Module 7: Cardiovascular

normal heart sounds

S1 and S2

S1

“lub” - closure of AV valves. initiates systole (contraction)

S2

“dub” - closure of semilunar valves. initiates diastole (relaxation)

physiologic S3

“Lub Dub ta” / “Kentucky” - rapid ventricular filling, highly compliant. present in children, athletes, pregnancy

ventricular gallop S3

“ta Lub Dub” - RAPID VENTRICULAR FILLING, stiff ventricle. HF, MI, increased workload, fluid volume overload

S4

“ta Lub Dub” - FORCEFUL ATRIAL CONTRACTION against stiff ventricle. HF, MI, increased workload, fluid volume overload

preload

amount of myocardial stretch before contraction (end diastolic pressure)

increased preload indicates

fluid volume overload - edema

decreased preload indicates

fluid volume deficit (dehydration)

afterload

amount of resistance the heart must overcome to eject blood during systole/contraction

increased afterload indicates

vasoconstriction and increased BP

decreased afterload indicates

vasodilation and decreased BP

what happens if electrical conduction of heart does not originate from SA node?

AV node becomes pacemaker, slow heart rate, concerns of decreased perfusion - dizziness, LOC

what happens if electrical conduction to atria is erratic and irregular?

atrial fibrillation

P wave

atrial depolarization/contraction

QRS complex

ventricular depolarization/contraction & atrial repolarization/resting

T wave

ventricular repolarization/resting

if jugular venous pulse is visible >45 degrees

fluid volume overload, RS heart failure or cardiac issues, increased preload

order for auscultation of heart sounds

aortic, pulmonic, tricuspid, mitral (A Poor Tired Monkey)

small, weak pulse characteristics

Diminished pulse pressure

Weak and small on palpation

Slow upstroke

Prolonged systolic peak

small, weak pulse causes (decreased SV)

Heart failure

Hypovolemia

Severe aortic stenosis

small, weak pulse causes (increased peripheral resistance)

Hypothermia

Severe congestive heart failure

large, bounding pulse characteristics 

Increased pulse pressure

Strong and bounding on palpation

Rapid rise and fall with a brief systolic peak

large bounding pulse causes (increased SV or decreased peripheral resistance)

Fever

Anemia

Hyperthyroidism

Aortic regurgitation

Patent ductus arteriosus

large bounding pulse causes (increased SV due to decreased HR)

Bradycardia

Complete heart block

Conditions resulting in decreased compliance of the aortic walls

Aging

Atherosclerosis

lift

A diffuse lifting left during systole at the left lower sternal border, a lift, or heave is associated with right ventricular hypertrophy caused by pulmonic valve disease, pulmonic hypertension, and chronic lung disease

thrill

palpated over the second and third ICS; may indicate severe aortic stenosis and systemic hypertension. if palpated over the second and third LEFT ICSs, may indicate pulmonic stenosis and pulmonic hypertension

accentuated apical impulse

sign of pressure overload, has increased force and duration but is not usually displaced in left ventricular hypertrophy without dilatation associated with aortic stenosis or systemic hypertension

laterally displaced apical impulse

A sign of volume overload, result of ventricular hypertrophy and dilatation associated with mitral regurgitation, aortic regurgitation, or left-to-right shunts

refers to a shift in the location of the maximal impulse (PMI), the point on the chest where the heartbeat is most strongly felt, to the left side of the body

sinus arrhythmia

HR speeds up and slows down in a cycle, usually becoming faster with inhalation and slower with expiration

atrial fibrillation

ventricular contraction occurs irregularly. At times, short runs of the irregular rhythm may appear regularly.

S3 causes if heard in people >40

usually associated with decreased myocardial contractility, myocardial failure, congestive heart failure, and volume overload of the ventricle from valvular disease

S4 causes

usually an abnormal finding and is associated with coronary artery disease, hypertension, aortic and pulmonic stenosis, and acute MI

summation gallop

simultaneous occurrence of S3 and S4

pericardial friction rub

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 which may increase with exhalation and when the client leans forward

heart murmur characteristics

timing, intensity (grade 1-6), pitch, quality, shape or pattern, location, transmission, ventilation, and position

assessment findings of RS cardiac problems

increased jugular venous distention, visible jugular venous pulse >45 degrees, generalized edema

assessment findings of LS cardiac problems

respiratory symptoms - dyspnea, crackles, decreased O2 sats

peripheral artery disease - chronic

arterial insufficiency. pain with activity, stops with rest. bilateral

peripheral artery disease - acute

can lead to loss of limb. peripheral arterial occlusion. tissue ischemia and pain. unilateral

peripheral venous disease - chronic

venous insufficiency. peripheral pooling. bilateral

peripheral venous disease - acute

pulmonary embolism. acute - deep venous thrombosis. redness, edema, pain. unilateral

peripheral artery disease

lack of blood flow to distal areas - tissue pain

peripheral venous disease

lack of blood return to central circulation (heart) - peripheral pooling

lymphedema

• Caused by blocked lymph vessels

• Nonpitting

• Usually unilateral

• No skin ulceration or pigmentation changes

venous insufficiency

• Caused by obstruction or insufficient deep veins

• Varying levels of pitting present

• Usually bilateral

• Skin ulceration and pigmentation may be present

clicks

systolic/ejection sounds (valves)

snaps

diastolic/opening sounds (valves)

gallops

S3 and S4 are extra sounds associated with ventricular filling

systolic murmur

in between S1 and S2

diastolic murmur

after S2