Cardiovascular

Description

Flashcards on Cardiovascular, created by Esther Kim on 10/17/2016.
Esther Kim
Flashcards by Esther Kim, updated more than 1 year ago
Esther Kim
Created by Esther Kim almost 8 years ago
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Resource summary

Question Answer
Features of R ventricle - most anterior cardiac surface - thin wall - Under lower pressure
Features of L ventricle - Lies behind R ventricle (except for apex) - Powerhouse of the pump
Which side of heart sounds louder? Left heart sounds are more prominent and louder
Anatomy: Base of Heart - Superior aspect of the heart - Rt & Lt 2nd ICS - Defines junction between pulmonic a. & R ventricle - Close to sternum
Anatomy: Apex - Bottom of heart, defines inferior tip - Apex at 5th ICS - 7-9 cm from midsternal line
Name the arteries and their respective valves 1. Pulmonary artery --> Pulmonic Valve 2. Aorta --> Aortic Valve
Where are the Atrioventricular Valves? 1. R Atrium to R Ventricle --> Tricuspid valve 2. L Atrium to L ventricle --> Mitral Valve (Bicuspid) "try before you buy"
Circulation: heart to lungs Flows from R ventricle --> lungs via pulmonary artery
Circulation: lungs to heart Blood returns from lungs--> L atrium through pulmonary veins
Circulation: heart to body Left ventricle to all over body
Circulation: body to heart Blood returns from body to R atrium via vena cava
Systole ventricular contraction
Diastole ventricular relaxation
Valves during systole Aortic & Pulmonic valves --> open Mitral & Tricuspid valves --> close
Cardiac Cycle 1. Pulmonary veins pump blood from lungs to L atrium 2. Passes through mitral valve into L ventricle 3. Pressure in L ventricle > L atrium, mitral valve closes 4. Blood ejected out aorta through aortic valve 5. Mitral valve closure = S1
When does systole begin? After S1
When/which valves close/open during Systole? 1. LV pressure > Aortic pressure --> Aortic Valve opens - Blood pumped out of heart into aorta 2. LV pressure < Aortic pressure --> Aortic Valve closes 3. Aortic valve closure = S2
When does diastole begin? Begins with S2
When and which valve opens during diastole? Mitral valve opens as pressure rises in L atrium (not normally audible)
When/where does contraction occur in diastole? After period of rapid ventricular filling, atrial contraction occurs (Usually inaudible)
S3 Rapid Ventricular Filling in Diastole
S4 Atrial Contraction in Diastole
Which part of cardiac cycle is auscultated? - CLOSURE of valves responsible for heart sounds - normal heart sounds: S1 and S2 (sometimes s3 and s4 heard)
Cardiovascular Exam 1. Assess Jugular Venous Pressure (JVP) 2. Assess Carotid Pulse 3. Examine Heart - Inspection - Palpation - Auscultation 4. Peripheral Vascular Exam
JVP exam - pt comfortable & supine - Head raised to 30˚ and tilted away from you - use tangential lighting to identify landmarks ID amplitude and timing of venous pulsations
Measure JVP - ID highest pt of venous pulsation of internal jugular along SCM border - Measure vertical distance above sternal angle
JVP look and feel - Arterial pulsations: look and feel like single strong impulses - Venous pulses: look like billowing sails with gentler wave forms - Compare with apical/radial pulse
Normal JVP vs. Significance of Abnormal JVP Normal JVP: < 4 cm above sternal angle Elevated JVP may indicate volume overload or R heart failure (CHF)
Pt position for Carotid Pulse Supine with head of bed elevated at 30˚
where to inspect for carotid pulse medial to sternocleidomastoid muscles
What to palpate for carotid pulse - Amplitude - Rate - Contour - Thrills
How to auscultate carotid pulse (before palpation) - Have pt hold breath - Use stethoscope bell to listen for bruit - listen for rumbling sound of turbulent blood flow through artery
Pt's position for cardiac exam - Starting position supine w/head elevated to 30˚ - Other positions include: a. Left Lateral Decubitus (LLD) b. Sitting up, leaning forward
Examiner's positioning for cardiac exam stands on R side of patient
What to look for in Cardiac Exam: Inspection - Heaves - Point of Maximum Intensity (PMI) or Apical Impulse
What to feel for in Cardiac Exam: Palpation - Lifts and heaves, thrills, PMI - Cardiac Silhouette
What to listen for in Cardiac Exam: Auscultation - Heart Sounds - Murmurs
Location of Apical Impulse 4th or 5th intercostal space
Normal Diameter of Apical Impulse Less than 2.5 cm
Normal Amplitude of Apical Impulse Usually small, brisk, tapping
How to measure duration of Apical Impulse Listen, feel, and estimate proportion
Designated Areas of Precordium to Auscultate - Right 2nd ICS - Left 2nd through 5th ICS - Apex
Proper Cardiac Auscultation: Bell vs. Diaphragm Use both diaphragm and bell: - Diaphragm for higher pitched sounds - Bell for lower pitched sounds
Proper Cardiac Auscultation for Left Lateral Decubitus Position - Use bell - Bring LV closer to chest wall Accentuates S3, S4, and mitral stenosis murmur
Proper Cardiac Auscultation for Sitting Up, Leaning Forward - Use Diaphragm - Accentuates aortic murmurs
Purpose of Cardiac Auscultation using Squatting, Valsalva maneuvers Makes different murmurs louder or softer
When/Where is S1 and S2 loudest? - S1: loudest at apex (mitral valve closing) - S2: loudest at base (aortic valve closing)
When do you hear systole and diastole? - Systole: between S1 and S2 - Diastole: between S2 and S1
Which is longer- systole or diastole? Systole is shorter than diastole
When are pulses palpable? During systole
Significance of L heart sounds S1 = mitral closure S2 = aortic closure
Significance of R heart sounds S1 = tricuspid closure S2 = pulmonic closure
Which side of heart contracts later? Right side contracts slightly later S1 = M1*T1 S2 = A2*P2
Splitting Heart Sounds - Splitting refers to separation of heart sounds into 2 components - Though both S1 and S2 an be split, splitting of S2 is more clinically important
When are physiologic splitting heart sounds accentuated? When do they disappear? - Separation of S1 or S2 into separate sounds accentuated by inspiration - Disappears with expiration
What causes Extra Heart Sounds in Systole - Ejection sounds are pathologic, caused by opening of valves that should be closed - occurs early in systole, immediately after S1
Which valves are affected with extra heart sounds in systole Aortic or pulmonic valves
Auscultating Extra heart sounds in systole - High pitched - Sharp, clicking quality - Heard best with diaphragm
Systolic Clicks - Heard mid-to-late systole - most common in Mitral Valve Prolapse - High-pitched
Extra heart sounds in Diastole: Opening Snap - Heard early in diastole - Usually caused by opening of stenotic MV - Loud, high-pitched snapping sound
Extra heart sounds in Diastole: S3 (Ventricular Gallop) - Physiological OR pathological - Heard early in diastole during rapid ventricular filling - Can be physiologic in children but usually pathologic in patients >40 yo
Extra Heart Sounds in Diastole: S4 - Atrial Gallop - Heard late in diastole, just before S1 - Dull, low-pitched sound - Heard best with Bell - Can be physiologic, but more often pathologic
Heart Murmurs - Longer duration than heart sounds - Often caused by turbulent blood flow through a valve - can indicate disease or be benign - heard best over respective auscultatory areas for the involved valve
Innocent Mumurs - Turbulent blood flow across valve due to strong ventricular ejection of blood - common in children & young adults - no evidence of cardiovascular disease - no physiological/structural abnormalities
Pathologic Murmurs - arise from structural abnormalities in valves - stenosis --> hardening/narrowing of valve --> impedes valve blood flow - Regurgitation --> failure of valve to close completely --> allows blood backflow
Important Traits to Note in Heart Murmurs - Location - Intensity - Timing - Pitch - Quality - Radiation
Heart Murmurs: Grading (1-6) - Grade 1: very faint - Grade 2: quiet, but heard immediately - Grade 3: moderately loud - Grade 4: loud - Grade 5: very loud, heard with stethoscope partially off of chest - Grade 6: heard with stethoscope completely off of chest
Systolic Mumurs May be innocent OR pathologic - Early Systole - Midsystolic - Late systolic - Holocystolic
Diastolic Murmurs ALWAYS pathologic - early diastolic - mid-diastolic - late diastolic
Qualities of Heart Murmurs - Harsh (stenosis) - Blowing (regurgitation) - Rumbling - Musical
Characteristics of Heart Murmur Contours Pattern of sound intensity over time - crescendo: gets louder - descrescendo: gets softer - crescendo-decrescendo - plateau: intensity constant
Adventitious Heart Sounds Mixed cycle: not confined to one aspect of cardiac cycle
Pericardial friction rub Type of mixed cycle - inflammation of pericardial sac
Patent Ductus Arteriosus Type of adventitious heart sounds mixed cycle - congenital opening between aorta and pulmonary arteries
Venous Hum (continuous) - Type of mixed cycle - Adventitious heart sounds - benign turbulent blood flow in jugular veins
Documenting CV Exam: precordium Precordium is quiet without lifts - No carotid pulations or JVD noted
Documenting CV exam: JVP JVP measured at 3cm above sternal angle with HOB elevated to 30 degrees
Documenting CV exam: carotid pulses 2+ and equal without thrills or bruits - upstrokes are brisk
Documenting CV exam: PMI -tapping, 7 cm lateral to MSL in 5th ICS - No lifts or thrills of precordium or apical impulse
Documenting CV exam: S1, S2 - Crisp S1, S2: louder at base - S1 louder at apex - physiologically split S2
Documenting CV exam: S3, S4 - No S3, S4 gallops - No murmurs or rubs
CV exam checklist - Inspect precordium with pt supine at 30 - Inspect carotid arteries & jugular veins for pulsations/distention - Measure JVP - Auscultate carotid arteries before palpating for thrills - Palpate precordium for lifts and thrills; palpate apical impulse - Palpate for PMI in LLD - Auscultate with diaphragm in aortic, pulmonic, tricuspid, mitral areas Auscultate with bell in A/P/T/M areas Auscultate with bell in LLD Auscultate with diaphragm sitting up, leaing forward
Points of Cardiac Auscultation: 1. Aortic (R 2nd ICS) 2. Pulmonary (L 2nd ICS) 3. Tricuspid (L 4th ICS) 4. Mitral/Apex (L 5th ICS)
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