Cardiovascular

heart position

base = left 2nd intercostal space

apex = left 5th intercostal space

right ridge of the sternum to the left mid-clavicular line

great vessels

* superior and inferior vena cava
* pulmonary artery
* pulmonary veins
* aorta

sinoatrial node (SA node)

* posterior wall of right atrium
* 60-100 BPM
* conduct impulses over R/L atrium at the same time

atrioventricular node (AV node)

* located in the internal septum
* relays impulses to the AV bundle
* impulse travels down purkije fiber in the ventricles
* 40-60 BPM

EKG/ECG phases

==P-wave== = atrial depolarization causing atrial contraction

PR interval = spans from atrial depolarization to the beginning of ventricular depolarization

==QRS complex== = ventricular depolarization causing ventricular contraction

ST segment = between ventricular depolarization and beginning of ventricular repolarization

==T-wave== = ventricular depolarization causing ventricles to rest

QT interval = total time for ventricle depolarization and depolarization

normal heart sounds

S1 = AV valves close, heard best at the Apex (left MCL, 5th intercostal)

S2 = SL valves close, heard best at the base of the heart (2nd intercostal)

extra heart sounds

S3 = heard after S2, caused by ventricular vibration due to ventricular resistance during atrial contraction (can be normal in children)

S4 = just before S1 (late diastole)

causes of heart murmurs

increased amount blood velocity (speed), heart defects, faulty valves, abnormal heart chambers or septal defects

heart murmur characteristics

* timing - systole or diastole
* intensity: grade 1-6
* pitch: high, medium, low
* quality: blowing, rushing, roaring, rumbling, harsh, musical
* location: over which valve
* transmission: other areas than origin

jugular venous pulse and pressure

* central lines get put into the internal jugular vein
* pressure tells us about right sided heart function
* right-sided heart failure = pressure/volume increases due to backed up blood in vein

ischemia

decreased blood flow to tissue (reversible or nonreversible)

infarction

no blood flow to tissue causing tissue death

hypervolemia

high blood volume, can cause hypertension, elevated BP, and pulmonary failure

hypovolemia

low blood volume, dehydration

dependent position

leg/arm below level of the heart

trendelenburg position

head down and legs up

nocturia

excessive voiding at night, associated with left sided heart failure or obstructive sleep apnea

arteriosclerosis

thickening or hardening of arteries

when auscultating the heart include:

rate, rhythm (regular or irregular)

how to auscultate carotid arteries

* use the bell of the stethoscope
* have patient hold their breath
* listen for bruit, blowing, or swishing sounds
* include rate, rhythm, and strength (+2 normal)

signs of arterial insufficiency

* pallor or redness
* loss of hair
* shiny skin
* coolness of skin
* absence of pulse or sounds (occlusion)
* intermittent pain

signs of venous insufficiency

* cyanosis
* rusty/brownish color
* edema
* pain
* thick/tough skin

type of ulcer and characteristics?

arterial vascular disease (arterial insufficiency)

more distal (toes), deep, circular, blackish base

type of ulcer and characteristics?

venous vascular disease (venous insufficiency)

irregular, painful, superficial, red/yellow base, larger, medial malleolus/anterior tibial area

valvular heart disease

* Acquired or Congenital
* Stenotic Valve – does not open completely
* Incompetent Valve – does not close completely
* Causes: Rheumatic Fever, Endocarditis

Angina pectoris

* Chest pain due to ischemia (lack of blood flow) of heart tissue
* Caused: Arteriosclerosis of Coronary Arteries (arteries are clogged and blood cant pass through)
* Can occur due to increased demand on the heart – stress/activity
* Can occur at rest due to spasms
* S/S: Squeezing pain, shouldn’t last more than 30 minutes 

Myocardial infarction (heart attack)

* Left ventricle more commonly affected
* Complete or near complete occlusion of a coronary artery (no blood flow to the heart) -> more severe Angina Pectoris
* Pain last more than 5 minutes that radiates to left shoulder/jaw/arm and not relieve by nitroglycerin
* Other S/S: Fatigue, nausea, sweating, pallor, thready pulse….
* Female patients are more likely to have abnormal symptoms

atrial arrhythmias/disrhythmias

atrial fibrillation (quivering instead of contracting); high risk for stroke

ventricular arrhythmias/dysrhythmias

ventricular tachycardia/fibrillation (quivering instead of contracting); lethal and person often has no pulse

* CPR and defibrillation

heart failure

* Heart failure occurs when either ventricles fail to pump blood efficiently into aorta or pulmonary arteries -> decreased CO
* Left sided more common -> fluid will back up to the lungs (edema) causing breathing problems
* Will sound like crackles when listening to lung sounds
* Right sided -> peripheral symptoms, edema in the legs

pericarditis

* inflammation of the pericardium
* S/S: pericardial friction rub and chest pain (worse with inspiration)
* cause: MI, infection, trauma, surgery

endocarditis

* inflammation/infection of the endocardium → progresses to valvular diseases
* common with intravenous drug users

edema

* caused by obstruction or insufficiency of deep veins over time
* pitting: +1 - +4
* unilateral? bilateral?
* ulcers and abnormal skin color (brown) may be present

Raynaud’s disorder

* caused by vasoconstriction or spasms of the toes and fingers
* S/S = rapid changes in color (pallor/cyanosis/erythema), pain, swelling, numbness, tingling, burning, throbbing, coldness

Varicose veins

* incompetent valves in veins, weak walls or obstruction
* reasons = pregnancy, obesity, prolonged sitting or standing
* veins appear distended or bulging
* can lead to peripheral vascular disease