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Health Assessment Module 3 Chapter 19
Terms in this set (43)
Area on anterior chest overlying heart and great vessels
Tough, fibrous, double-walled sac that surrounds and protects heart
Muscular wall of heart; it does pumping
Thin layer of endothelial tissue that lines inner surface of heart chambers and valves
Bicuspid (mitral)- Left
Open during heart's filling phase (diastole) to allow ventricles to fill with blood
Close during filling phase (systole) to prevent regurgitation of blood back into atria
SL (semilunar) Valves
Between ventricles and arteries
Aortic- Left (open during systole to allow blood to be ejected from heart)
No valves are present between vena cava and right atrium or pulmonary veins and left atrium
Abnormally high pressure in left side of heart gives pulmonary congestion
Abnormally high pressure in right side of heart shows in neck veins and abdomen (as in JVD)
Extra heart sounds
S3 and S4
Occurs with closure of AV valves and thus signals beginning of systole
Mitral component (M1) slightly precedes tricuspid component (T1)
Usually hear 2 sounds as one
Can hear this sound over all precordium but loudest at apex
Occurs with closure of semilunar valves and signals end of systole
Aortic component of second sound (A2) slightly precedes pulmonic component (P2)
Heard over all precordium but loudest at base
Effect of Respiration
- Volume of right and left ventricular systole is just about equal but can be affected by respiration
- When aortic valve closes significantly earlier than pulmonic valve you can hear 2 components separately- this is a split S2
- Increased respirations cause increase pulse
- In some cases ventricular filling creates vibrations that can be heard over chest
- Occurs when ventricles resistant to filling during early rapid filling phase (protodiastole)
- Occurs immediately after S2, when AV valves open and atrial blood first pours into ventricles
Pathologic S3 (ventricular gallop)
Persists when sitting up and indicates decreased compliance of the ventricles as in heart failure
Left side- heard at apex in the left lateral position
Right side- heard at left lower sternal border with the person supine and is louder in inspiration
Also Occurs: Mitral regurgitation, aortic/tricuspid regurgitation, high cardiac output states in the absence of heart disease such as; hyperthyroidism, anemia, and pregnancy
When primary condition is corrected gallop disappears
Heard frequently in children and young adults; may persist after 40 years, especially in women; usually disappears when the person sits up.
Occurs at end of diastole, at pre systole, when ventricle resistant to filling; atria contract and push blood into noncompliant ventricle which creates vibrations; occurs just before S1
May occur in adults older than 40 to 50 years with no evidence of cardiovascular disease, especially after exercise
Pathologic S4 (atrial gallop)
Left sided: Occurs with decreased compliance of the ventricle (CAD, cardiomyopathy) and systolic overload (after load), including outflow obstruction to the ventricles (aortic stenosis) and systemic HTN. Heard best at the apex in left lateral position.
Right sided: Heard at left lower sternal border and may increase with inspiration. Occurs with pulmonary stenosis or pulmonary HTN
Extra heart sound - blowing, swishing sound. Indicates turbulent blood flow
Occurs: Velocity of blood flow increases- exercise
Viscosity of blood decreases- anemia
Structural defects in valves- narrowed or incompetent valve
Unusual openings in chambers- dilated chamber or wall defect
Venous return that builds during diastole
Opposing pressure ventricle must generate to open aortic valve against higher aortic pressure
JVD (jugular venous distension)
Sign of right sided heart failure- if present past 45 degree angle
If heart failure is present the veins will elevate more than 4 cm and stay elevated as long as you push while doing the abdominojugular test
Normal- 2cm or less above sternal angle
Elevated= level of pulsation that is >3cm above sternal angle
Occurs: heart failure, cardiac tamponade, and constrictive pericarditis
Opening in the atrial septum where 2/3 of blood is shunted into the left side of the heart, where it is pumped out through aorta.
Closes within the first hour after birth
1/3 of oxygenated blood is pumped by right side of heart out through pulmonary artery but it is detoured through this to the aorta.
Closes usually within 10 to 15 hours of birth
Normal HR on infant
100-180 BPM immediately after birth
- Thickening of arteries increases systolic BP and pulse pressure
- Increase in CAD, HTN, and heart failure
CVD (cardiovascular disease)
Occurs at higher rates with increased age
For women, comparable rates occur 10 years later in life than for men, but this gap narrows with advancing age
Causes: Interaction of genetic, environmental, and lifestyle factors
-Highest percent of men than women have HTN until 45 years, after that similar percentages; after 63 women are much higher than men
-HTN 2 to 3 times more common among women taking oral BC, especially obese and older women
- HTN in Blacks is among highest in world and is rising- develop earlier than life, and their average BP is much higher
- Blacks have greater rate of stroke, death due to heart disease and end-stage kidney disease
DM (Diabetes Mellitus)
Risk of CVD is higher among
Can cause damage to large blood vessels that nourish brain, heart and extremities; this results in stroke, CAD, peripheral vascular disease (PVD)
Occurs with MI and low cardiac output states as a result of decreased tissue perfusion
Carotid Sinus hypersensitivity
Pressure over the carotid sinus leads to decreased HR, BP, and cerebral ischemia with syncope- may occur in older adults with HTN or occlusion of the carotid artery
Turbulent blood flow
Bruit- auscultated at carotid artery (blowing, swishing sound)
Thrill- vibration that is palpated
Opening of SL valves that makes a sound due to presence of stenosis (aortic or pulmonic)- short, high-pitched, with a click quality and is heard better with the diaphragm
Aortic- 2nd right interspace and apex
Pulmonic- 2nd left interspace and grows softer with inspiration
Mid systolic Click
Associated with mitral valve prolapse; occurs mid-to-late systole and is short and high pitched with a click quality; best heard with diaphragm at apex
Mitral prosthetic valve sound
Opening click just after S2- loud, heard over the whole precordium, and loudest at the apex and left lower sternal border
Calcification of pulmonic valve restricts forward flow of blood
Thrill in systole at 2nd and 3rd left interspace; ejection click often present after S1, diminished S2 and usually with wide split, S4 common with RV hypertrophy
Murmur- systolic, medium pitch, coarse, crescendo-decrescendo, best heard at 2nd left interspace, radiates to the left and neck
Stream of blood regurgitates back in to LA during systole through incompetent mitral valve. In diastole, blood passes back into LV again along with new flow; results in LV dilation and hypertrophy
Subjective: fatigue, palpitation, orthopnea, PND
Objective: Thrill in systole at apex. Lift at apex. Apical impulse displaced down and to left. S1 diminished, S2 accentuated, S3 at apex often present.
Murmur: Pansystolic, often loud, blowing; best heard at apex; radiates well to left axilla
Back flow of blood through incompetent tricuspid valve into RA
Objective: Engorged pulsating neck veins, liver enlarged. Lift at sternum if RV hypertrophy present; often thrill at left lower sternal border
Murmur: Soft, blowing, pan systolic; best heard at left lower sternal border; increases with inspiration
Patent Ductus Arteriosus (PDA)
Persistence of channel joining left pulmonary artery and aorta.
S: Usually none in early childhood
O: BP has wide pulse pressure and bounding peripheral pulses. Thrill often palpable at left upper sternal border. Continuous murmur hear in systole and diastole called machinery murmur
Arterial Septal Defect (ASD)
Abnormal opening in the atrial septum, resulting usually in left-to-right shunt and causing large increase in pulmonary blood flow.
S: Symptoms in infants are rare; Children and young adults have mild fatigue and DOE.
O: Sternal lift is often present. S2 has fixed split, with P2 often louder than A2. Murmur is systolic, ejection, medium pitch, best heard at base in 2nd left interspace. Murmur is caused not by shunt itself but by increased blood flow through pulmonic valve.
Ventricular Septal Defect (VSD)
Abnormal opening in septum between the ventricles, usually sub aortic area.
S: Small defects are asymptomatic. Infants with large defects have poor growth, slow weight gain; later they look pale, thin delicate. May have feeding problems; DOE; frequent respiratory infections; and, when condition is severe, heart failure
O: Loud, harsh holosystolic murmur, best heard at left lower sternal border, may be accompanied by thrill. Large defects also have soft diastolic murmur at apex (mitral flow murmur) caused by increased blood flow through mitral valve.
Tetralogy of Fallot
Four components: (1) right ventricular outflow stenosis, (2) VSD, (3) right ventricular hypertrophy, (4) overriding aorta. Result: shunts a lot of venous blood directly into aorta away from pulmonary system; thus blood never gets oxygenated.
S: Severe cyanosis, not in first months of life but develops as infant grows and right ventricular outflow (i.e., pulmonic) stenosis gets worse. Cyanosis with crying and exertion at first, then at rest. Uses squatting posture after starts walking. DOE is common. Development is slowed.
O: Thrill palpable at left lower sternal border. • S1 normal; S2 has A2 loud and P2 diminished or absent. Murmur is systolic, loud, crescendo-decrescendo.
Coarctation of the Aorta
Severe narrowing of descending aorta usually at the junction of the ductus arteriosus and the aortic arch, just distal to the origin of the left subclavian artery. Results in increased workload on left ventricle. Associated with defects of aortic valve in most cases, associated patent ductus arteriosus and associated VSD.
S: In infants with associated lesions or symptoms diagnosis occurs in the early months as heart failure develops. For asymptomatic children, growth and development are normal. Diagnosis follows abnormal BP findings. Adolescents may complain of vague lower-extremity cramping, worse with exercise.
O: Arm hypertension over 20 mm Hg high than leg measures. Absent or greatly diminished femoral pulses. A systolic murmur is heard best at the left sternal border, radiating to the back.
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