Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
43 Cards in this Set
- Front
- Back
Pulmonary/Systemic Circulation
|
pulmonary vein-only oxygenated vein
pulmonary artery-deoxygenated blood |
|
Internal Position/Surface Landmarks
|
-heart goes from right side of sternum to the midclavicular line
-apex is at bottom, base at top -point of max impulse (PMI)-pulse at 5th ICP @ mid clavicular line -goes from 2nd to 5th ICS -pericordium -mediastinum - |
|
Positioning of the atria and ventricles
|
-heart rotated so right ventricle is more anterior
-most of left ventricle is posterior -->important for valves |
|
Great vessels of the heart
|
-superior and inferior vena cava-return blood of body to right atrium
-pulm artery takes deox blood to lungs from right ventricle -pulm veins take oxy blood lungs to left atrium -aorta takes ox blood from left ventricle-->rest of body |
|
Layers of the heart
|
-mostly connective tissue
-endocardium-CT continuous w inner lining of heart -myocardium-inner layer -contracts and pushes blood out of the heart -pericardium-outter layer of heaer pericardial cavity-in btw two laters with fluid -epicardium in btw myo and cavity |
|
Passage of blood through heart
|
blood in sup and inferior vena cava-->right atrium-->through atrioventricular valve (tricuspid)-->right ventricle-->heart contract-->trixupsid valve closes and blood out through pulm artery through pulm valve-->lungs
blood into pulm veins-->left atrium-->mitral valve (bicuspid)-->left ventricle-->heart contracts-->mitral valve closes-->blood out aorta through aortic valve |
|
Valves
|
atrioventricular-btw artria and ventricles
pulmonic and aortic valves-btw ventricles and vessel |
|
Sounds
|
when valves close
S1-when AV valves close-->blood ejected from ventricles -LUB S2-when semilunar valves close -DUB |
|
Systole pumping
|
ventricles contract
-right ventricle pumps blood into pulmonary arteries (pulmonic valve open) -the left ventricle pumps blood into the aorta (aortic valve is open |
|
Diastole pumping
|
-blood flows from the right atrium to the right ventricle (tricuspid valve open)
-blood flows from left atrium to left ventricle (mitral valve is open) |
|
Cardiac Cycle
|
pressure builds until high enough to open a valve
diastole-ventricles relaxed-->filled with blood-->pressure increases-->aortic valve opens longer period than systole -your BP is the pressure needed to open the valve -the higher the pressure, the more needed to be done/more contraction |
|
Blood distribution in heart
|
more to right
less to left -a little bit less blood in left side of heart during inspiration bc its sequestered in lung picking up O2 --left ventricular side has less volume->not going to take as long to squeeze out during systole |
|
Differences in valve closings
|
-aortic valve is going to close quicker than pulmonic
--normal finding when you breathe in **** |
|
S3 and S4
|
-if ventricle is tight--doesn't like blood coming in->make bruit, turbulent sound
S3-early diastole when blood is entering the ventricle S4-at end of diastole when blood is already in ventricle and atria does a little contraction to get the last bit of blood into ventricle-->ventricle kick (atrial systole) -when ventricle doesnt like this -turbulent |
|
Cardiac Output
|
CO=SVXHR
-btw 4-6 L of blood per min |
|
Preload
|
-volume overload
-length at which ventricular muscle stretches at end of diastole -as blood is pouring in during diastole-->this muscle is going to stretch -excersize-->more blood return to the heart-->ventricles stretch more than at rest -greater it stretches--greater the strength of next contraction (starling 4) -if there is fluid--preload problem -give diuretic |
|
Afterload
|
pressure overload
-the opposing pressure that the ventricle has to generate to open the aortic valve (resistance against which the ventricle has to pump blood -normally 5-10 mmHg -if aortic vessel pressure is 80-have to get to 80 -the higher the pressure the harder the ventricle has to work -pressure problem--an afterload problem |
|
Significant subjective data
|
-orthopnea
-how many pillows do you sleep with -fluid in cough -dyspnea-hard to breathe -gender -men more heart disease until menopause -race -blacks 2X likely to have more hypertension |
|
Assing the precordium
|
-inspect
-palpate -auscultate |
|
Blood Pressure
|
BP=CO X SVR
Systolic-pressure generated by left ventricle -when LV ejects blood into aorta and arterial tree Diastole-pressure generated by blood remaining in arterial tree -when ventricles are relaxed |
|
Assessing Blood Pressure
|
-pumping up high enough to be above systolic-occluded artery-no sound
-->letting air out slowly-->a little like a bruit (turbulent through artery) diastolic-pressure generated by blood remaining in arterial tree-when ventricles are relaxed -blood free flowing |
|
Assessment of Carotid arteries
|
-palpate medial to sternomastoid muscle in neck
-one carotid at a time -palpate in lower or upper third of neck, not middle -if palpate near thyroid cartilage--carotid sinus--causes HR to drop -auscultate carotid-bruit=carotic stenosis -hypertension or high cholesterol |
|
Jugular Venous Pressure
|
-JVP
-commonly expressed as vertical height (in cm) of column of blood (in head) in relation to the sternal angle (angle of Louis) -mean height=hydrostatic pressure within right atrium -6-10cm H2O -use internal jugular vein -right side closer and more direct to heart -can see pulsation in sternal notch when someone is lying down |
|
Inspection of the Jugular Venous Pressure
|
If you can't see the head of the pulsating column of blood in int. jug vein
-->because hydrostatic pressure so high head of column disappeared behind angle of jaw -->increase angle andsit the patient bolt right up OR -because hydostratic p in right atrium so low that head lies behind clavicle -->low reclining angle -may need to lay down flat **cite angle of patient when describing height |
|
Assessment of the precordium
|
-inspect the anterior chest for lifts of heaves
-palpate across the precordium -palpate apical pulse -APT M (aortic, pulmonic, tricuspid, mitral valve) -percuss around the 5ICS mid clavicular line - |
|
Lifts and Heaves
|
-heart enlarged (ventricle dilation from too much fluid or ventriclar hypertropy)
-lift during systole |
|
Thrills
|
-murmur
-turbulent blood flow -vibration -feels like a cat purring |
|
Hypertrophy
|
-heart bigger
-apex lower and further over -moves maximal impulse |
|
Auscultation routine
|
-hear aorta on right side (hear better)
-hear pulmonic on left opposite bc heart is twisted in the body -tricuspid-5 ICS along sternal border -mitral valve best heard 5ICS MCL (same as PMI) Herbs-3 ICS where LUB DUB sound same -listen on left lateral decubitus position |
|
Identifying S1 and S2
|
-apex: S1>S2 (LUB)
-base-S2<S1 (DUP) -S1=R wave on ECG -S1-carotid artery pulse |
|
Physiological Split S2
|
-during inspiration
-aortic valve closes before pulmonic --->since there is LESS blood on the LEFT it contracts faster |
|
S3 Auscultation
|
-ventricular gallop
boom boomboom Lub dup dup low pitch hear with bell -decreased compliance of ventricle w/ CHF on right side->pathological S3 -lie on side to listen -pregnant, anemic, hypothyroid -can be physiological or pathological |
|
S4 Auscultation
|
-atrial gallop
boomboom boom low pitched -hear through bell -sound right before S1 -almost always pathological |
|
Systolic Clicks/Systolic Extra Sounds
|
-early systolic ejection click
-midsystolic click -aortic stenosis-calcification of valves-->doesn't open to nicely --turbulent --make a noise -midsystolic click-btw S1 and S2 -valves go backwards-->make a clicking sound |
|
Diastolic Extra Sounds
|
-normally opening of AV valves is silent
-stenosis of valves-->open with noise -sharp and high pitched -open and snap -hear in diaphragm or 3/4 ICS at sternal border |
|
Murmurs
|
-like a bruit
-bolowing, swishing sound of turbulent blood flow through stenosed or loosely closing valve -pay attention to timing, location, loudness/intensity (scale 1-6) |
|
Types of Murmurs
|
*midsystolic ejection murmurs
-aortic and pulmonic stenosis *pansystolic regurgitant murmurs -mitral and tricuspid regurgitation *diastolic rumbles of AV Valves -mitral and tricuspid stenosis *Early diastolic murmurs -aortic and pulmonic regurg |
|
Midsystolic Ejection Murmurs
|
if aorta or pulmonic valves are stenosed (tight)
-open-murmur |
|
Pansystolic Rugurgitant Murmurs
|
-in systole
-tricuspid and mitral close improperly -regurgitation -blood back -more common w mitral valve |
|
Diastolic Rumbles of AV Valves
|
-valvular defect
-much more serious -if mitral and tricusp stenosed-->close-->murmur |
|
Early Diastolic Murmurs
|
-valvular defect
-much more serious -aortic and pulmonic do not close properly-->valves go back -blood back -can cause syncope |
|
Rub
|
painful rubbing sound during systole and diastole
|
|
Scaling of heart sound intensity
|
1-barely hear
2-louder-normal 3-louder 4-should hear a thrill 5-very loud when part of stethoscope on it--out of chest 6-pretty much hear without stethoscope |