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Ch. 19 Health Assessment - Heart and Neck Vessels
Terms in this set (65)
area on the anterior chest directly overlying the heart and great vessels
passive early filling of the ventricles in the diastole phase; rapid
presystole (atrial systole)
also known as atrial kick when 25% of stroke volume is pushed into ventricle due to contraction of the atria. Active filling phase of diastole.
sound of atrioventricular valves closing. M1 (mitral component) closes just before T1 (tricuspid component). Sound loudest at apex of heart. Coincides with carotid artery pulse and is lower pitched.
sound of semilunar valves closing. A2 (aortic closure) occurs slightly before P2 (pulmonic closure). This sound is loudest at base of heart.
blood volume in heart
this is the same on the right and left sides of heart, but sometimes due to respiration, there is more in the right and less in the left. Greater amount of blood is sequestered in lungs during inspiration and momentarily decrease amount returned to left side, decreasing stroke volume.
caused when aortic valve closes significantly earlier than pulmonic valve due to shorter left ventricular systole because of effects of respiration. Occurs every 4th heartbeat.
vibrations heard during diastole; occurs when ventricles are resistant to filling during early rapid filling phase (protodiastole). Sounds like a gallop. Occurs with heart failure and volume overload. Sometimes only heard on left side.
occurs at the end of diastole at presystole when ventricle is resistant to filling; sound from atria pushing blood into noncompliant ventricle. Occurs with CAD. May occur non-pathologically in aging adults.
gentle, blowing, swooshing sound that can be heard in chest wall due to turbulent flow or collision currents. Occurs when velocity of blood increases (exercise, thyrotoxicosis), viscosity of blood decreases (anemia), structural defects in valves (stenosis or regurgitant valve), or unusual openings in chambers (dilated chamber, septal defect).
include S1, S2, and abnormally S3 and S4. Usually low frequency and listened with bell of stethoscope.
venous return that builds during diastole, length to which ventricular muscle is stretched. If this gets greater, then the stronger the contraction of the heart and increased stroke volume
opposing pressure the ventricle must generate to open the aortic valve against the higher aortic pressure. Resistance against which the ventricle must pump its blood
expose right side of the heart's information because pulse results from a backwash of blood. Seen in order of A, C, X, V, Y, and back to A.
when blood spurts back up the jugular vein when the atria contracts in diastole. RA contracts, tricuspid open.
ventricular contraction causes tricuspid valve to bulge backward (from closing) causing a small increase in backflow.
blood rapidly fills the atria again while it is relaxed and blood is being ejected from the heart. RA relaxes, tricuspid closed.
occurs with passive atrial filling because of increasing volume in right atria and increased pressure. RA filling, tricuspid closed.
reflects passive ventricular filling from atrium emptying. RA empties, tricuspid open.
Increased blood volume 30-40%. Increased pulse rate of 10-15 beats/min - returns to normal 10 days postpartum. Increased cardiac output. Decreased BP as a result of peripheral vasodilation. Exaggerated splitting of S1 and increased loudness of S2 are common, as is S3 sometimes. An ejection systolic murmur is also common. Mammary souffle.
continuous murmur from breast vasculature, accented in systole. Caused by increased blood flow through internal mammary artery (lactation). Can be obliterated.
infants and children
Placenta oxygenates blood and returns it to the right side of the heart. 2/3 of blood in fetus is pumped through foramen ovale (hole in atrial septum), and pumped out to LA and then LV and then aorta to rest of body; 1/3 of blood goes to pulmonary artery, detoured through ductus arteriosus to the aorta. At birth, lungs need to be used so blood enters lungs instead of going through placenta. Foramen ovale closes within first hour, ductus arteriosus closes within 10-15 hours after birth. LV starts to hypertrophy. Apex in 4th intercostal space until age 7. Fatigue while nursing indicates heart failure.
hemodynamic changes with aging
aging increases systolic BP, caused by thickening and stiffening of large arteries, caused by collagen and calcium deposits in vessel walls and loss of elastic fibers. Diastolic BP may decrease after 60, increases pulse pressure. No change in resting HR or CO at rest, but decreased ability of heart to augment CO with exercise.
hemodynamic changes, dysrhythmias, ECG has prolonged PR interval and QT interval (QRS unchanged). Increased incidence of bundle branch block. Chance of CVD increases with age - hypertension, heart failure. S4 sometimes occurs non-pathologically, and systolic murmurs too. Also occasional premature ectopic beats. S3 is always associated with heart failure and abnormal over 35 years.
abnormal heart rhythm. Common in aging people, usually asymptomatic but can compromise CO and BP with disease.
Fast, abnormal heart rate. not tolerated well in older people, shortened diastole may compromise stuff.
potential risk factors for myocardial infarctions
abnormal lipids, smoking, hypertension, diabetes, abdominal obesity, psychosocial factors, inadequate consumption of fruits and vegetables, alcohol use, lack of regular physical activity. Unusual fatigue is top prodromal symptom for women.
culture and genetics
high blood pressure more common in women, taking oral contraceptives, and African Americans. Smoking rates have decreased but due increase risk of MI and stroke due to increased oxygen demand. High levels of LDL may cause problems. Obesity, diabetes mellitis can cause damage and CAD, PVD. Women have more CVD then men and different perception in pain with heart attacks.
chest pain, dyspnea, orthopnea, cough, fatigue, cyanosis or pallor, edema, nocturia, past cardiac history, family cardiac history, patient-centered care.
chest pain. Occurs when heart's own blood supply can keep up with metabolic demand. May have pulmonary, musculoskeletal, or Gi origin. Squeezing clenched fist may be characteristic of this.
difficult or labored breathing
paroxysmal nocturnal dyspnea (PND)
difficult breathing that wakes you up from sleep at night. Occurs with heart failure, increased volume of intrathoracic blood that cannot be accommodated by heart.
coughing up of blood. Often a pulmonary disorder but also occurs with mitral stenosis.
condition in which you wake up during the night because you have to urinate. Laying down promotes fluid resorption and excretion; this occurs with heart failure in person who is ambulatory all day.
risk factors for coronary artery disease
include elevated cholesterol, elevated BP, blood sugar levels above 100 mg/dL or known DM, obesity, smoking, low activity level, hormone replacement therapy.
OTC blood thinner, but actually is beneficial in preventing MIs. But may lead to potential risk of HI bleeding.
Vitamin D replacement
Vitamin D supplementation. A deficiency in this amy increase risk of CVD and is associated with hypertension, diabetes, metabolic syndrome, left ventricular hypertrophy, and chronic vascular inflammation.
order of objective data
pulse and BP first, extremities, neck vessels, and then precordium. Begin observations peripherally and move toward heart.
indicates turbulence from local vascular cause and is marker for atherosclerotic disease. Increase risk of transient ischemic attack and ischemic stroke. Sometimes occurs with no significance in older adults. Audible when lumen is occluded 1/2 to 2/3.
venous jugular pulse
pulse felt from jugular veins. The higher the venous pressure is, the higher position you need. If low venous pressure, only visible when completely supine, or flat. If these are distended, it usually signifies increased CVP as with heart failure.
Abdominojugular test (hepatojugular reflux
compress splanchnic blood flow so everything is rerouted to the venous system, if heart is okay and able to pump additional volume, jugular veins will rise for a few seconds and then recede back to previous level. If heart failure is present, jugular veins will elevate more than 4 cm and stay elevated.
pulsation created as left ventricle rotates against chest wall during systole. If you feel it over greater surface areas then usually left ventricular dilation which occurs with heart failure and cardiomyopathy. Not palpable in pulmonary emphysema because of overriding lungs.
increased force and duration but no change in location occurs with left ventricular hypertrophy and no dilation (pressure overload)
sustained forceful thrusting of the ventricle during systole. Occurs with ventricular hypertrophy as result of increased workload. Not normal in child, even with thin ribcage.
palpable vibration, feels like the throat of a purring cat. Signifies turbulent blood flow and directs you to locate origin of loud murmurs
rhythm varies with person's breathing, increasing at peak of inspiration and slowing with expiration
isolated beat is early, or pattern occurs in which every third or fourth beat sounds early
irregulary irregular beat
no pattern to sounds, beats come rapidly as in atrial fibrillation
signals a weak contraction of ventricles, occurs with atrial fibrillation, premature beats, and heart failure. When radial artery is palpated and you see how many beats actually get there.
split S2 that is unaffected by respiration; split is always there.
split S2 in which sounds fuse on inspiration and split on expiration. This is opposite of usual.
associated with mitral valve prolapse, heard during systole
Grade 1 - barely audible; heard only in quite room and then with difficulty. Grade 2 - clearly audible but faint. Grade 3 - Moderately loud, easy to hear. Grade 4 - loud, associated with thrill palpable on chest wall. Grade 5 - very loud; heard with one corner of stethoscope lifted off chest wall; associated thrill. Grade 6 - loudest, still heard with entire stethoscope lifted off chest wall; associated thrill.
murmurs that may occur with healthy heart or with heart disease.
murmurs that always indicate heart disease
mitral stenosis murmur
murmur that is low pitched and rumbling. Sometimes only heard when on left side.
aortic stenosis murmur
murmur that sounds harsh.
aortic regurgitation murmur
murmur that is soft high-pitched diastolic murmur only heard when person is leading forward in sitting position
murmur with no no valvular or other pathologic cause. Usually Grade 2, midsystolic, short, creschendo-descreschendo, and with vibratory or musical quality.
murmur caused increased blow flow to the heart
infants and children objective data
cyanosis at or just after birth signals oxygen desaturation of congenital heart disease. Most important signs of heart failure in infant are persistent tachycardia, tachypnea, and liver enlargement; also engorged veins, a gallop rhythm. Persistent tachycardia if more than 200 beats in newborn and more than 150 beats in infant. Bradycardia is less than 90 beats in newborn and less than 60 beats in infant/children. Sinus arrythymia is common and ok, as is a split S2 (but not fixed). Murmurs also are common. Common for children to have S3.
hernia on the diaphragm. Causes the heart apex to be shifted to the right because usually occurs more often on the left.
a rare anomaly in which heart is located on right side of chest.
turbulence of blood flow in jugular vein system. Common in children and not pathological.
congestive heart failure clinical picture
dilated pupils, skin pale, gray or cyanotic, anxiety, falling O2 saturation, dyspnea, orthopnea, crackles, wheeze, cough, decreased blood pressure, nausea and vomiting, ascites, dependent pitting edema, confusion, jugular vein distention, infarct, fatigue, S4 gallop and tachycardia, enlarged spleen and liver, decreased urine output, weak pulse, cool moist skin. Overall decreased cardiac output and kidney's compensatory mechanisms to increase blood volume which makes congestion worse.
What are the secondary agents for HTN?
What is the most common postoperative tachydysrhythmia?
What does ST segment elevation suggest?
What is an aortic valve regurgitation (insufficiency)?
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