Cardiavascular

around 7 yrs old

listen on both infants and children on the 4th intercostal

At what age can you start listening to the heart at the 5th intercostal space?

Until then where do you listen from and why?

difference between diastolic and systolic pressure.

older adults

What is pulse pressure? What age group is this more common in?

180

What is the average HR for neonats?

yes, children usually have higher heart rates and resp as their system are not fully developed

Are the vital signs in infants and children different? Why or why not?

when diastolic BP is less and 80 and systolic BP is 130 and higher

older adults

What is isolated hypertension and which age group is it most common in?

they have more blood volume bc of the fetus abt 30-50% more blood causing HR to go up 10-20 bpm

however their BP goes down due to vessels dialating to accommodate for the fetus and hormones that pass through

When a women is pregnant what happens to her blood pressure?

• being couch potato

• pollution

What would be some environmental affects that would cause an impact in our health?

some of us can be genetically predisposed to certain illnesses due to genetics (high BP, diabetes, cancer, etc) as well as certain races particularly african america/black have higher BP due to their inefficiency to up take sodium through the channels

How do genetics influence our health?

good HDL and bad is LDH

What is good cholesterol and bad cholesterol?

they can have an ache or sharp pain between scapulas in the back or even dull ache in the chest near clavicles

How would a myocardial infraction present on a woman?

they are abt the same since men and women now experience similar stressors and lifestyles

What are the stats on MIs for men and women?

• transporting nutrients and oxygen to the body

• removing wastes and CO2

• maintaining adequate perfusion or organs and tissues

What are the major functions of the cardiac system?

via the blood things are “dumped” into the blood stream and it delivers it to tissue

How does the cardiac system move nutrients and O2 through the body?

it happens a lot in the pulmonary circuit, CO2 leaves as O2 enters and as the body is delierving oxygenated blood with nutrients each tissue dumps their waste

Explain how the CS removes wastes and CO2 from the body?

thin sac composed of layers that surround the heart

the pericardium is a cavity really between all the layers of tissue that have some fluid that helps have friction for the heart to contract, however too much fluid means the heart isn’t getting adequate support/blood from other systems and is failing

What is the pericardium?

What purpose does it serve?

at the bottom of heart (5th intercostal)

it’s not flat and more to the left of the body :)

The apex of the heart is located where?

How does the heart sit within the human body?

mitral and tricuspid valves as well as the semilunar valves and aortic valves

the difference is the mitral and tricuspid valves have leaflets and the SL valves have cusps and separate the blood from great arteries while the other two separate atria from ventricles

List the AV valves.

1. SVC/IVC

2. right atrium

3. tricuspid valve

4. right ventricle

5. Pulmonary valve

6. Pulmonary arteries

7. Pulmonary veins

8. left atrium

9. mitral valve

10. left ventricle aortic valve

11. aorta

How does blood flow through the heart?

• palor

• cyanosis

• nail beds

• chest rise and fall and shape/look

• a lot of what you do for resp can be done for the heart too, especially for peripheral vascular

What can be done for inspection of the heart?

4th intercostal on infants and children but 5th intercostal on adults

if upon inspection you notice/feel (palpation) the heart too off to the side it means the heart is enlarged

Where do we get the apical impulse?

it occurs bc it is a forceful ventricular thrust meaning the heart is working too hard not what we want to see

Explain heave or lift of the heart.

feel apical impulse on exhalation and palpate precordium for a thrill

What can we do for palpation of the heart?

a palpable vibration, feels like the throat of a purring cat

this popping up means there is turbulent blood flow and directs you to find the location of the murmur

What is a thrill of the heart?

S - when the heart muscles contact and pump blood into the from the heart to the arteries (aortic and pulmonary)

D- when heart muscles contract and allow the cambers (ventricles and atrium) to fill with blood

Explain systole and diastole.

S1 - sound that occurs bc of the closing of the AV valves

Located int tricuspid and mitral valves

heard over the entire precordium but best heart at the apex

What is S1?

Where is it located?

Where is it best heard/loudest?

S2 - closure of the semilunar valves

located at semilunar valves

hear all over precordium but best heard at the base of the heart

What is S2?

Where is it located?

Where is it best heard/loudest?

S1 split means you are hearing the tricuspid and mitral valves separately, rarely occurs but is normal if it does

S2 split is also normal and occurs during towards the end of inspiration, it is hearing the aortic and semilunar valves separately

What is meant by split sound?

you can do this alone or with the help of someone else

it is getting the radial pulse and apical pulse and comparing the two pulses. Usually subtract to see the difference but the two should be close, if not there is a problem somewhere in the peripheralvascualr system

What is a pulse deficite?

• S3 and S4

• clicks

• snaps

• friction rubs murmurs

What are some other heart sounds?

S3 - ventricular filling sound, occurs during the diastole period of the rapid filling phase. can be confused with S2

heard at the apex at the lower left sternal border, S3 doesn’t vary in timing with respirations, S3 is lower pitched

What is S3?

Where is it located?

How does it sound?

in adults, it is pathologic S3, or ventricular gallop, and persists when sitting up. This means there is a decreased compliance of the ventricles aka heart failure

this can also happen with volume overload as seen in mitral regurgitation and aortic or tricuspid regurgitation

When is S3 abnormal?

S4 - ventricular filling sound, occurs when atria contract in late diastole heard before S1

heard best at the apex with the person in left lateral position

L sides S4 is more common than R sided, right sided best heard at the left lower sternal border and can increase with inspiration

What is S4?

Where is it located?

physiologic occurs with older adults 40-50 and doesn’t really mean CV disease is at play

pathologic S4 L sided occurs with decreased compliance of the ventricle (coronary artery disease) and systolic over load (afterload) including outflow obstruction to ventricles (aortic stenosis.

S4 right sides is more associated with pulmonary stenosis or pulmonary hypertension

Explain S4 in both physiological and pathologic senses.

check in later

How does a click sound, sound like. Is this good or bad?

S3 is at the start of Diastole while S4 is at the end of it

When does S3 and S4 start and end?

with blood filling the ventricles

What does S3 and S4 interfere with?

check in later

What is a snap sound of the heart?

happens when the heart is inflamed

Explain friction rubs of the heart?

murmurs are tuberlunet blood flow

structural defects or physiologic conditions (wear and tear)

What do murmurs cause?

What can cause them?

heard/caused when velocity of blood increases (flow murmur)

• i.e. exercising

viscosity of blood decreases

• i.e. anemia

What are the things to know about murmurs?

specifics!

pericardial friction rub

What can still be heard if the patient holds their breath?

hight pitched sractchy scraping sound

How does pericardial friction rub sound?

Pericardial friction rub

What condition is common after an MI?

inflammation of the pericardial sac

what causes and pericardial friction rub?

pericardial effusion

What may cause a muffled S1 and S2 sound?

sounds that do not belong (should not be heard)

Describe and adventitious sound?

• friction rubs

• clicks

• snaps

• S3

• S4

What are the types of adventitious sounds?

these are adventitious sounds in children and young adults and is common place here

Explain Innocent adventitious heart sounds?

occurs bc of of physiological change

• pregnancy

• anemia

• fever

• hyperthyroidism

Explain physiologic adventitious heart sounds?

structural valve defects, abnormal chamber openings

Explain pathologic adventitious heart sounds?

coronary arteries

What arteries feed the heart oxygen and nutrition?

Coronary Arteries

This artery if blocked can lead to an MI.

not getting O2 or nutrients due tot he high BP causing tension on the heart, requiring more effort to feed the rest of the body and the heart itself

If diastolic BP is high what is the heart not getting because of what?

SV - volume of blood pumped out of left ventricle of the heart during each systolic cardiac contraction

CO - equals the volume of blood in each systole (SV) and the bets per minute (HR)

Explain stroke volume and cardiac output/

assessment of the cardiac output valve based on patients size

Explain cardiac index.

volume is the venous return that builds during diastole

• length to which the ventricular muscle is stretched at the end diastole just before contraction

What is preload?

is pressure, the opposing pressure the ventricle must general to open the aortic valve against the higher aortic pressure

What is afterload?

the heart being able to match cardiac eject to the changes that happen during ventricular filling therefore regulating ventricular contraction and ejection

• under normal circumstances the heart is able to increase SV appropriately according to venous return

Explain starlings law.

Hint: remember physio