Ch 20 (Heart & neck vessels)

Whats the precordium?

The area on the anterior chest that overlies the heart & great vessels.

How many chambers does the heart have?

4 chambers— right & left atria & ventricles

What ar the great vessels connected to the heart?

Superior & inferior vena cava

Pulmonary artery,

Pulmonary veins

Aorta

What are the 2 continuous blood loops in circulation?

Pulmonary circulation & systemic circulation

What are the 3 layers of the heart wall?

Pericardium, myocardium & endocardium

What separates the right & left sides of the heart?

Septum

Whats the function of the atrium?

Serves as a thin-walled reservoir for holding blood

Whats the function of the ventricle?

Thick-walled, muscular pumping chamber

Whats the main purpose of heart valves?

Prevent the black flow of blood

How do heart valves open & close?

Passively, in response to pressure gradients in moving blood

Whats the 4 valves in the heart?

2 atrioventricular (AV) valves & 2 semilunar (SL) valves

What are the AV valves & their locations

Tricuspid (Right AV) & mitral/bicuspid (left AV) valves

What anchors the valve leaflets to the papillary muscles?

Collagenous fibers called chordate Tendineae

When do AV valves open?

Open during diastole to allow ventricles to fill

When do AV valves close?

Close during systole to prevent regurgitation

Trace the direction of blood flow thru the heart

Vena cava → right atrium → tricuspid valve → right ventricle → pulmonic valve → pulmonary veins → left atrium → mitral valve leaflets→ left ventricle → aortic valve → aorta → body

Whats S1

Sound from closure of AV calves, marking the start of systole

Wheres S1 the loudest?

At the apex

Whats S2

Sound from closure of semilunar valves, marking end of systole

Where’s S2 the loudest?

at the base

How does registration affect heart sounds?

”More to the right, less to the left” — inspiration increases right heart volume

Whats the 3rd heart sound? (S3)

Occurs when ventricles resist filling during early diastole

When does S3 occur?

Immediately after S2

Whats the 4th heart sound? (S4)

Occurs at the end of diastole when ventricles resist filling resists filling

When does S4 occur?

Just b4 S1

Whats a murmur?

Blowing, swooshing sound due to turbulent blood flow

List 3 conditions that increase murmers

Increase velocity, decreased viscosity or structural valve defects

Whats 4 characteristics describing heart sounds?

Frequency, intensity, duration & timing 

Whats cardiac output?

Stroke volume x heart rate

Whats average resting cardiac output?

4–6 L/min

what affects cardiac output?

Preload & afterload

What age-related changes occur in the heart?

↑ systolic BP, thickened LV wall, ↓ sympathetic response, fatigue.

What ECG changes occur w/ aging?

Slowed conduction, ectopic beats common

Whats leading cause of death in adults 65+?

Cardiovascular disease

Name 4 recommended healthful factors for CVD prevention

No smoking, no obesity, physical activity, healthy diet

What are key risk factors in ASCVD risk estimation?

Age, sex, cholesterol, BP, diabetes, smoking, HTN treatment

How does hypertension affect the heart?

Accelerates atherosclerosis

How does smoking affect oxygenation?

Reduces oxygen transport & promotes vessel injury

What increases CVD risk in women?

Premature menopause, pregnancy complications, atypical symptoms

What subjective data are collected in cardiac assessment?

Chest pain, dyspnea, orthopedic, cough, fatigue, cyanosis/pallor, edema, nocturnal, history & risk factors

What should be asked abt chest pain?

Onset, type, triggers, relief & associated symptoms

What should be assessed abt dyspnea?

Onset, triggers, position, time of occurrence & ADL impact.

What does orthopedic indicate ?

Difficulty breathing while lying flat

What should be asked abt cough?

Duration, time, sputum & triggers

What should be asked abt edema?

Location, timing & relief factors

Whats nocturna & why is relevant?

Nighttime urination; may indicate heart failure 

What is checked in objective cardiac assessment?

Rate, rhythm, S1/S2, murmurs, extra sounds

Whats normal heart rate range?

50-95 bpm

Wheres S1 best heard?

Apex w/ diaphragm

Where’s S2 best heard?

Base w/ diaphragm

When’s a split S2 heard?

End of inspiration, normal variant

Where’s S3 best heard?

At apex, w/ bell, pt in left lateral position 

Where’s S4 best heard?

At apex, w/ bell in left lateral position

How are murmurs graded?

1 to 6 by loudness

What other murmur characteristics are noted?

Pitch, pattern, quality, Location 

In older adults, what physical finding is common but not pathologic?

Occasional ectopic beats

What lifestyle changes promote heart health?

Aspirin therapy, BP/cholesterol control, smoking cessation, healthy diet, exercise, weight control

What are ischemic causes of chest pain?

Angina pectoris, Variant angina, acute coronary syndrome

What are non-ischemic cardiac causes of heat pain?

Pericarditis, mitral valve, prolapse, aortic dissection

WHat are pulmonary causes of chest pain?

Pulmonary embolism, pneumonia, pneumothorax

What are GI causes of chest pain?

GERD, esophageal spasm, cholecystitis, pancreatitis

What are musculoskeletal causes of chest pain?

Costochondritiis, muscle strain

What are psychogenic causes of chest pain?

Depression & anxiety

What symptoms may women have during a heart attack?

Chest fullness, arm/back/neck/jaw pain, SOB, sweating, nausea

How does angina pain present?

Pressure-like, brought by activity, relived w/ rest

How does MI pain differ?

Heavy, vice-like, not relieved by rest

How does pericarditis pain differ?

Shapre, relieved by leaning forward

What pain is seen w/ pulmonary embolism?

Sharp pain worsening w/ deep breaths

What pain is seen w/ GERD?

Burning after meals, may mimic angina

In case study, what are possible risk factors before subjective/objective data?

From context: likely HTN, smoking, obesity, family history — content not expanded in slides.

Why would nocturia occur in heart disease?

Fluid redistribution, increases nighttime kidney perfusion

Why might pitting edema & lack of leg hair occur?

Poor circulation & chronic venous insufficiency

Why might an S3 be present?

Heart failure or volume overload