Cardiovascular Flashcards
(43 cards)
1
Q
Pack Year Hx Formula
A
- # of cig packs (20 cigs in pack) x # of smoking yrs = pack yr
2
Q
Chest pain (CP) or chest discomfort ⇒ often signals…
A
CAD
3
Q
Anterior chest pain, often tearing or ripping, radiating to back or neck ⇒ indicates…
A
acute aortic dissection
4
Q
Acute coronary syndrome
A
- any of clinical syndromes caused by acute MI, including…
- unstable angina
- non-ST elevation MI (minor coronary artery is blocked ⇒ blocks blood supply to heart)
- ST elevation infarction (major coronary artery is blocked ⇒ blocks blood supply to heart)
5
Q
Causes of palpitations
A
- irregular heartbeat
- rapid acceleration or slowing of heart
- increased forcefulness of cardiac contraction
6
Q
CP causes
A
- MI
- aortic dissection (when aorta start to split open)
- pero/myo/endo-carditis (infection of diff heart layers)
7
Q
Orthopnea
A
- dyspnea that occurs when pt is lying down
- Improves when pt sits up
- Make sure that reason pt uses extra pillows or sleeps upright is SOB and no other causes
8
Q
Paroxysmal nocturnal dyspnea (PND)
A
- episodes of sudden dyspnea and orthopnea that wakes pt from sleep, usually 1-2 hours after going to bed, prompting them to sit up, stand up, or go to window for air
- May have associated wheezing and coughing
- Episode usually subsides but may recur at abt same time on subsequent nights
9
Q
Dependent edema (what + causes)
A
- appears in lowest body parts– feet and lower legs when sitting or sacrum when bedridden
- Causes:
- cardiac (HF)
- peripheral vascular disease
- nutritional (hypoalbuminemia)
- positional
10
Q
Peripheral edema indicates…
A
HF
11
Q
Apical Impulse/Point of maximal impulse (PMI)
A
- point on chest wall where heart’s impulse can be most strongly felt, which is typically located near the apex of the left ventricle
- Abnormal: if you can’t find pulse in that spot ⇒ displaced ⇒ might be cardiomyopathy (enlarged heart) or HF
- Apical impulse easily palpated in children and slender adults
- As anteroposterior chest diameter increases ⇒ harder to palpate apical pulse
- Obesity/thick chest wall makes apical pulse palpation difficult
- Most prominent precordial impulse may not be at apex of left ventricle
- In pts w/ COPD, most prominent palpable impulse (PMI) may be in xiphoid or epigastric area as result of right ventricular hypertrophy
12
Q
S1
A
- closure of mitral valve produces this sound
- In some pathological conditions, early systolic ejection sound (Ej) accompanies opening of aortic valve
- Decreased sound in ⇒ first-degree heart block
- “Lub” sound in “lub-dub” heart sound
13
Q
S2
A
- closure of aortic valve produces this sound
- May hear opening (OS) sound after S2 if valve leaflet motion restricted ⇒ like in mitral stenosis
- Decreased sound in ⇒ aortic stenosis
- “Dub” sound in “lub-dub” heart sound
14
Q
S3
A
- rapid deceleration of column of blood filling and pounding against ventricles’ walls
- associated w/ HF
- Often heard in children and young adults as a “third heart sound” + in elite athletes
- In older adults, called “S3 gallop” ⇒ indicates pathologic change in ventricular compliance like too much fluid as in HF
15
Q
S4
A
- atrial contraction to force blood to left ventricle makes this sound
- Happens before S1
- Associated w/ CAD
- Indicates atherosclerotic disease (hardening of arteries) ⇒ snapping sound bc atrium is losing elasticity
- Means there’s pathologic change in ventricular compliance
- Compliance: ease w/ which heart muscle relaxes as it fills w/ blood
- Poor compliance ⇒ produces stiff ventricle w/ reduced ability to expand as it receives blood
- normal in adults
16
Q
Murmurs
A
- swishing-like, longer duration sounds due to turbulent blood flow
- Associated w/ S1 or S2
- Indicates valve problems
- best heard in 2nd right intercostal space, often originating at/near aortic valve
- Cause: Stenotic valves can cause this bc abnormally narrowed valvular orifice that obstructs blood flow like in aortic stenosis ⇒ causes murmur
- loud murmur aortic stenosis often radiates to neck in direction of arterial flow, esp on right side
- Stenosis: narrowing
- If aortic valve is narrowed ⇒ produces turbulent blood flow
- Regurgitant murmur: when valve fails to fully close like in aortic regurgitation or insufficiency ⇒ lets blood leak backward in retrograde direction ⇒ regurgitant murmur
17
Q
Split Sounds
A
- Split S1: split closing of mitral and tricuspid valves
- earlier mitral sound: louder, means high pressures on left side of heart, heard loudest at cardiac apex
- later tricuspid sound: softer, heard best at lower sternal border
- Split S2: split closing of aortic and pulmonic valves during inspiration
- During inspiration, filling time of right heart increases ⇒ increases stroke volume and lengthens duration of right ventricle compared to left ventricle ⇒ delays closure of pulmonic valve P2 ⇒ splits S2 into two audible components
- Stroke volume: amt of blood ejected by ventricle w/ each heartbeat
- Hard to hear in obese pts or ppl w/ increased anteroposterior diameter chest walls
- During inspiration, filling time of right heart increases ⇒ increases stroke volume and lengthens duration of right ventricle compared to left ventricle ⇒ delays closure of pulmonic valve P2 ⇒ splits S2 into two audible components
18
Q
Auscultation Points (aortic, pulm, erb’s, tricuspid, mitral)
A
- Aortic valve: 2nd intercostal space to right of sternal border
- Pulmonic/Pulmonary valve: 2nd intercostal space to left of sternal border
- Erb’s point: 3rd intercostal space to left of sternal border
- Tricuspid valve: 4th intercostal space to left of sternal border
- Mitral valve: 5th intercostal space midclavicular line
19
Q
Inspection/ Palpation of JVP
A
- What: JVP palpation gives info abt pt’s volume and cardiac status by showing pressure of right atrium
- If pt has JVD/↑ JVP elevate bed to → 45, 60, 90*
- If pt has ↓ JVP → have pt lie flat to see neck veins
- Abnormal: ↑ JVP of 98% specific for ↑ left ventricular end-diastolic pressure and ↓ left ventricular ejection fraction
20
Q
Jugular Venous Distention (JVD)
A
- what: increased jugular venous pressure due to increased blood volume
- Jugular Venous Pressure (JVP): right atrial pressure
- causes
- HF
- ↑ central venous pressure
- tricuspid stenosis
- superior vena cava obstruction
- constrictive pericarditis
- anything that interferes w/ filling of right atrium or movement of blood to right ventricle
21
Q
Left Sided HF
A
- Comes in diastolic or systolic forms
- Systolic HF: left ventricle can’t contract normally ⇒ ↓ ejection fraction of < 40% (norm is 50%) = ↓ amt of blood that comes from left ventricle w/ each pump
- Cause: CAD w/ MI Hx
- Lower ejection fraction you get ⇒ more fatigued you get + higher incidence of depression
- Diastolic HF: left ventricle can’t relax properly ⇒ preserved ejection fraction
- Cause: aging heart muscles
- S&S:
- SOB/DOE (dyspnea on exertion)
- Crackles/Rales at bases: crackles start at base and works way up bc of gravity and fluid in lungs
- Tachypnea: ↑ RR
- Diaphoresis: excessive sweating due to fluid retention
- Weight gain
- Fatigue
- Extra heart sounds
- Mental status changes: depends on severity
- Capillary refill > 3 secs
22
Q
Right Sided HF
A
- what: seeing more congestion of fluid backing up in periphery
- S&S:
- Hepatomegaly
- Splenomegaly
- Ascites
- Dependent pitting edema
- Edema in lower extremities, likely pitting
- ↑ JVD (Kussmaul’s sign)
- Weight gain: bc of fluid retention
- Anorexia: can progress to cardiac cachexia bc pt just don’t have appetite to eat
- Extra heart sounds: S3 associated w/ HF
23
Q
Coronary Artery Disease (CAD)
A
- what: buildup of plaque within coronary arteries ⇒ can lead to MI
- S&S: Angina pectoris: CP related to CAD but person doesn’t actually have MI
24
Q
Pericarditis
A
- inflammation of pericardium (sac-like tissue that surrounds and protects heart)
- Usually rare and will resolve on its own
- S&S:
- CP that can radiate to left shoulder
- May be relieved w/ leaning forward
- SOB when reclining
- Palpitations
- Low-grade fever
- Cough
- Weakness/Fatigue
- Lower extremity edema ⇒ can lead to cardiac tamponade (abnormal accumulation of fluid between layers of pericardium ⇒ places pressure on heart and possibly impairing cardiac pumping function in severe cases)
- CP that can radiate to left shoulder
- Causes/Risk Factors:
- MI
- Inflammatory disorders
- Trauma to chest wall
- Viral
25
Myocarditis
- what: inflammation of heart muscle/myocardium ⇒ affects heart's electrical system and muscle cells
- S&S:
- If mild ⇒ may be asymptomatic
- CP
- SOB
- Arrhythmia
- Lower extremity edema
- Fatigue/Malaise (if severe ⇒ can lead to HF, MI, sickle cell)
- Causes/Risk Factors:
- Infection (viral, bacterial, fungi)
- Drug rxn
- Inflammatory disorders
26
Endocarditis
- what: life-threatening inflammation of cardiac lining/endocardium (lining of heart's chambers and valves) ⇒ can damage heart valves
- S&S:
- New onset murmur
- Pallor
- Diaphoresis
- SOB
- CP while breathing
- Malaise
- Unintentional weight loss
- Nausea
- Splenomegaly
- Causes/Risk Factors: Sepsis
27
Valvular Defects
- what: can occur in any 4 valves of heart
- Abnormal heart ⇒ regurgitation occurs or airway stenosis (leads to murmur)
- Pt can live like this for a while and ⇒ may progress to cardiomyopathy or HF
- S&S:
- CP
- SOB
- Murmur
- Not feeling well / ill-appearing
28
Arrhythmias
W/ arrhythmias of atrium like in A-fib ⇒ blood starts to pool ⇒ heart doesn’t pump efficiently ⇒ clotting ⇒ clots get stuck in smaller vessels bc clots can travel and get stuck in heart (causes MI), lungs (causes pulmonary embolism), brain (causes stroke)
29
Midsystolic murmur
- Begins after S1 and stops before S2
- Cause: blood flow across semilunar (aortic and pulmonic) valves
30
Pansystolic (Holosystolic) murmur
- Starts w/ S1 and stops at S2 w/o gap between murmur and heart sounds
- Cause: regurgitant (backward) flow across atrioventricular valves
31
Late Systolic murmur
- Starts mid or late systole and persists up to S2
- Cause: mitral valve prolapse and often, but not always, followed by systolic click
32
Early Diastolic murmur
- Starts immediately after S2 w/o discernible gap and usually fades to silence before nxt S1
- Often w/ regurgitant flow across incompetent semilunar valves
33
Mid- Diastolic murmur
- Starts short time after S2 and fades before next S1
- Means: turbulent flow across atrioventricular valves
34
Late Diastolic (Presystolic) murmur
- Starts late in diastole and usually continues up to S1
- Means: turbulent flow across atrioventricular valves
35
How to Document CP
- If pt has MI + CP ⇒ pt won’t be able to pinpoint where pain is ⇒ pain more diffuse throughout chest
- Pt would describe pain as “feeling like there’s an elephant sitting on chest”
- If pt has crushing chest pain w/ pain radiation to left arm ⇒ MI (🚩)
- If pt has CP that gets worse when moving around/changing positions ⇒ likely musculoskeletal issue
- If musculoskeletal issue ⇒ pt can pinpoint pain
- If pt has CP that increases w/ activity and trying to get more oxygen but pain keeps increases ⇒ more serious issue
- NV, diaphoresis (excessive sweating not caused by exercise or hot temps), palpitations, SOB, CP ⇒ identify first if it’s an MI
36
How to Document Murmurs
- Timing & Duration: at what part of cycle is murmur heard? Is it associated w/ S1 or S2 or is it continuous?
- Pitch: high/low-pitched? (low best heard w/ bell)
- Quality: type of sound: harsh, raspy, vibratory, musical, blowing?
- Intensity Grades 1-6:
- 1: barely audible, faint, heard only after being "tuned in," maybe not heard in all positions
- 2: quiet but clearly audible, heard immediately after placing stethoscope on chest
- 3: moderately loud
- 4: loud w/ palpable thrill
- 5: very loud w/ easily palpable thrill, may be heard w/o stethoscope
- 6: very loud w/ palpable and visible thrill, don't need stethoscope to hear it
- Location: where is murmur heard loudest?
- Murmurs originating in right side of heart ⇒ tend to vary w/ respiration more than left-sided murmurs
- include respiration and pt position
37
BP Categories
- normal: < 120 / < 80
- elevated: 120 - 129 / < 80
- HTN stage 1: 130 - 139 / 80 - 90
- HTN stage 2: 140 + / 90 +
- HTN Crisis: 180 + / 120 +
38
red flags
- If pt has crushing chest pain w/ pain radiation to left arm ⇒ MI
- CP w/ activity
- BP of 180 + / 120 + (HTN Crisis)
39
age-related considerations INFANTS
- At birth they have…
- Closure of ductus arteriosus
- Closure of foramen ovale
- Murmurs common 48hrs after birth bc of closures of ductus arteriosus and ovale
- Benign S3 common
- Sinus arrhythmias common w/ inspiration and expiration
- Rhythm itself varies: may speed up w/ inspiration and slow down w/ expiration
40
age-related considerations CHILDREN & OLDER ADULTS
apical impulse (PMI) should be easily palpated
41
age-related considerations PREGNANCT WOMEN
- Normal
- Blood vol increases 40-50% from pre-pregnancy lvls ⇒ ↑ increased cardiac output, HR, edema
- ↑ CO2 and HR
- Split S1 sound heard
- S3 sound heard
- Systolic ejection murmur (SEM) heard over pulmonic region (2nd intercostal space to left of sternal border)
- Monitor for Abnormalities
- Pre-eclampsia: ↑ BP and proteinuria ⇒ seizures ⇒ death of fetus and mother
- Eclampsia: seizures ⇒ death of fetus and mother
- Peripartum cardiomyopathy: heart enlarges near delivery time
42
age-related considerations GERIATRICS
- ↓ Myocardium size
- Left ventricle wall thickens
- ↓ stroke volume (SV), CO2, myocardial elasticity
- More difficult to find apical impulse due to ↑ AP diameter
- S4 more common
- Caused by atherosclerosis, MI, or aging ⇒ need to investigate pt-specific cause
- Exercise may reverse or slow some age related changes
43
Prevention of CVD
- Aspirin usage monitor
- 40 - 59 yo ⇒ higher risk for CVD so use cautiously
- 60+ yo ⇒ not recommended bc of bleeding risks
- Diet: Cholesterol & Lipid management
- DM management so that fasting glucose lvl is < 110 mg/dL and HgA1c is < 7%
- Conversion of Afib to normal sinus rhythm or, if chronic, put on anticoagulants
- DM (II) and metabolic syndrome increases person’s risk for CVD ⇒ monitor those
