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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.
SVC/IVC
right atrium
tricuspid valve
right ventricle
Pulmonary valve
Pulmonary arteries
Pulmonary veins
left atrium
mitral valve
left ventricle aortic valve
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
