Cardiovascular & Peripheral Vascular

where does the left side of the heart receive blood from and where does it send blood

- receives from the lungs

- delivers to the body

where does the right side of the heart receive blood from and where does it send blood

- receives from the body

- delivers to the lungs

what does S1/"lub" mean

- that the tricuspid and mitral valves are closed

- it is the beginning of systole

what does S2/"dub" mean

- that the aortic and pulmonic valves are closed

- it is the end of systole & the beginning of diastole

what is atrial kick

- 25% of total blood volume in the ventricles

systole vs diastole

systole: the contraction and the propelling of blood forward

diastole: when the heart muscle relaxes and fills with blood

what does cardiac output (amount of blood leaving the heart) depend on?

- stroke volume (amount of blood that is ejected from the heart with one contraction)

- heart rate (60-100 normally)

what is preload?

- degree of stretch of the heart muscle before contraction

what is afterload?

- the pressure that the heart muscle has to overcome to eject blood during contraction

what is contractility?

- force of contraction of the myocardium

what does inotropic mean?

- medications that tell your heart to contract with more or less power

difference between normal ejection fraction (EF) and low ejection fraction (EF)

normal ejection fraction (EF): 55%-70% of the blood in the left ventricle is pumped out with each contraction (EF of 0.55 or 0.7)

low ejection fraction (EF): following a heart attack, damaged heart muscle can not pump as efficiently -- leading to less blood being pumped out to the body with each heartbeat

What are the normal BPM for the SA node

60-100 BPM

What are the normal BPM for the AV node

40-60 BPM

What are the normal BPM for the Bundle of His node

20-40 BPM

how does the respiratory system interact with the cardiovascular system

- exchanges O2/CO2

- angiotensin I to II

- maintains BP

how does the endocrine system interact with the cardiovascular system

- distributes hormones

- secretes ANP

- fluid and electrolyte balances

- lowers blood volume and pressure

- erythropoietin

- RBC production

- epinephrine/norepinephrine

- increases HR

- increases contraction force

how does the muscular system interact with the cardiovascular system

- nutrient delivery

- removes CO2/lactic acid

how does the skeletal system interact with the cardiovascular system

- delivers calcium, minerals, calcitonin

- produces blood cells

- produces heart

how does the urinary system interact with the cardiovascular system

- regulates volume

- renin/angiotensin

- erythropoietin

what is the order in which blood pumps from your heart and lungs

body -> right atrium -> right ventricle -> pulmonary artery -> lungs to be exchanged -> comes back thru pulmonary veins -> left atrium -> left ventricle -> aorta -> body

how does the sympathetic nervous system affect HR vs the parasympathetic nervous system

SNS: increases HR

PNS: decreases HR

what are some developmental variations in infants in their cardiovascular system?

murmurs, and HR 110-160 -- usually the time when murmurs are noted or picked up

what are some developmental variations in children in their cardiovascular system?

sinus arrhythmia (the heart rate increases slightly when you breathe in and slows down when you breathe out), S3, innocent murmurs, and HR 60-100

what are some developmental variations in pregnant women in their cardiovascular system?

systolic murmur, apical impulse displace, changes in BP

what are some developmental variations in older adults in their cardiovascular system?

orthostatic hypotension, auscultatory gaps, decrease in CO, thickening of heart valves, increase in systolic BP

what are some cultural/ethnic variations with japanese & puerto ricans

lower HTN (hypertension), and cholesterol

what are some cultural/ethnic variations with middle aged white people

higher mortality with coronary artery disease

what are some cultural/ethnic variations with black people

earlier onset and greater severity of coronary artery disease

what are some cultural/ethnic variations with african american women

increased incidence of coronary artery disease

what are some cultural/ethnic variations with native americans under 35 yro

2x mortality from heart disease

what are some cultural/ethnic variations with mexican people

greater risk of obesity

what are classic symptoms of chest pain/heart issues

- angina/chest pain

- dyspnea

- cough

- edema

- syncope (fainting)

- palpitations

- fatigue

- paresthesia (pins and needles)

- intermittent claudication (blockage)

what are not so classic symptoms of chest pain/heart issues

- nausea

- epigastric distress

what are some COLDSPA symptoms of angina (myocardial ischemia)

C: tight pressing, heavy

O: discomfort occurring often w/exertion

L: across the chest and may radiate to shoulders, jaw, neck, upper abdomen

D: lasts up to 20 mins

S: mild to moderate pain

P: may be relieved with nitroglycerine

A: may occur w/difficulty breathing, nausea, or sweating

what are some COLDSPA symptoms of myocardial infarction (irreversible heart damage due to myocardial ischemia)

C: tight pressing, heavy

O: discomfort occurring with or w/o exertion

L: across the chest and may radiate to shoulders, jaw, neck, upper abdomen

D: lasts 20 mins to hours

S: often moderate to severe pain

P: rest does not relieve

A: may occur w/nausea, vomiting, weakness, sweating

what are some COLDSPA symptoms of aortic dissecting aneurysm (tear in the wall lining of aorta)

C: tearing ripping sensation

O: abrupt

L: in chest radiating to neck, back, abdomen

D: lasts hours

S: severe

P: aggravated by hypertension; relieved only with treatment

A: also seen with difficulty swallowing, hoarseness, leg pain, syncope

what are some COLDSPA symptoms of pericarditis (inflammation of the parietal pleura next to the pericardium)

C: sharp, stabbing, pounding feeling when heart beats

O: ongoing

L: pericardial pain radiating to shoulders or neck

D: ongoing

S: severe

P: aggravated by breathing position changes, coughing, and may be relieved with sitting forward

A: also seen with fever, weakness, tiredness, coughing, trouble breathing, or pain when swallowing

edema is a sign of what kind of heart disease

right sided heart failure and vascular disease

dyspnea / cough is a sign of what kind of heart disease

left sided heart failure

what is intermittent claudication

- muscle pain, cramping, aching, or fatigue in the lower extremities (most commonly the calves, thighs, or buttocks)

- triggered by physical activity like walking and quickly relieved (usually within 10 minutes) by rest.

- critical warning sign PAD

- indicates reduced blood flow

what is important to remember when assessing the carotid artery

to assess one side at a time

explain what the abdominojugular reflux/hepatojugular refux is when assessing the jugular vein

- patient lies flat or with their upper body elevated at a 30- to 45-degree angle, with the neck relaxed so the internal jugular venous pulse is visible

- The clinician will apply firm, steady pressure to the mid-abdomen or right upper quadrant for 10 to 30 seconds.

- The clinician watches the column of blood in the internal jugular vein in the neck

positive: sustained rise in jugular venous pressure (JVP) of greater than 3 cm that lasts for more than 10 to 15 seconds during continued abdominal pressure -- this tells us that the right ventricle cannot handle the temporary increase in blood returning from the abdomen.

negative: The neck veins may rise briefly when pressure is first applied, but they quickly return to baseline within 10 seconds despite holding the abdominal pressure.

what is a bruit?

a blowing, swishing sound indicating blood flow turbulence outside of the heart, usually in blood vessels; normally none is present

when auscultating the heart, what region do you listen for rate, rhythm, extra sounds or murmurs

apex/mitral -- functionally the same thing/area

what is a murmur?

An unusual or extra whooshing/swishing sound originating inside the heart or across its valves.

what is a thrill?

A palpable (physical) vibration or buzz felt by touch. (often compared to the purring of a cat)

what are we looking for when we percuss the heart

the size of it

what are abnormal pulsations in a cardiovasc. assessment of the precordium (thorax)

- thrills at the base

- life/heave at the sternal border

- volume overload at the apex

- pressure overload at the apex

what are the 3 positions you want a patient in when auscultating their heart

- sitting up/forward

- 30-45 degrees laying supine

- left lateral side

where is S1/"lub" heard best on the body

- apex

- left sternal border

what accentuates the S1 sound

- anemia

- hyperthyroidism

- exercise

- mitral or tricuspid stenosis (abnormal narrowing or constriction)

what can diminish the S1 sound

- a 1st degree atrioventricular (AV) block

- a mild heart rhythm delay where electrical signals take longer than normal to pass from the heart's atria to its ventricles

where is S2/"dub" heard best on the body

- base

- erbs point

- with diaphragm of stethoscope

what accentuates the S2 sound

- exercise

- hypertension

- pulmonary hypertension (high blood pressure in the arteries that carry blood from the right side of the heart to the lungs)

what diminishes the S2 sound?

- aortic stenosis (narrowing of the aortic valve opening)

- pulmonary stenosis (pulmonary valve or the area around it is too narrow)

what causes a S4 sound to be heard

- enlarged ventricles (puts pressure on valves)

- hypertension

- aortic stenosis

- history of myocardial infarction (MI)

what is a pericardial rub and what does it sound like

- when two pericardial layers rub together (extra fluid)

- high pitched leathery sound even when a patient holds their breath

what conditions is pericardial rub associated with

- pericarditis

- pericardial effusion

- acute myocardial infarction (MI) = heart attack

where is the aortic area (anatomically)

second right intercostal space

where is the pulmonic area (anatomically)

second left intercostal space

where is the erbs point (anatomically)

third left intercostal space (left sternal border)

where is the tricuspid area (anatomically)

fourth left intercostal space (left lower sternal border)

where is the mitral/apex area (anatomically)

fifth left intercostal space (mid clavicular line)

what are the 5 different types of ways a murmur can happen/look

1. increased flow thru normal valve

2. flow thru constricted valve

3. flow into dilated camber

4. backflow thru incompetent valve

5. shunting (splitting off of the normal route)

what are the signs of right sided heart failure

- fatigue

- increased peripheral venous pressure

- ascites

- englarged liver & spleen

- distended jugular veins

- anorexia/GI distress

- weight gain

- edema (knee and below)

what are the signs of left sided heart failure

- paroxymal nocturnal dyspnea

- elevated pulmonary capillary wedge pressure (increased pressure in the left atrium and left ventricle during filling)

- cough

- crackles

- wheezes

- blood tinged sputum (spitting up blood)

- restlessness

- confusion

- orthopnea

- tachycardia

- exertional dyspnea

- cyanosis

in an adult, what pulse is strongest/most commonly assessed

radial and pedal (dorsalis pedis)

in an child, what pulse is strongest/most commonly assessed

brachial and femoral

what are the 5 arteries/pulse locations and point where they are

1. brachial

2. femoral

3. popliteal

4. tibial

5. dorsalis pedis (pedal)

what are the 2 deep veins

femoral and popliteal

what are the 2 superficial veins

great saphenous and small saphenous

what is/are perforator veins

they connect superfical veins with deep veins

what is stasis

when blood sticks to an area

- can coagulate and block flow

explain the rates for pulses

0 = non-palpable/absent

+1 = weak, diminished, and barely palpable

+2= normal, expected

+3 = strong obliterates with pressure

+4 = bounding unable to obliterate

document a normal pulse as 2+/4

what are 3 functions of the lymphatic system

- drains excess fluids & plasma proteins & returns to venous system

- trap & destroy microorganism part of the immune system

- absorbs lipids from the small intestine into the bloodstream

*if it hurts, its an infection*

*if it doesn't hurt, it's cancer*

how big should lymphnodes be

less than 1 inch

where are epitrochlear nodes located

- located approximately 3 cm above the elbow on the inner (medial) aspect of the arm

what do epitrochlear nodes do

- drain the lower arm and hand

- lymph from the remainder of the arm and hand drains to the axillary lymph nodes

what are the 2 groups of superficial inguinal nodes

1. horizontal chain

2. vertical chain

where is the horizontal chain located

on the anterior thigh just under the inguinal ligament

where is the vertical chain located

close to the great saphenous vein (superficial vein that runs up the inside of the leg from the foot to the groin)

what is the function of the superficial inguinals

to drain the legs, external genitalia, and lower abdomen and buttocks

what is PAD stand for

peripheral artery disease

what does PVD stand for

peripheral vascular disease

what age does PAD prevalence rise

>10% in clients 60-70

what are signs and symptoms of PAD

- painful cramping

- leg numbness or weakness

- coldness in lower leg or foot

- sores

- change in color of the leg

- hair loss

what are signs of PAD progressing/worsening

- pain at rest

- intensity

- lack of relief

- neuropathy may cause these symptoms not to show

what is this called

arterial insufficiency

- not a pressure wound!

- just an ulcer

what is this called

venous insufficiency

- PVD

what is critical limb ischemia

not getting O2 to tissues

- may need amputation

what would be a way of treating critical limb ischemia

restore blood flow, heal wounds, and save the limb

what are the 6 P's (for not having O2 to an extremity)

- pain

- pulseness

- paresthesia (numbness/tingling)

- paralysis

- pallor (pale)

- poikilothermic (cold)

what is the order in which you would preform the assessment

- inspection

- palpation

- auscultation

*percussing is not a thing when assessing PVS*

what are you inspecting in the arms

- size, edema, patterning

- color

- fingertips (clubbing spooning)

What are you palpating in the arms?

- temp

- capillary refill

- pulses

- lymph nodes -> generally shouldn't feel

what are you inspecting in the legs

- color

- hair

- ulcers

- edema

- varicosities (veins in legs) & thrombophlebitis (blood clot)

What are you palpating in the legs?

- edema

- temp

- lymph nodes

- pulses

what is this test called

allen's test

what is this test called

manual compression test