Cardiovascular: Heart and Neck Vessels

Question 1

What is the Precordium?

Answer 1

area on the anterior chest that overlies the heart and great vessels

Question 2

What is the apical impulse?

Answer 2

where apex beats against chest wall

Question 3

What is systole?

Answer 3

the first heart sound (lub)

results in closure of tricuspid and mitral valves

Question 4

What is diastole?

Answer 4

second heart sound (dub)

results in closure of the aortic and pulmonic valves

Question 5

When does the heart of an infant begin to beat?

Answer 5

end of the 3 week’s gestation

Question 6

What are some clues to cardiopathology?

Answer 6

height, weight, and feeding patterns

Question 7

What cardiovascular alterations are seen in the pregnant female?

Answer 7

30-40% increase in blood volume

increase of cardiac output and pulse rate

Question 8

What is orthostatic hypotension?

Answer 8

Orthostatic hypotension is defined as a decrease in systolic blood pressure of 20 mm Hg or a decrease in diastolic blood pressure of 10 mm Hg within three minutes of standing when compared with blood pressure from the sitting or supine position.

Question 9

What are ectopic beats?

Answer 9

• Ectopic heartbeats are small changes in a heartbeat that is otherwise normal. These changes lead to extra or skipped heartbeats

Question 10

What are some congestive heart failure symptoms?

Answer 10

The symptoms of congestive heart failure vary, but can include:
fatigue,
diminished exercise capacity,
shortness of breath, and
swelling (edema).

Question 11

In which ethnic group is heart disease and stroke highest?

Answer 11

African american

Question 12

White men and women are more likely to be overweight true or false?

Answer 12

true

Question 13

Which ethnic groups have the highest prevalence of diabetes?

Answer 13

African americans and Mexican americans

Question 14

For a cardiovascular assessment what are some health assessment topics are discussed to collect subjective data?

Answer 14

Angina
Dyspnea
With exertion? Heart failure
Orthopnea
Paroxysmal Nocturnal Dyspnea (PND)
Heart failure
Cough

Question 15

What is angina?

Answer 15

• Angina is chest pain or discomfort caused when your heart muscle doesn’t get enough oxygen-rich blood. It may feel like pressure or squeezing in your chest. The discomfort also can occur in your shoulders, arms, neck, jaw, or back. Angina pain may even feel like indigestion. But, angina is not a disease.

Question 16

What is dyspnea?

Answer 16

difficult or labored breathing

Question 17

What is orthopnea?

Answer 17

Orthopnea or orthopnoea is shortness of breath (dyspnea) that occurs when lying flat, causing the person to have to sleep propped up in bed or sitting in a chair.

Question 18

What is paroxysmal nocturnal dyspnea (PND)?

Answer 18

Paroxysmal nocturnal dyspnea or paroxysmal nocturnal dyspnoea (PND) refers to attacks of severe shortness of breath and coughing that generally occur at night. It usually awakens the person from sleep, and may be quite frightening.

Question 19

What is cyanosis?

Answer 19

Cyanosis refers to bluish discoloration of skin, nail beds and mucous membranes. Normally haemoglobin carries most of the oxygen in blood. This oxygen carrying capacity of haemoglobin in the blood (present in the arteries) is called oxygen saturation.

Question 20

What is pallor?

Answer 20

an unhealthy pale appearance

Question 21

What is edema?

Answer 21

Edema is the medical term for swelling. Body parts swell from injury or inflammation. It can affect a small area or the entire body. Medications, infections, pregnancy, and many other medical problems can cause edema.

Edema happens when your small blood vessels become “leaky” and release fluid into nearby tissues. That extra fluid builds up, which makes the tissue swell.

Question 22

What is nocturia?

Answer 22

Nocturia is a condition in which you wake up during the night because you have to urinate. This condition becomes more common as people age and occurs in both men and women, sometimes for different reasons.

Question 23

What are some risk factors for cardiovascular disease?

Answer 23

Elevated serum cholesterol 
Elevated blood pressure
Blood sugar levels above 130
Diabetes Mellitus
Obesity
Smoking
Sedentary lifestyle
Stress/depression
Low socioeconomic status
Diet high in saturated fat
Family history

Question 24

Which gender is more at risk for coronary artery disease?

Answer 24

-females
Coronary artery disease leading cause of death in women
1 out of 2.4 due to cardiovascular disease
1 out of 29 breast cancer (women perceive breast cancer as greater risk)

All women should be screened for risk factors

Question 25

What atypical symtoms are women experiencing when they have heart disease or myocardial infarction?

Answer 25

``` Angina: hot/cold burning sensation; tender to touch in back shoulders, arms or jaw Often no chest discomfort or pain Nausea vomiting, indigestion, shortness of breath or extreme fatigue Throbbing above waist Breathlessness Cold sweat Feeling of impending doom Edema ```

Question 26

What is the assessment order for a cardiovascular assessment?

Answer 26

``` Assessment Order Inspection Precordium and neck vessels Palpation Precordium and neck vessels Extremities Auscultation Heart sounds ```

Question 27

What side of the heart does the jugular vein tell you about?

Answer 27

right side of the heart | observe for distention

Question 28

What are the expected findings when palpating the carotid artery (remember one side at a time)?

Answer 28

smooth contour amplitude is 2+ moderate equal bilaterally

Question 29

What are the abnormal findings when palpating the carotid artery?

Answer 29

diminished pulse (decreased stroke volume, 1+) significantly strong pulse (4+) unequal bilaterally

Question 30

When palpating the precordium what are the expected and unexpected findings?

Answer 30

- precordium is the outer aspect of the heart so palpate apex, left sternal border, and base - expected: nothing - abnormal: thrill: vibration (purring cat): indicates turbulent blood flow. heave: sustained forceful thrust

Question 31

What are the expected and unexpected findings when auscultating the carotid artery?

Answer 31

``` Lightly place the bell on the carotid At the angle of the jaw At the midcervical area At the base of the neck Expected findings Hear nothing Abnormal findings Bruit – blowing swishing sound; turbulent blood flow ```

Question 32

What pattern is used in the auscultation of heart sounds?

Answer 32

utilize the diaphragm and bell in a z pattern

Question 33

What are the expected findings when auscultating heart sounds?

Answer 33

``` S1 (lub) Closure of AV valves Start of systole (contraction) Loudest at apex Can coordinate with carotid pulse S2 (dub) Closure of semilunar valves (aortic/pulmonic) End of systole Loudest at base Split can be normal with inspiration, especially in young patients Rate and Rhythm Regular – sinus rhythm Sinus arrhythmia: irregular rate in young adults and children; increases with inspiration, decreases with expiration 60-100 bpm ```

Question 34

What are the unexpected findings when auscultating heart sounds?

Answer 34

Irregular rhythm or rate: Bradycardia is less than 60 Tachycardia is greater than 100 Arrhythmias: irregularity of rhythm EXTRA HEART SOUNDS (Diastolic) S3 Heard immediately after S2, early in diastole (filling) Difficulty with filling causes vibration when AV valves open S4 Heard immediately before S1, end of diastole Ventricles resistant to filling Clicks May indicate valve dysfunction Opening snaps Valve having difficulty opening; stenosis Prosthetic heart sounds Sounds made by artificial valves; check history Pericardial friction rub Grating sound; inflammation of pericardium; very painful

Question 35

What are murmurs?

Answer 35

whooshing sound as a result of turbulent bloodflow

Question 36

What is a stenosis?

Answer 36

flow through a constricted area/vessel

Question 37

What is a mitral valve prolapse?

Answer 37

Regurgitant (Regurgitant fraction is the percentage of blood that regurgitates back through the aortic valve to the left ventricle due to aortic insufficiency, or through the mitral valve to the atrium due to mitral insufficiency.) or backward flow

Question 38

What is shunting?

Answer 38

septal wall defects

Question 39

What are the causes of murmurs?

Answer 39

Whooshing sound as a result of turbulent blood flow 3 basic types of flow “pathology” Flow through a constricted area/vessel (i.e. stenosis) Regurgitant or backward flow (i.e. mitral valve prolapse) Shunting (i.e. septal wall defects) Other non-pathological causes of murmurs Exercise Decreased blood viscosity

Question 40

How are abnormal heart sounds described?

Answer 40

``` Location Timing Duration Frequency Intensity Quality Change with reposition? ```

Question 41

What are some causes of heart failure?

Answer 41

decreased cardiac output | kidney's compensatory mechanism

Question 42

What is decreased cardiac output going to cause?

Answer 42

Heart fails as a pump; Circulation becomes backed up and congested Heart unable to pump enough blood to meet metabolic demands

Question 43

What are the kidney's compensatory mechanisms?

Answer 43

Abnormal retention of sodium and water to compensate for the decreased cardiac output increases blood volume and venous return, causing further congestion

Question 44

What are some acute causes of heart failure?

Answer 44

``` Myocardial infarction (heart attack), dysrhythmias, pulmonary emboli causes direct damage to the heart’s contracting ability ```

Question 45

What are some chronic causes of heart failure?

Answer 45

Hypertension, coronary artery disease (CAD), valve disorders Chronically working against increased pressure

Question 46

What are the clinical manifestations of left sided heart failure?

Answer 46

``` Left ventricular dysfunction Back up into pulmonary veins: LUNGS Pulmonary edema, crackles, wheezes S3 & S4 sounds Weakness, fatigue Dyspnea Shallow resp; rate 32-40, dry cough; low O2 sat Paroxysmal Nocturnal dyspnea, orthopnea Nocturia ```

Question 47

What are the clinical manifestations of right sided heart failure?

Answer 47

``` Less common Right ventricular dysfunction Back up into systemic circulation: ABDOMEN JVD, liver spleen, GI, peripheral edema Weight gain, ascites Anasarca Fatigue Dependent, bilateral edema Nausea Anorexia, bloating ```