NUR 319 Ch 20 Heart and Neck Vessels Abnormals

Angina Pectoris

stable (no change in pain pattern within last 60 days) Pressurelike pain (e.g., tightness, squeezing, burning, heaviness that lasts 3-5 minutes precipitated by activity and often resolves with rest and/or nitroglycerin) Generalized substernal or retrosternal: can radiate to teeth, jaw, neck, one or both arms or shoulders; or there may be no pain and only associated symptoms: Diaphoresis, nausea, vomiting, dyspnea, fatigue 

Acute Coronary Syndrome (ACS)

(unstable angina, myocardial infarction) Heaviness; viselike, squeezing, crushing, tightness; vague, burning, constricting, or pressure; poorly localized pain lasting 20-30 minutes to hours and does not resolve with rest or nitroglycerin Generalized substernal or retrosternal: can radiate to teeth, jaw, neck, one or both arms or shoulders; or there may be no pain and only associated symptoms Indigestion-like feeling, nausea, vomiting, dizziness, flushing, perspiration, palpitations, dyspnea, fatigue 

Pericarditis

Sudden sharp and stabbing pain relieved often by sitting or leaning forward and worsens by lying down or with inspiration. Dry cough, muscle and joint aches, fever.  

Pulmonary Hypertension

Cardiac-like chest pain with exertion. Possibly associated with dyspnea, lower extremity edema, and fatigue

Heart Failure

Signs and symptoms can appear in decreased cardiac output, the kidney’s compensatory mechanisms such as retention of sodium and water, increased blood volume and venous return. 

Abnormal pulsations on the precordium

Thrill

palpable vibration that feels like the throat of a purring cat. The thrill signifies turbulent blood flow and directs you to locate the origin of loud murmurs.

Abnormal pulsations on the precordium

Lift (heave)

occurs with right ventricular hypertrophy; diffuse lifting impulse during systole at the left lower sternal border. It may be associated with retraction at the apex.  

Abnormal pulsations on the precordium

Apex (volume overload)

Cardiac enlargement displaces the apical impulse laterally and over a wider area when left ventricular hypertrophy and dilation are present. Common in heart failure. 

Abnormal pulsation on the precordium

Apex (pressure overload)

The apical impulse is increased in force and duration but is not necessarily displaced to the left when left ventricular hypertrophy occurs alone without dilation. This is pressure overload, as found in aortic stenosis or systemic hypertension

Patent Ductus Arteriosus (PDA)

Hole in the channel joining left pulmonary artery to aorta. Normal in fetus, usually closes spontaneously within hours 

Arterial Septal Defect (ASD)

Abnormal opening in atrial septum, cause left-to-right shunt. Causes large increase in pulmonary blood flow

Ventricular Septal Defect (VSD)

Abnormal opening in septum between ventricles, usually subaortic. If large, the extra left-to-right blood volume can overload the right heart and lungs causing right-sided heart failure. 

Tetralogy of Fallot

(1) pulmonic (right ventricular outflow) stenosis, (2) VSD ( (3) compensatory right ventricular hypertrophy, and (4) overriding aorta that recieves blood from both R and L ventricles. Result: shunts a lot of venous blood directly into aorta away from pulmonary system; thus blood never gets oxygenated. Squatting position after starts walking. Dyspnea of exertion. Develops as infant grows. 

Cortication of the Aorta

Severe narrowing of descending aorta, Results in increased workload on left ventricle and obstruction of distal blood flow. 

Aortic Stenosis

Calcification of aortic valve cusps restricts forward flow of blood during systole. LV hypertrophy develops 

Pulmonic Stenosis

Calcification of pulmonic valve restricts forward flow of blood 

Mitral Regurgitation

Stream of blood regurgitates back into LA during systole through incompetent mitral valve. In diastole, blood passes back into LV again along with new flow, results in LV dilation and hypertrophy. Fatigue, palpitation, orthopnea, paroxysmal nocturnal dyspnea. Thrill in systole at apex, lift at apex, apical impulse displaced, S1 diminished S2 accentuated, S3 at apex often present. Murmur: pansystolic, often loud, blowing.

Tricuspid regurgitation

Backflow of blood through incompetent tricuspid valve 

into RA, engorged pulsating neck veins, liver enlarged. 

Lift at sternum if RV hypertrophy present; often 

thrill at left lower sternal border. Murmur: Soft, blowing, 

pansystolic; best heard at left lower sternal border; 

increases with inspiration

Mitral Stenosis

Calcification of the mitral valve; impeding the blood flow. Diminished irregular arterial pulse. Low pitch murmur, palpitations, an pulmonary edema

Tricuspid Stenosis

Calcification of tricuspid valve impedes forward flow into RV during diastole. O: Diminished arterial pulse, jugular venous pulse prominent. Murmur: diastolic rumble; best heard at left lower sternal border; louder in inspiration 

Aortic Regurgitation

Stream of blood regurgitates back through incompetent aortic valve into LV during diastole. LV dilation and hypertrophy caused by increased LV stroke volume. Rapid ejection of large stroke volume into poorly filled aorta, then rapid runoff in diastole as part of blood pushed back into LV. 

Pulmonic Regurgitation