | timing loudness pitch/frequency pattern quality location radiation posture (sitting/supine/left lateral) |
| when is murmur timing problematic | when heard between S2 and S1 (diastolic) is problematic when heard between S1 and S2 (systolic) can occur with normal/with heart disease |
| quality of heart murmurs | musical, blowing, harsh, rumbling, grating, swish, snap, click, thud |
| developmental differences of the heart in infants | - heartbeat at 3 weeks of gestation - blood shunt via foramen ovale to left side of heart and aorta - |
| foramen ovale | hole in the septum between left and right atria allows blood to bypass the lungs in gestation |
| normal pulse in infant and children | infants: 120-140 BPM children 3-4: 80-120 children 5-6: 75-115 children 7-9: 70-110 |
| developmental considerations in pregnant women | increase blood volume by 30-40% decreased blood pressure normal pulse has increase of 10-15 BPM |
| developmental considerations for aging adults | - elevated systolic BP = thickening/stiffening of leg arteries - left ventricular wall thickening d/t vascular stiffness (need increased force) - decrease in diastolic BP & increase in systolic BP increase pulse pressure |
| collecting subjective data (symptoms) for coronary heart disease | chest pain, dyspnea, orthopnea, cough, fatigue, cyanosis/pallor, edema, nocturia |
| collecting subjective data (Hx) for coronary heart disease | cardiac Hx fam cardiac Hx personal habits/risk factors -- smoking/HLD/obesity/sedentary/EtOH medications ADL change |
| sequence for physical exam for heart | inspect - neck for visible pulsation palpate - carotid artery auscultate - bruits |
| considerations for cardiac percussion | limited value unless technology is not readily available |
| where to auscultate for bruits | auscultate for bruits in 3 places (with bell) |
| how to inspect JVD | supine position + head elevation apply pressure at bottom of neck area where vein enters thorax @ clavicle |
| CVP | central venous pressure measurement of pressure in large veins near RA indicator of blood volume returning to heart (preload) |
| what does high CVP mean | fluid overload right sided heart failure increased thoracic pressure impaired right ventricular function |
| what does low CVP mean | hypovolemia decreased venous return to heart |
| thrills | "purring" palpable vibration/murmur indicative of turbulent blood flow |
| lifts and heaves | physiologically ventricle thrusts and can be felt, abnormal |
| what does S1 coincide with? | carotid artery pulse R wave on ECG |
| aortic heart sounds (auscultation) | heard best at base @ 2nd intercostal space right sternal border S2 is louder |
| pulmonic heart sounds (auscultation) | heard best at 2nd intercostal space left sternal border at base of heart S2 is louder |
| Erb's point heart sounds (auscultation) | heard best at 3rd intercostal space left sternal border S1 and S2 is equally loud |
| tricuspid heart sounds (auscultation) | heard best at 5th intercostal space left sternal border at apex of heart S1 louder |
| mitral heart sounds (auscultation) | heard best at 5th intercostal space at mid clavicular (aka apical) S1 is louder (aka R wave on ECG, also coincides with carotid artery pulse) |
| pericarditis | inflammation of the pericardial sac symptomatic chest pain (stabbing pain relieved by sitting/leaning forward) |
| cardiac tamponade | excess fluid within the pericardium which puts pressure on the heart |
| causes of cardiac tamponade | pericarditis and aortic dissection |
| cor pulmonale | condition causing right side of heart to fail d/t abnormal enlargement of right side of heart |
| what causes cor pulmonale | lung disease or pulmonary blood vessel disease such as COPD simple explanation long term blood pressure in lung arteries/right ventricle cause disease |
| examples of conditions causing cor pulmonale | COPD - right ventricular hypertrophy pulmonary HTN - loud S2 and left sternal border lift |
| myocardial infarction | heart attack, ischemia of the myocardium primarily left ventricle angina equivalents |
| angina equivalents | MI symptoms including dizziness, nausea, diaphoresis, dyspnea, and pain in locations other than the chest |
| myocarditis | inflammation of myocardium d/t autoimmune dz OR pathogenic cause |
| heart failure (important) | acute vs chronic decreased cardiac output due to failure of heart pumps leading to backed up circulation/congestion |
| what causes the signs and symptoms of heart failure (important) | - heart inability to pump blood for bodily need - kidney compensatory mechanism for abnormal Na/H2O retention to compensate for decreased cardiac output > increasing blood volume and venous return causing more congestion |
| aortic stenosis | aortic valve calcification restrict blood flow in systole and cause LV hypertrophy |
| symptoms of aortic stenosis | fatigue, dizziness, fainting/syncope, angina, palpitations, pallor, murmur |
| mitral regurgitation | type of pansystolic regurgitant murmur caused by incompetent mitral valve leading to backflow into left atrium during the systole |
| symptoms of mitral regurgitation | fatigue, orthopnea, palpitations, thrill/lifts, cardiac murmur |
| pansystolic regurgitant murmurs | murmur extending through entire systolic interval from S1 to S2. |
Created by:
sleepingbear
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