week 4 cardiac

heart size

heart size

• 5 in long

• 3.5 diameter

• 2.5 thickness

Female heart

smaller, less in weight compared to male heart

heart beat

can be easily palpated and auscultated

In a healthy person the blood flows

unidirectionally (one way)

precordium

the area on the chest to listen for heart sounds

pericardium

double layered sac that encloses the heart

fluid between the pericardium

is there to reduce friction when the heart is contracting

when cardiac valves are pathologic

forward blood flow is restricted, resulting in regurgitation or cardiac murmurs

S1

• lub

• first heart sound

• made due to the closure of the AV valves (tricuspid and mitral valves)

• when ventricles are filled, loudest at the apex of the heart (bottom)

S2

• dub

• second heart sound

• made due to the closure of the semilunar valves (aortic and pulmonic valves)

• when ventricles empty blood to the pulmonic artery and aorta

• loudest at the base of the heart (top)

interatrial septum

separates the left and right atrium

interventricular septum

separates the left and right ventricle

pulse grading

1+: faint, weak and thready

2+: normal pulse

3+: brisk

4+: bounding

aortic area

• 2nd ICS

• Rt sternal boarder

  • S2 louder than S1

pulmonic area

• 2nd ICS

• Lft sternal boarder

  • S2 louder than S1

Erbs point area

• 3rd ICS

• Lft sternal boarder

• S1=S2

Tricuspid area

• 4th ICS

• Lft sternal border

• S1 louder than S2

Mitral area

• 5th ICS

• Lft midclavicular line

• S1 louder than S2

Cardiac murmurs are associated with

• tricuspid regurgitation

• tricuspid stenosis

• mitral regurgitation

• mitral stenosis

• aortic regurgitation

Cardiac murmur grading

• 1/6: barely audible

• 6/6: loudest

major risk factors for heart disease

1. HTN

2. Smoking

3. Diabetes

4. Obesity

5. High Cholesterol

Heart sounds are interpreted according to

• pitch

• duration

• intensity

• phase

angle of louis

in line with the second rib

how to name ICS

by the rib above

cardiac nerve supplying the heart

• sympathetic nerves

• parasympathetic nerves

sympathetic nerves

• cardiac nerves that are responsible for the stimulation of the heart

• increases heart rate

• increases dilatation of the coronary arteries

parasympathetic nerves

• cardiac nerves that are responsible for decrease in the stimulation of the heart

• decrease in heart rate

• decrease in dilatation of the coronary arteries

Point of maximal impulse (PMI)

• heard the loudest at the 5th ICS, left midclavicular line

• can be palpated or auscultated

PMI in infants

• loudest at the 4th ICS, left midclavicular line

• heart is horizontally positioned

Percussion of the heart

anticipated dullness sound

Normal BP

<120/80

Prehypertension

120/80- 139/89

HTN

140/90

African americans

have a higher incident of HTN

pedal pulses

located lateral and parallel to the big toe

popliteal pulses

located medially behind the knees

femoral pulses

located at the inguinal area

posterior tibialis

located at the grove behind the medial malleolus and Achillies tendon

radial pulses

located lateral to the wrist, in line with the thumbs

ulner pulses

located medial to the wrist, in line with the small finger

ECG

electrical representation of cardiac cycles that are documented by the deflection on recording paper

Electrical initiation of the heart

• occurs in the SA node (pacemaker)

• fires at 60-100 joules/ min

AV node

• fires at 60 j/min

bundle branches

• fires at 40-60 j/min

cardiac depolarization or contraction

• occurs when cardiac currents fire from the SA nodes and spread across the atria causing a cardiac contraction

• during this time the cardiac cells are positively charged

Repolarization

• cardiac cells are relaxed

• negatively charged

Imbalance of electrolytes

• such as sodium, potassium, and calcium

  • can result in dysregulation of the cardiac contraction system

P-wave

atrial depolarization/ contraction

atrial repolarization

is hidden behind the QRS complex

QRS

ventricular depolarization/ contraction

T-wave

ventricular repolarization/ relaxation

ventricular tachycardia

• rhythm is rapid, regular heart beat

• as high as 200 bpm

heart block

• slow heart rate

• as low as 20-40 bpm

• conduction between the atria and ventricles are disrupted

S/S of heart failure

• JV pulsation over 3cm, with head above 45*

• low BP

• fatigue

• tachycardia

• HR >120 bpm

• ankle edema

• SOB

• S3 on auscultation

• weak peripheral pulses

Severe aortic regurgitation

syncronous head bobbing with heart beat

infective endocarditis

• thin red line (splinter hemorrhage)

• present on the nailbeds of a cardiac patient

atrial insufficency

legs are cold with no hair growth

venous insufficency

legs are warm with pain from prolonged sitting or standing

Raynauds syndrome

fingers and hands have intermittent skin pallor and rubor

allens test

used to determine patency in the radial and ulnar arteries

varicosity

does not disappear when legs are elevated

when intake is > than output

the client is retaining fluids

JVD > 3cm causes

• increased venous pressure

• fluid overload (CHF)

• pressure at the superior vena cava

female Caucasians 65-74 yrs

have a higher incidence of cardiovascular diseases

native Americans below the age of 35

have 2x incidence of cardiovascular death or mortality

smoking

is attributed to cardiovascular diseases

Use of cocaine

is attributed to

• HTN

• MI

• ruptured aorta

S3 (ventricular gallop)

• occurs when there are vibrations when the AV valves open and blood goes to the ventricles.

• heard after S2

• May be heard in

  • healthy children

  • healthy adults

  • 3rd trimester of pregnancy

S4 (atrial gallop)

• occurs by atrial contraction and ejection of blood to the ventricles in late diastole

• heard before s1

• can be heard in

  • healthy children

  • well fit individuals

  • healthy elderly

tetraology of fallot

• 4 cardiac defects

  • dextroposition of aorta

  • pulmonary stenosis

  • Right ventricular hypertrophy

  • ventricular septal defect

patent ductus arteriosus

• opening between pulmonary artery and descending aorta

• should close 24-48 hours after birth

• if it does not close you will hear cardiac murmurs upon auscultation

Foramen ovale

• passage way of blood between the right and left atria

• should close shortly after birth

• failure to close then cardiac murmurs can be heard

70% of children

• will have innocent cardiac murmur

• common with fever or anemia

innocent cardiac murmurs

arise from high blood flow across normal heart structures

conditions that increase metabolism

• like fever and anemia will increase cardiac murmurs

average heart beat in 24hrs

100,000

when all blood vessels are connected end to end

• it totals 60,000 miles

  • would go 2x around the world

MI

• feeling of indigestion

• nausea

• SOB

GERD

• feeling of indigestion

• nauseas

• SOB

• eructation

  • hoarseness

pulses paradoxus

• abnormally large decrease in BP during inspiration

• as much as 10mmHg

causes of pulses paradoxus

• immune system response due to heart attack or cardiac surgery