Cardiovascular System

Diastole

The phase of the cardiac cycle when the heart muscle relaxes and the ventricles fill with blood.

Example: The lower number in a blood pressure reading 80 in a 120/80 reading

Identify the chest landmark location for the Tricuspid Auscultatory Area

The 4th or 5th intercostal space at the left lower sternal border.

Shock

A life-threatening state of profoundly decreased tissue perfusion leading to widespread cellular hypoxia and organ impairment.

Example: Severe blood loss from trauma causes a critical drop in blood pressure, leading to hypovolemic shock.

Dysrhythmia

An abnormal or irregular heartbeat rhythm caused by a disturbance in the electrical conduction system.

Example: Atrial fibrillation causes the heart to beat irregularly and often too quickly.

What physical skin features distinguish Brawny Edema from pitting edema

Fluid can no longer be displaced (no pitting); tissue palpates as firm or hard, and skin appears shiny, warm, moist, and thickened with brown pigment discoloration.

Why must physical assessment of peripheral vascular extremities always be performed bilaterally?

To compare symmetry in temperature, pulse strength, color, and edema between both sides of the body.

Myocardial Infarction (MI)

Death of heart muscle tissue resulting from prolonged loss of blood supply (commonly known as a heart attack).

Transient Ischemic Attack (TIA)

A temporary episode of neurological dysfunction caused by brain ischemia without permanent tissue death (often called a mini-stroke).

Perfusion

The passage and circulation of blood through capillary beds to deliver oxygen and nutrients to body tissues.

Example: Warm, pink fingers with quick capillary refill indicate good peripheral tissue perfusion

Which non-pharmacological nursing measures help reduce peripheral edema?

• Limb elevation above heart level • Dietary sodium reduction • Fluid restriction • Monitoring daily weights

What are the typical wound features of an arterial insufficiency ulcer?

Ulcers with smooth edges, a "punched out" appearance, and minimal drainage

Which heart valve closures generate the second heart sound (S2)?

The closure of the Semilunar valves: Aortic and Pulmonic valves.

True or False: Cardiac Output refers to the volume of blood pumped by the heart with each individual beat.

FALSE.

Cardiac Output is the volume pumped per minute. The blood pumped with each individual beat is Stroke Volume.

Metabolic Syndrome (Syndrome X)

A cluster of risk factors—including high blood pressure, elevated blood sugar, excess abdominal fat, and abnormal cholesterol levels—that increases cardiac disease risk.

Example: A person with abdominal obesity, hypertension, and high fasting blood glucose is diagnosed with metabolic syndrome.

Which heart valve closures generate the first heart sound (S1)?

The closure of the Atrioventricular (AV) valves: Tricuspid and Mitral valves.

What tool should a nurse use when a peripheral pulse cannot be detected by manual palpation?

A Doppler ultrasound device

Which nonmodifiable risk factors contribute to coronary heart disease?

• Family history of heart disease • Gender (higher risk in men and postmenopausal women) • Increased age • African American ethnicity

Epicardium

The thin outermost membrane layer covering the surface of the heart.

What is the primary underlying cause of venous insufficiency in the lower extremities?

Decreased venous return leading to increased blood pressure inside the veins.

Identify the chest landmark location for the Mitral (Apical) Auscultatory Area.

The 5th intercostal space at the left midclavicular line.

What is the primary difference in function between the diaphragm and the bell of a stethoscope?

• Diaphragm: Best for hearing high-pitched sounds (e.g., normal S1 and S2 heart sounds).

• Bell: Best for hearing low-pitched sounds (e.g., extra S3/S4 heart sounds or murmurs).

Ischemia

An insufficient blood supply to a tissue or organ, restricting the delivery of oxygen and nutrients.

Why does lying flat in bed increase the heart's workload compared to sitting upright?

Lying flat shifts peripheral blood from the lower extremities into the trunk, increasing venous return to the atria and boosting stroke volume and cardiac workload.

Intermittent Claudication

Cramping leg pain triggered by exercise and caused by inadequate arterial blood flow, which is relieved by rest.

Systole

The phase of the cardiac cycle when the heart muscle contracts and pumps blood out of the chambers.

Example: The top number in a blood pressure reading (120 mmHg in 120/80 mmHg) measures arterial pressure during systole.

Trace the path of blood flow from the lungs through the heart to the systemic body tissues.

Pulmonary Veins → Left Atrium → Mitral (Bicuspid) Valve → Left Ventricle → Aortic Valve → Ascending Aorta → Systemic Circulation

What is the primary objective of applying antiembolism stockings?

To compress superficial leg veins and deep vein systems, maintaining venous return and preventing blood pooling and thrombus formation.

Identify the chest landmark location for the Aortic Auscultatory Area.

The 2nd intercostal space at the right sternal border.

Telemetry

Continuous electronic monitoring and transmission of a patient's cardiac electrical activity from a distance.

Example: A hospitalized patient wears portable chest leads so nurses can continuously observe their heart rhythm at a central station.

Automaticity

The ability of heart cells to generate an electrical impulse spontaneously and independently.

Example: The Sinoatrial (SA) node fires on its own to set the normal heart rhythm without needing a signal from the brain.

What is the primary function of the cardiovascular system?

To act as a transport system delivering blood containing oxygen, nutrients, metabolites, and hormones to every cell in the body.

Cardiac Biomarkers

Proteins released into the bloodstream when heart muscle cells are injured or damaged.

Example: A doctor orders a troponin blood test to check if a patient with chest pain had a heart attack

Stroke Volume (SV)

The volume of blood ejected by the left ventricle with each individual heartbeat.

Example: An average heart ejects approximately 70 mL of blood per contraction.

What characterises 1+ Pitting Edema?

A slight indentation (2 mm) with normal contours and rapid rebound.

Which primary pacemaker structure determines heart rate under normal physiological conditions?

The Sinoatrial (SA) Node

What key nursing interventions promote venous return and prevent venous stasis in bedbound patients?

• Applying sequential compression devices (SCDs) • Applying antiembolism stockings • Encouraging leg exercises • Avoiding constrictive clothing or position constriction • Administering anticoagulation prophylaxis

Myocardium

The thick, middle muscular layer of the heart responsible for pumping action.

Example: Severe loss of blood flow can cause tissue death in the myocardium.

What is a pulse deficit, and how is it determined?

The difference between the apical heart rate and a peripheral pulse rate, calculated by subtracting the radial rate from the apical rate when assessed simultaneously

What skin and hair characteristics are associated with chronic lower extremity arterial insufficiency?

Skin that is cool to touch, pale (worsening with elevation), shiny, thin, hairless, accompanied by muscle atrophy and diminished or absent pulses.

What characterises 2+ Pitting Edema?

A deeper pit (4 mm) that lasts longer than 1+ with a fairly normal contour.

What is the primary underlying cause of arterial insufficiency?

Insufficient arterial blood supply to an area causing tissue ischemia and necrosis.

Contractility

The natural squeezing force or strength generated by the contracting heart muscle.

Example: Epinephrine increases heart muscle contractility to pump blood more forcefully during exercise.

Trace the path of blood flow from the systemic venous return through the heart to the lungs.

Vena Cava → Right Atrium → Tricuspid Valve → Right Ventricle → Pulmonic Valve → Pulmonary Artery → Lungs

What characterises 3+ Pitting Edema?

A deep pit (6 mm) that remains for several seconds after pressing, with obvious swelling.

Endocardium

The innermost tissue layer lining the inner chambers and valves of the heart.

Example: Bacteria in the bloodstream can infect this inner lining, causing endocarditis.

What skin appearance and discoloration are characteristic of chronic venous insufficiency?

Brawny edema with firm, thickened skin and brown pigment discoloration caused by iron deposits from broken-down red blood cells.

What is a carotid vascular bruit, and how is it assessed?

A blowing or swishing sound caused by turbulent blood flow in a narrowed carotid artery, assessed via auscultation with a stethoscope.

What is the expected normal time frame for capillary refill after pressing a nail bed?

Less than 2 to 3 seconds

What are the typical wound features of a venous insufficiency ulcer?

Irregular edges with weeping, wet drainage.

Sequential Compression Devices (SCDs)

Inflatable leg sleeves connected to a pump that compress leg veins rhythmically to promote venous return and prevent blood clots.

Example: A bedridden post-surgical patient wears SCDs on both calves to prevent deep vein thrombosis.

What does pain at rest indicate in a patient with arterial insufficiency?

It indicates a worsening, severe vascular condition with critical tissue ischemia

Angina

Chest pain or discomfort caused by reduced blood flow and oxygen supply to the heart muscle.

Example: A patient feels pressure in their chest while climbing stairs that goes away when they res

What three main physiological factors directly determine stroke volume?

1. Accommodation of incoming blood volume (preload/stretch)

2. Contractility of the heart muscle

3. Resistance to blood flow in the circulatory system (afterload)

Syncope

A temporary, sudden loss of consciousness (fainting) caused by a transient decrease in blood flow to the brain.

Example: A patient standing up too quickly experiences sudden dizziness and faints momentarily.

Stroke

Sudden brain cell damage or death caused by impaired blood flow (ischemic) or bleeding (hemorrhagic) in the brain.

Example: A sudden arterial blockage causes facial drooping and arm weakness on one side of the body

Which modifiable risk factors contribute to coronary heart disease?

• High blood pressure • Cigarette/tobacco use • High blood cholesterol • Physical inactivity • Obesity • Diabetes • Daily living stress

Cardiac Output (CO)

The total volume of blood pumped by the heart in one minute.

Example: A healthy resting adult pumps about 5 L of blood per minute throughout the bod

Thrombus

A stationary blood clot formed within a blood vessel or heart chamber.

Example: Prolonged immobility leads to the formation of a deep vein thrombus in the lower leg.

Identify the chest landmark location for the Pulmonic Auscultatory Area

The 2nd intercostal space at the left sternal border.

How does leg positioning affect pain in venous insufficiency versus arterial insufficiency?

• Venous insufficiency pain is relieved by leg elevation. • Arterial insufficiency pain is relieved by leg dangling (dependent positioning).

How do blood vessels change with aging and lifestyle factors in older adults?

They undergo calcification, fatty degeneration, and diminished elasticity, leading to higher blood pressure and decreased cardiac output.

They undergo calcification, fatty degeneration, and diminished elasticity, leading to higher blood pressure and decreased cardiac output.

A palpable, purring vibration felt over a turbulent or narrowed artery, detected through gentle palpation.

What is the mathematical formula used to calculate Cardiac Output (CO)?

CO=HR×SV (where HR is Heart Rate in beats per minute, and SV is Stroke Volume per beat).

What is the normal measurement limit for jugular venous pressure relative to the sternal angle when elevated at 45 degrees?

Less than 3 cm

What characterises 4+ Pitting Edema?

A deep pit (8 mm) that remains for a prolonged time (possibly minutes), with frank swelling.

Why is chest pain that worsens with deep breathing or movement unlikely to be cardiac ischemia?

Pain caused by cardiac ischemia originates from internal heart muscle hypoxia and does not change with chest wall motion or lung inflation (which typically indicates musculoskeletal or pleuritic causes).