cardiovascular system

Question 1

the hearts structure and function

Answer 1

 Structures
 Heart
 Blood vessels
 Main functions
 Deliver oxygen and
nutrients to body cells
 Remove waste products
 Maintain perfusion to
organs and tissues

Question 2

5 areas for listening to the heart

Answer 2

aortic, pulmonic, erbs point, tricuspid, mitral valve

Question 3

pericardium

Answer 3

 Outer protective layer
 Fibrous sac that surrounds the heart

Question 4

myocardium

Answer 4

 Middle muscular layer
 Thickest layer
 Made up of contractile cells

Question 5

endocardium

Answer 5

 Inner smooth layer

Question 6

sinoatrial node

Answer 6

initiates
electrical impulses

Question 7

AV node

Answer 7

slows down impulses to the
ventricles

Question 8

preload

Answer 8

volume of blood in the ventricles after diastole

Question 9

after load

Answer 9

The afterload is the amount of pressure that the heart needs to exert to eject the blood during ventricular contraction.

Question 10

jugular venous pressure

Answer 10

 Reflects right atrial
pressure
 When right atrial
pressure increases fluid
backs up in the lungs =
heart failure
 When pressure is
increased it may result in
jugular vein distention
(JVD)

Question 11

health history

Answer 11

 Common or concerning symptoms
 Chest pain or discomfort: chest pain is considered cardiac until proven
otherwise!
 Pain or discomfort radiating to the neck, left shoulder or arm, and back
 Arrhythmias: skipped beats, palpitations
 Dyspnea
 Cough
 Edema
 Nocturia-excessive urination at night
 Fatigue
 Cyanosis
 Pallor

Question 12

angina pectoris

Answer 12

chest pain
resulting from decreased blood flow
to the heart

Question 13

palpitations

Answer 13

 Heart skipping, racing, fluttering

Question 14

paroxysmal nocturnal dyspnea

Answer 14

Paroxysmal nocturnal dyspnea-
severe onset SOB or coughing while
sleeping. May awaken suddenly.

Question 15

dyspnea and orthopnea

Answer 15

 Dyspnea- difficulty breathing
 Orthopnea- difficulty breathing
when lying flat

Question 16

symptoms of heart failure

Answer 16

 Cough
 May signal heart failure
 Coughing pink,
frothy sputum =
heart failure
 Edema in feet or
ankles = heart
failure
 Edema
 Does it clear at night
when patient puts feet
up?
 Fatigue
 May signal heart is not
adequately supplying
oxygen
 Cyanosis or pallor
 Poor oxygenation of
body

Question 17

what would you ask a cardiac patient

Answer 17

What do we want to ask our patient about past
history?
 Heart problems or previous heart disease?
 Murmurs?
 Congenital heart disease/defect – can affect
ability of the heart to pump
 Rheumatic fever? (caused by Strep A – can
damage heart valves)
 Hypertension? (most important risk factor
contributing to heart disease)
 Elevated cholesterol or triglycerides – both
can contribute coronary artery disease
(CAD)
 Diabetes?

Question 18

family history

Answer 18

What do we want to ask the
patient about family history?
 Coronary artery disease?
 Hypertension?
 Sudden death younger than
60?
 Stroke?
 Diabetes?
 Obesity?

Question 19

lifestyle habits

Answer 19

What do we want to ask the
patient about lifestyle habits?
Nutrition / diet
Smoking
Alcohol
Exercise

Question 20

physical exam

Answer 20

Comfortable and calm
 Explain procedure
 Examination gown (opened
in the front)
 Assist to examining table
 Cover with drape
 Perform examination from
patient’s right side
 May need patient to change
positions

Question 21

general impression

Answer 21

 General Impression
 Affect: anxiety may occur
with MI
 Color: cyanosis, pallor
 Temperature: cool, moist -
concerning

Question 22

neck vessels

Answer 22

 Inspection
 Observe the neck for distended jugular veins
 The jugular vein should not be distended or bulging with the patient sitting at 45 degrees or greater
 Distention may indicate right-sided heart failure
 If distention is noted place the patient at 45, 60 and 90 degrees and assess for distention
 Document at which positions you observe distention
 Auscultation
 Using the bell of the stethoscope listen over the carotid artery and direct patient to hold their breath.
 A swishing or blowing sound may indicate a narrowing vessel = bruit
 If a bruit is audible, consider not palpating the carotid artery or GENTLY palpate
 Always auscultate carotid arteries prior to palpation! Palpation may change the heart rate and impulse.

Question 23

apical impulse

Answer 23

 If the apical pulse is larger than 1-
2cm = suspect cardiac enlargement
 May not be palpable in larger
clients
 Should be the size of a nickel if
palpable

Question 24

auscultation of the heart

Answer 24

 Positioning patient
 Supine
 Turning to left side –
brings heart forward to
better hear apical
 Sitting and leaning
forward- may reveal extra
heart sounds or murmur
 Inspection
 Apical pulse – may be
visible
 Palpation
 Auscultation- regular rate
and rhythm?

Question 25

assessing the carotid pulse

Answer 25

Weak = low cardiac output, hypovolemia
Inequality of pulses = arterial occlusion
0 = absent 1+ = Weak – easy
to obliterate 2+ = normal 3+ = Bounding –
unable to obliterate
Never palpate right and left carotid arteries simultaneously
Note rate, rhythm and amplitude (strength)
Place your index and middle fingers on the right then the left
carotid arteries, and palpate the carotid pulse
Keep the patient’s head elevated to 30°
 If the apical pulse is larger than 1-
2cm = suspect cardiac enlargement
 May not be palpable in larger
clients
 Should be the size of a nickel if
palpable
Bounding = high cardiac output, hypervolemia

Question 26

apical impulse

Answer 26

 If the apical pulse is larger than 1-
2cm = suspect cardiac enlargement
 May not be palpable in larger
clients
 Should be the size of a nickel if
palpable

Question 27

auscultation of the heart

Answer 27

 Positioning patient
 Supine
 Turning to left side –
brings heart forward to
better hear apical
 Sitting and leaning
forward- may reveal extra
heart sounds or murmur
 Inspection
 Apical pulse – may be
visible
 Palpation
 Auscultation- regular rate
and rhythm?

Question 28

lub - dub

Answer 28

normal heart sounds caused by closing of the valves

Question 29

lub

Answer 29

recoil of blood against av closed valves
systole

Question 30

dub

Answer 30

recoil of blood against closed semilunar valves
diastole

Question 31

the cardiac cycle

Answer 31

 The cardiac cycle
 Systole: period of
ventricular contraction
 Diastole: period of
ventricular relaxation

Question 32

heart murmurs

Answer 32

MURMUR
S
Abnormal, turbulent blood flow which
creates a swooshing sound
 Increased blood volume (in
pregnancy)
 Structural valve defects – may be
congenital
 Abnormal chamber openings
 Can be benign or serious
Use the diaphragm and bell of the
stethoscope to listen for murmurs.
Assess the patient supine, left lateral
and sitting leaning forward. This
change the position of the heart
increasing the likelihood of hearing the
murmur.

Question 33

causes of heart disease

Answer 33

diabetes, smoking, gender (males), lifestyle, genetics, ageing, diet

Question 34

signs of coronary artery disease and MI

Answer 34

in men:
discomfort in back, neck, jaw, tingling in the limbs, chest pain, shortness of breath,

women:
sudden dizziness, nausea vomiting, unusual tiredness, heartburn like feeling,

Question 35

changes in the body during pregnancy

Answer 35

vasodilation, decrease in vasoconstriction, increased sympathetic activity, increased heart rate, plasma volume expansion, total blood volume increase, increased cardiac output, left ventricular mass increases, chambers dilate

Question 36

child and infant considerations

Answer 36

 At birth, lung aeration causes circulatory changes
 This is because in the womb, the fetus’s blood is shunted through the foramen ovale and ductus arteriosus into the left side of the heart and out the aorta, bypassing the lungs
 The foramen ovale closes.
 Murmurs are commonly heard in the newborn and throughout childhood
 The heart should be auscultated at approximately the fourth intercostal margin to the left of the Mid clavicular line
 Until the age of 7 where it moves to the 5th ICS

Question 37

newborn and infant heart rate

Answer 37

 For a newborn, the HR should be 120–160 beats/min.
 At 6 months, rate is approximately 120 beats/min.
 At 6 months to 1 year, rate is approximately 110 beats/min

Question 38

aging adult

Answer 38

 The most common aging change is increased stiffness of the
large arteries, called arteriosclerosis
 Blood pressure increases as elasticity decreases in arteries with
proportionately greater increase in systolic pressure
 An older adult’s baroreceptor response to positional changes is
slightly less efficient and a slight decrease in blood pressure may
occur.
 Orthostatic hypotension occurs when blood pressure falls upon
standing.
 Increasing the risk of FALLS
 The chambers of the heart may increase in size.

Question 39

arteries

Answer 39

 Carry oxygenated, nutrient-
rich blood from the heart to
the capillaries
 Major arteries of arm:
brachial, radial, ulnar
 Major arteries of the leg:
femoral, popliteal, dorsalis
pedis, posterior tibial

Question 40

veins

Answer 40

Carry deoxygenated, nutrient
-depleted, waste-laden blood
from the tissues back to the
heart
 Three types of veins: deep
veins, superficial veins, and
perforator veins
 Femoral, popliteal,
saphenous veins

Question 41

lymphatic system

Answer 41

 Lymphatic capillaries, lymphatic vessels, lymph nodes
 Capillaries and fluid exchange
 Small blood vessels
 Form the connection between the arterioles and venules
 Allow the circulatory system to maintain vital equilibrium

Question 42

peripheral arterial disease

Answer 42

top of toes, top of feet, lateral ankle region
pale to pink ulcers, no granulation, or necrotic tissue, round punched out appearance

Question 43

peripheral venous disease

Answer 43

medial parts of the lower legs and ankles,
ulcers with swollen edges, granulation is present, deep red to pink, edges irregular and shallow

Question 44

risk factors for venous stasis

Answer 44

 Long periods of standing still, sitting, or lying down.
 Lack of muscular activity causes blood to pool in the legs,
which, in turn, increases pressure in the veins.
 Varicose (tortuous and dilated) veins, which increase
venous pressure. Damage to the vein wall can also
contribute to venous stasis.

Question 45

reduce risk factors associated pvd

Answer 45

 Quit smoking if you’re a smoker.
 If you have diabetes, keep your blood sugar under control.
 Exercise regularly. Aim for 30 minutes at least three times a week
after you’ve gotten your doctor’s OK.
 Lower your cholesterol and blood pressure levels, if necessary.
 Eat foods that are low in saturated fat.
 Maintain a healthy weight.

Question 46

current symptoms

Answer 46

 Skin changes
 Leg pain, heaviness, or aching
 Leg veins
 Leg sores or open wounds
 Swelling in legs or feet
 Men: sexual activity changes
 Swollen glands or nodules

Question 47

subjective data history

Answer 47

 Past
 Previous problems with circulation in arms or legs
 Heart or blood vessel surgeries or treatments
 Family
 Varicose veins, diabetes, hypertension, coronary heart disease, or elevated
cholesterol or triglyceride levels

Question 48

lifestyle and health practices

Answer 48

 Tobacco use
 Regular exercise
 Oral contraceptives use
 Degree of stress
 Peripheral vascular problems interfering with ADLs
 Medications to improve circulation or control blood pressure
 Support hose

Question 49

arms palpation and inspection

Answer 49

 Fingers, hands, and arms for
temperature
 Capillary refill time
 Radial, ulnar, and brachial
pulses
 Epitrochlear lymph nodes
 Allen test

Question 50

legs inspection and palpation

Answer 50

 Skin color
 Distribution of hair
 Lesions or ulcers
 Edema
 Temperature
 Superficial inguinal lymph nodes
 Femoral pulse, listening for bruits
 Popliteal, dorsalis pedis, posterior tibial pulses
Inspect for
varicosities and
thrombophlebitis
by asking client to
stand:
Homans sign

Question 51

pregnancy considerations

Answer 51

 With the dynamic increase in maternal blood volume, a
physiologic anemia commonly develops.
 Progesterone acts on the vessels to make them relax and dilate.
 Dizziness and lightheadedness are common
 Increased edema and varicosities
 Varicose veins in the lower extremities, vulva, and rectum are
common
 More prone to development of thrombophlebitis

Question 52

older adult considerations

Answer 52

 Hair loss on the lower extremities occurs with aging and is,
therefore, not an absolute sign of arterial insufficiency in the older
client.
 With aging, lymphatic tissue is lost, resulting in smaller and fewer
lymph nodes.
 Varicosities are common in the older client.
 A bruit is abnormal because of the high risk of CVA from a carotid
embolism, abdominal or femoral aneurysm.

Question 53

S3 heart sound

Answer 53

S3 (Third Heart Sound)

Also called a ventricular gallop, the S3 has a low frequency and is heard best using the bell of the stethoscope at the apical area or lower right ventricular area of the chest with the client in the left lateral position. The sound is often accentuated during inspiration and has the rhythm of the word “Ken-tuc-ky.” S3 is the result of vibrations caused by the blood hitting the ventricular wall during rapid ventricular filling.

The S3 can be a normal finding in young children, people with a high CO, and in the third trimester of pregnancy. It is rarely normal in people older than 40 years and is usually associated with decreased myocardial contractility, myocardial failure, congestive heart failure, and volume overload of the ventricle from valvular disease.

Question 54

S4

Answer 54

S4 (Fourth Heart Sound)

Also called an atrial gallop, S4 is a low-frequency sound occurring at the end of diastole when the atria contract. It is caused by vibrations from blood flowing rapidly into the ventricles after atrial contraction. S4 has the rhythm of the word “Ten-nes-see” and may increase during inspiration. It is best heard with the bell of the stethoscope over the apical area with the client in a supine or left lateral position, and is never heard in the absence of atrial contraction.

The S4 can be a normal sound in trained athletes and some older clients, especially after exercise. However, it is usually an abnormal finding and is associated with coronary artery disease, hypertension, aortic and pulmonic stenosis, and acute MI.

Question 55

pericardial friction rub

Answer 55

Pericardial Friction Rub

Usually heard best in the third ICS to the left of the sternum, a pericardial friction rub is caused by inflammation of the pericardial sac. A high-pitched, scratchy, scraping sound, the rub may increase with exhalation and when the client leans forward. For best results, use the diaphragm of the stethoscope and have the client sit up, lean forward, exhale, and hold their breath.

The pericardial friction rub can have up to three components: atrial systole, ventricular systole, and ventricular diastole. These components are associated with cardiac movement. The first two components are usually present. If only one component is present, the rub may be confused with a murmur. Friction rubs are commonly heard during the first week after an MI. If a significant pericardial effusion is present, S1 and S2 sounds will be distant.

Question 56

innocent murmur

Answer 56

Innocent Murmur

Not associated with any physical abnormality, innocent murmurs occur when the ejection of blood into the aorta is turbulent. Very common in children and young adults, they may also be heard in older people with no evidence of cardiovascular disease. A client may have an innocent murmur and another kind of murmur.

Question 57

physiologic murmur

Answer 57

Physiologic Murmur

Caused by a temporary increase in blood flow, a physiologic murmur can occur with anemia, pregnancy, fever, and hyperthyroidism.