125 cardio and peripheral vascular

heart location

base of hear is broad and at top -apex is bottom at 5 ICS -heart sits mostly left and is measured from 2nd to 5th ICS

external and internal

jugar vein, for jugular and venous pressure

tricuspid valve

RA to RV

pulmonary valve

RV to pulmonary arteries

mitral valve

LA to LV -aka biscupid

aortic valve

LV to aorta

supply brain

carotid arteries and jugular veins

upper limbs

subclavian arteries and superior vena cava

lower limbs

thoracic aorta and inferior vena cava

systole

contraction of ventricles

diastole

ventricles relax

perfusion

The process of delivering blood from capillaries to tissues

cardiac output

amount of blood ejected from the LV each minute (CO= Stroke Volume x HR)

sinoatrial node

natural pacemaker. Sends an impulse to atrial muscles to contract and begin the cardiac cycle

atrioventricular node

transmits the SA impulse to activate Bundle of HIS & Purkinje Fibres AND Synchronize/Mediate impulses

bundle of his and bundle branches

conduct impulses through ventricular wall

purkinje fibres

conduct impulses to ventricular walls

para and symp

control heart rate and can be impacted by stress

sounds

start of systole and start of diastole

P wave

atrial depolarization (atrial contraction)

PR interval

SA-BB conduction

QRS

ventricular systole/contraction (hidden is atrial diastole)

T wave

ventricular diasotle (fillling)

general survey

temp, bp, MAP, pulse

unexpected findings in gen survey

cyanosis, scar (chest area), sweating, peripheral vascular changes

risk factors

smoking, diet, active, stress, family hx, personal hx, bp and cholesterol levels, cardiac meds?

assessment

chest pain/issues, radiating pain, breathing troubles, papitations, diaphoresis, sleep changes, activity changes, edema, nocturia, cough

radiating pain

neck, jaw, shoulder, arm, back

orthopnea

SOB when lying on your back

JVP

jugular venous pulsations, reflects pressure in RA, measure should be less than 3cm

IAP (intra abdominal pressure)

listen w/ bell of stethoscope for bruits -palpate one side at a time -compare bilaterally -normal rate, rhythm, quality w/ no extra sounds

cardiac inspection

thorax and precordium for scars, pulsations, deformities, lesions, masses, heaves -30 degree angle

palpation

apical pulse at 5th ICS at MCL -hands and arms for abnormal findings -thorax and precordium with palm

s1

lubb -closure of atrioventricular valves -contraction -systole start

s2

dubb -closure of semilunar valves -relax -diastole start

all people enjoy time magazine

-aortic -pulmonic -earbs -tricuspid -mitral

aortic

R 2nd ICS

pulmonic

L 2nd ICS

earbs

S1 and S2 best L 3rd ICS

tricuspid

4th ICS on L -lower left sternal border

mitral

L 5th ICS -medial to MCL

S2 physiological split

when valves close at slightly different times due to changes in intrathoracic pressure (especially during inspiration)

S3 and S4. sounds

(extra heart sounds) - S3 : “Lub du bub” (may be expected in people less than 40 or in CHF) - S4: “Be Lub Dub” (Pathological origin)

murmurs

(whooshing) - Caused by disrupted blood flow due to septal defects, valve abnormalities, Patent ductus arteriosus, or stenotic vessels

systolic murmurs

Aortic or pulmonic stenosis, AV valve regurgitation, VSD

diastolic murmurs

AV valve stenosis, Aortic or pulmonic regurgitation

innocent murmur

result of turbulent blood flow -during systole

red flags

LOC Changes Chest Pain Shortness of breath (!!!) Lightheadedness Fluid Volume Overload ECG changes

peripheral vascular ax

(including Fascial Compartments) ➔ Pulses ➔ Edema ➔ Compartment syndrome? ➔ Deep venous thrombosis?

lymphatics assessment check

-check for -Lymphedema -Lymph nodes -Chylothorax (fluid leaks into space between lung and chest wall)

arteries

Thick walled, elastic, high pressure - Largest is the Aorta

veins

- Thinner and less elastic, low pressure - Valves to prevent back-flow - Superior vena cava

capillaries

Location of exchange of gases, nutrients, metabolites

lymphatic system

- Lymph nodes & vessels - Valves for flow - Maintains fluid balance & immune function - Run parallel to arteries & veins - Lymph drains into Thoracic duct & Right Lymphatic duct to subclavian veins to superior vena cava to right atrium

fascial compartments

- Fascia are sheets of connective tissue that enclose the blood vessels, nerves and muscles which make up compartments. - Limited stretch in the fascia can cause problems when there is inflammation to any of the enclosed components.

DVT

pain/edema/warmth -weak pulses -delayed cap refill -risk of pulmonary embolism (blood can’t drain properly)

health hx peripheral

- Pain - Numbness/tingling (sensation) - Cramping - Changes in Skin Colour - Edema - Function - Personal History - Medications - Family History (Hx of stroke, clots etc.) *Keeping in mind CVS questions!

PVS and lymph inspection

- All extremities, comparing colour, size, and quality. - Hint: bring back Skin/Hair/Nails -raynauds, cyanosis, mottling

lymphedema

one or both limbs that lymphatic system struggles and lymph collects in parts of body -usually legs, arms more risky -

edema

fluid -depress area for cap refill to asess -pitting or non pitting

epitrochelear nodes

support forearm with elbow flexed -finger pads between bisceps and triceps (3cm above medial epicondyle) -usually not palpable: note size, consistency, mobility and tenderness

inguinal nodes

horizontal: medial (symphsis pubis) to lateral -vertical: proximal upper/medial thigh -may be palpable: <2cm, mobile and non tender

palpation for PVS

distal to proximal -TEXTURE/MOISTURE ◆ TEMPERATURE ● Warm and Dry or Trunk Warm-Extremities Cool ◆ TURGOR ◆ CAPILLARY REFILL ● Less than or equal to 2sec/Between 2-3sec/Greater than or equal to 4sec ◆ EDEMA ● Determine if pitting or non pitting ● If pitting: grade it ◆ PULSES ● Documenting strength grade and comparing for symmetry

pulses

carotid, apical, brachial, radial, femoral, popliteal, posterior tibial, pedal

central pulses

carotid, apical, brachial, femoral

newborn pulses

check pulses on both side and all of them

pulse scale

doppler

when pulses are difficult to find -If pulse is then unable to be heard on the doppler, that is an emergent situation

compartment syndrome

usually caused by bleeding or swelling after injury into closed compartment or untreated DVT -pain and paresthesia - >6hr = permanent damage -under fascia but outside of vessels

limb ischemia

-death to limb from lack of blood flow -pain and quality -pallor (chronic pink due to compensatory vasodilation) -buergers test (pallor on elevation and erythema on dependency -pulselessness -polar sensations/poikilothermia ( cold compared to other limb) -paresthesia (burning, tingling, numbness -paralysis