-
Heart extends vertically from....
2nd left intercostal space to the 5th left intercostal space
-
Heart extends horizontally from...
right sternal border to left midclavicular line
-
Upper portion of the heart is called the
base
-
Lower portion of the heart is called the..
apex
-
Anterior chest overlying heart and great vessels is call the
precordium
-
Return blood to right atrium from upper and lower torso
Superior and inferior vena cava
-
Exits the right ventrical, bifurcates and carries 02 poor blood to the lungs
pulmonary artery
-
Return 02 rich blood to the left atrium
pulmonary veins
-
transports 02 rich blood from left ventrical to the body
Aorta
-
Thin walled chanbers
Right and left atria
-
Receive blood returning to the heart and pump into the ventricles
Atria
-
Thicker-walled chambers
Ventricles
-
Which ventricle is thicker?
Left
-
Pump blood out of the heart
ventricles
-
Valves between the atria and ventricles
Atrioventricular valves
-
Name the two atrioventricular valves
Tri cuspid and mitral valves
-
Separate ventircles from major arteries
Semilunar valves
-
Name the two semilunar valves
Aortic and pulmonary valve
-
Direct the flow of blood
Valves
-
Ensure blood only moves in "forward" direction
valves
-
Valve between the right atrium and right ventricle
Tricuspid
-
Vlave between the left atrium and left ventricle
Bicuspid
-
Separates the left ventricle from the aorta
Aortic valve
-
Separates the right ventricle from the pumonary artery
Pulmonary valve
-
Achor AV valves to papillary muscles within the ventricles
Chordae tendineae
-
Ensures that valves do not turn inside out
chardae tendinae
-
3 layers of the heart
- Pericardium
- myocardium
- endocardium
-
tough, inextensible, loose-fitting fibroserous sac that attaches to great vessels and surrounds the heart
pericardium
-
pericardial fluid secreted by the parietal pericardium and allows for smooth friction-free movement of the heart
pericardium
-
Electrical impulse originates in the
SA node in the superior aspect of the right atrium
-
Avter electric impulse leaves the SA node, it travels to
the AV node located in the inferior aspect of the right atrium
-
SA node normally discharges between how many beats per minute?
60-100
-
After electrical impulse leaves teh AV node, the impulses tranmit to
Bundle of His and pukinje fibers
-
Results in ventricular contraction
impulse through the bundle of his, purkinje fibers in the myocardium
-
What prevents excessive atrial impulses from reaching the ventricles?
AV node
-
If the SA node fails to dicharge, what heppens?
AV can generate ventricular contractions but at 40-60 per min
-
If SA and AV stop firing, what happens?
Bundle branches may contract but at slow 20-40
-
Ventricles are relaxed, AV valves are open
Diastole
-
high pressure in the ventricles lead to closing of the AV valves....called
systole
-
first heart shound
- Lub
- S1
- Closing of the AV valves
- Heard during systole
-
End of systole, when the aortic and pulmonic valves close...
-
Closing of AV and semilunar valves
-
opening of valves is
silent
-
S1 is the closing of the AV valves...which valves?
Mitral and tricuspid
-
S2 is the closing of what valves?
Aortic and pulmonic
-
S1 and S2 normally heard as one sound (separate). But may be heard as 2 if the associated valves close ealier thant he tricuspid. If the aortic valve closes before the pulmonic valve, it's called
Split S2
-
Known as diastolic filling sounds or extra filling sounds
S3 S4
-
Caused by ventricular vibration due to rapid ventricular filling
S3
-
Heard in early diastole after S2
S3
-
Known as a ventricular gallp
S3
-
Sounds like Ken Tuck E
S3
-
Caused by ventricular vibration but due to ventricular noncompliance during atrial contraction
S4
-
Blood being forced into stiff ventricles
S4
-
Heard in late diastole just before the S1
S4
-
Known as an atrial gallop
S4
-
Sounds like Ten'nes'see
S4
-
Can be normal or innocent in many children and some athletes
S3
-
Caused by CHF, Ischemic heart disease, anemia, restrictive myocardial disease
Pathologic S3
-
Can be normal or innocent in childrend and some atheletes
S4
-
Can be caused by hypertension, CAD, failing left ventricle, Restrictive cardiomyopathy
S4
-
Quadruple gallop
S3 and S4
-
Cuased by turebulent blood flow, causing swooshing or blowing sounds
Murmurs
-
Heard over the precordium
Murmurs
-
Conditions contributing to turbulent blood flow
- Increased blood velocity
- Structural vavle defects
- Valve malfuction
- Abmnormal chamber opening
-
Valves do not close tightly enough to prevent backlfow
regurgitation
-
Narrowing, stiffening, thickening, fusion or blockage of one or more of the valves of the heart
stenosis
-
vibratory sensation that feels similar to the purring of a cat
Thrill
-
a sustained, systolic outward movement of the percordium, associated with heart failure
Heave or lift
-
Most comon heart murmors
- Mitral regurgitation
- Aortic valve stenosis
- Aortic valve reguritation
- Mitral valve stenosis
-
Very faint, listener has to be really tuned in; may not be audible in all position...grade this murmur
Grade I
-
Quiet, but heard as soon as listener puts stehtoscope on client's chest, grade this mumer
Grade II
-
Moderately loud...grade this murmor
Grade III
-
Loud with a palpable thrill, grade this murmur
Grade IV
-
Very loud with thrill, may hera with stethoscope only partly on chest, grade this murmor
Grade V
-
Very loud with thrill; may hear w/o stethoscope, grade this murmur
Grade 6
-
A very faint murmor would be documented as
I/VI
-
Amount of blood pumped by the ventricles in a given period of time, usually calculated in one minutes period of time
Cardiac output
-
Determined by stroke volume
Cardiac output
-
CO = SV x HR
Cardiac output
-
Normal adult cardiac output is
5-6 liters/min
-
Amount of blood pumped from the heart with each contraction
SV
-
SV from left ventricle is usually
70mL/Beat
-
the greater the preload, the greater the
stroke volume
-
Increased afterload leads to
decreased stroke volume
-
Uniform, synchronized contraction of the myuocardium
contraction synergy
-
Conditions causing synchronous contractions decrease stroke volume
contraction synergy
-
increased myocardial contractility leads to
increased stroke volume
-
Sympathetic and parasympatheic stimulation can impact cardiat output by
increasing or decreaing the heart rate
-
Supply neck and head with oxygen and nutrients
Carotid arteries
-
Pressure wave closely coincides with S1
Carotid arteries
-
Pulse should have a smooth rapid upstroke and more dradual downstroke
carotid arteries
-
Return blood from head and neck to heart by way of the superior vena cave
jugular veins
-
two set, internal and external veings
Jugular veins
-
assessment is importatn for dtermining hemodynamics of right side of heart
jugular veins
-
level of jugular venous pressure reflects...
right atrial pressure
-
Right sided heart failure causes
increased jugular venous pressure
-
Cardiac tamponade
increased jugular venous pressure
-
Hypervolemia causes
increased jugular venous pressure
-
Chronic constrictuve pericarditis
increased jugular venous pressure
-
superior vena cava obstruction causes
increased jugular venous pressure
-
Pulmonary embolis causes
increased jugular venous pressure
-
Decreased jugular pressure occurs with decreased...
left ventricular output or decreased blood volume
-
Right internal jugular veingg most directly connected to _________ and provides best assessment for pressure changes
right atrium
-
5 traditional areas for auscultating heart sounds
- Aortic
- pulmonic
- erbs point
- tricuspid
- mitral
-
the 4 valve sounds are not heard dirctly over the valvues...they
radiate to specific areas of the chest.
-
APETM
- Aortic
- pulmonic
- erbs point
- tricuspid
- mitral
-
can hear systolic blood flwo from left ventricle through aortic valve into the aorta
Aortic area
-
can hear systolic blood flow from right ventricle through pulmonic valve into main pulmonary artery
pulmonic area
-
2nd ICS at right sternal border
aortic area
-
2nds or 3rd ICS at left sternal border (base of heart)
pulmonic area
-
3-5th ICS at left sternal border
Erb's point
-
4th or 5th ICS at lower sternal border
tricuspid area
-
5th ICS near left MCL (apex of heart)
Mitral area
-
Can hear aortic and pulmonc sounds
Erb's point
-
Can hear blood flowing from right atria, through tricuspid valve into the right ventricle during diastole
Tricuspid area
-
Can hear blood flow through the mitral valve into the left ventricle during diastole
Mitral area
-
Causes inflammation of all layers of the heart, which leads to impaired contractility and valvular function
Rheumatic carditits
-
Rheumatic carditis caused by
GABHS
-
Dyslipidemia highly predictive of development of?
CAD
-
Which clients hsould monitor their own heart rate or BP?
Those on cardiotonic and antihypertesive medications
-
Genetic predisoption for these diseases
hypertension, myocardial infarction, CHD, dylipidemai or DM
-
If a client can walk one block or climb 2 flights of stairs without symptoms, usually safe for what?
sex
-
Can you take nitro before intercourse?
Yes
-
what position may decrease cardiac workload in sexual intercourse?
side lying
-
Inability to breath in a supine position (orthopnea) may indicate
heart failure
-
If unable to palpate the apical pulse with a client in semi fowlers postion, ask to turn to
left side
-
what position to auscletate and palpate neck vessels and inspection, plapation and auusclutation of precordium performed in a.......position
supine, hob 30 degrees
-
Fully distended jugular veins indicates increased...
central venous pressure
-
abbnormal to see protrusion of jugular vein past _____ elevation
45 degree
-
-
Distension, buling or protrusion at 45, 60 or 90 may indicate
RS heart failure
-
Clients with COPD amy have elevated venous pressure only during____
expiration
-
An increase in venous pressure during inspiration (kussmaul's sign) amy occur in client's with
severe constrictive pericarditis
-
When do you auscultate the cartid arteries?
If the client is middle-aged or older or if you suspect CV disease
-
How do you auscultate for any bruits?
Place the bell of teh stethoscope over the carotid artery and ask the client to hold his/her breath so that any burits can be aucletated.
-
When assesing carotid arteris, always do what prior to palpation?
Auscultate
-
Normal for arteries to be elastic?
Yes
-
What are bruits indicitive of?
occlusive arterial disease
-
If more than 2/3 occluded may not be able to hear
bruit
-
absent on pulse amplitude scale
0
-
normal on pule amplitude scale
2+
-
bounding on pulse amplitude scale
4+
-
Pulse inequality may indicate what?
arterial constriction or occlusion in one carotid artery
-
Weak pulses may indicate what?
hypovolemai, shock or decreased CO
-
a boudning firm pulse may indicate what?
hypervolemia or increased CO
-
Loss of elasticity may indicate
arteriosclerosis
-
may indicate narrowing of artery
thrills
-
Apical may or may not be vislbe...normal?
yes
-
pulsations of the precordium may be caused by
left ventricle moving outward during systole
-
heaves or lifts...abnormal?
yes
-
normal amplitude of the apical pulse should feel like a
gentle tap
-
May not be able to palpate apical pulse in clintss with
pulmonary emphysema
-
where is S1 loudest?
apex
-
-
S1 best heard using
diaphragm
-
S2 best heard using
diaphragm
-
Systolic pause between
s1 s2
-
diastolic pause between
S2 S3
-
S4 may be heard at the end of diastole in well conditioned athletes and adults older than
40 oir50, especially after exercise
-
Walls are thick and strong, contain elastic fibers which allow them to stretch
arteries
-
Lymph drains into
venous system
-
after being filtered, lumph travels to either the
right lymphatic duct or the thoracic duct
-
What drains the right side of the body?
Right lymphatic duct
-
What drains the body except the right side
Thoracic lymphatic duct
-
how is lymp returne dto venous system?
subclavian veins
-
Removes excess fluid left behind in interstial spaces
lymphatic capillaries
-
cold, pale, clammy skin of hte extremities caused by
arterial insufficiency
-
warm skin and brown pigmentation around ankles is a characteristic of
venous insufficiency
-
Cramping in legs is indicitive of
intermittent claudication
-
associated with arterial disease
intermittent claudication
-
heavy aching sendsation aggravated by standing or sitting and relieved with rest is indicitive of
venouse disease
-
leg pain that wakes you up
associated with chronic arterial occlusive disease
-
who won't experience classic signs of venous or arterial disease?
diabetic neuropathy
-
May only hav e coldness, color change, numbness and ablnormal sensations
diabetic neuropathy
-
Heriditary but also accur with prolonged standing and pregnancy
varicose veins
-
ulcers on legs
arterial disease
-
ulcerns on toes feet and lateral ankles
arterial disease
-
painless ulcers on medial ankle on lower leg
venous disease ulcers
-
causes of peripheral edema
- Incompetent valves
- Decreased capillary osmotic pressure
- DVT
-
Enlarged lymph nodes are indicative of
local or system infective process
-
Estrogen increwases a womens risk for
- thromboembolic events
- raynauds
- hypertension
- edema
-
what is prescribed to increase blood flow
Pletal (cilostazol) and plavix (clopidogrel)
-
Increases blood flow and reduces tissue hypoxia
Trental
-
Topical medicatio that improves blood flow
Trypsin
-
Helps prevent venous pooling and increases blood return to the heart
support hose
-
Normal documentation for radial pulse
Radial pulse equal at +2 bilaterally
-
where to palpate the epitrochlear lymph node
between biceps and triceps muscles
-
abnormal or normal to not be able to palpate the epitrochlear lymph nodes
normal
-
hair loss of extremeities is normal or abnormal in older clients?
normal
-
loss of hair on extremeties is suggestive of what?
arterial insufficiency
-
smooth, even margins
occur at pressure areas asuch as toes and lateral ankle
arterial insufficiency ulcer
-
irregular edges
bleeding, possible bacterial infection
medial ankle
venous insufficiency ulcer
-
-
-
-
-
Non pitting edema seen with
- lymphedema
- pretibial myxedema (sign of hyperthyroidism)
-
local edema caused by
enous insufficiency such as varicose veins or thrombophlebitis
-
estemic edema caused by
- diseases of the heart
- liver
- kidneys
-
bilateral coolness of the lower extremeties may be due to
- cold room
- recently smoking cigarette
- anemia
- anxiety
-
nontender movable lymph nodes up to 1-2 cm, normal or abnormal?
Normal
-
Auscultate femoral pulses if
arterial occlusion suspected
-
marked by redness, thickening, tenderness along vein
Aching or cramping may accompany walking,
swelling and inflammation also often noted
superficial thrombophlebitis
-
Risk factors for DVT
- Age over 60
- immobile 3 days +
- Pregnancy and postpartum
- major surgery > 45 minutes in duration
- Long plane rides or car trips
- Cancer
- H.O previos DVT
- Stroke
- Acute MI
- CHF
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