CV/Peripheral

Systole: The phase of the cardiac cycle during which the heart is contracting and pumping blood out.
Diastole: The phase of the cardiac cycle during which the heart is at rest, allowing for filling of the heart.

Semilunar Valves: Open during systole.
- Aortic Valve: Between the left ventricle (L vent) and the aorta.
- Pulmonic Valve: Between the right ventricle (R vent) and the pulmonary arteries.
Atrioventricular Valves: Open during diastole.
- Mitral Valve: Between the left atrium and left ventricle.
- Tricuspid Valve: Between the right atrium and right ventricle.

Aorta: Carries oxygenated blood from the left ventricle to the arteries.
Vena Cava: Carries deoxygenated blood from the veins to the right atrium.
- Superior Vena Cava: Superior to the diaphragm; returns deoxygenated blood from structures located above the diaphragm.
- Inferior Vena Cava: Returns deoxygenated blood from structures located below the diaphragm.
Pulmonary Artery: Carries deoxygenated blood from the right ventricle to the lungs.
Pulmonary Vein: Carries oxygenated blood from the lungs to the left atrium.

Mechanism: Increasing filling pressure causes tension on the heart, which leads to the opening of valves and movement of blood from chamber to chamber and from chambers to great vessels.
Types of Heart Sounds:
- S1/S2: Vibration sounds from the leaflets of the heart valves closing.
  - S1: The first heart sound, made when the mitral and tricuspid valves close.
  - S2: The second heart sound, made when the aortic and pulmonic valves close.
- S3/S4: Adventitious, pathological sounds correlated with heart failure, myocardial infarction (MI), and hypertension (HTN). Best Heard: Positioned on the left lateral side.
- Cardiac auscultation locations:
  - Aortic area: 2nd ICS, Right sternal border (best for aortic stenosis)
  - Pulmonic area: 2nd ICS, Left sternal border
  - Erb’s point: 3rd ICS, Left sternal border (best for aortic regurg)
  - Tricuspid area: 4th ICS, Left sternal border
  - Aortic area: 5th ICS, Left midclavicular line (best for mitral regurg)

Definition: The palpation point of the apical impulse during the cardiac cycle.
Assessment: Best assessed in the supine position or tilted to the left (brings valves closer to the surface)
Description:
- Location: Internally located at the cardiac apex 5th ICS medial to the mid-clavicular line meets the 5th intercostal space.
- Diameter: Typically 1-2.5 cm wide; anything wider is considered an abnormal finding caused by hypertrophy.
- Amplitude: Describes the strength of the palpated impulse—assessed as diminished, variable, accentuated, increased, decreased, absent, or normal.
- Duration: Normal duration is 2/3 of systole; abnormal durations include abbreviated or elongated lengths.

Location: In the sternocleidomastoid muscle of the neck adjacent to the cricoid cartilage.
Palpation: Assess one carotid artery at a time to feel for pulsation and thrill.
Auscultation: Use the bell of the stethoscope while the patient holds their breath.
- Auscultated turbulence is known as a bruit.
  - 0: absent
  - 1+: diminished
  - 2+: normal
  - 3+: a little more full than normal
  - 4+: bounding
Tip: you FEEL thrill, and HEAR the bruit

Location: In the sternocleidomastoid muscle of the neck.
Clinical Significance: Jugular vein distention indicates heart failure.
Assessment Technique: Patient reclined at a 40-degree angle; visualization requires tangential lighting; have the patient hold their breath during auscultation with the bell of your stethoscope

Definition: Caused by the arterial pressure wave initiated when the left ventricle empties into the aorta.
Arterial Perfusion Testing through Allen Test: Usually performed before drawing an Arterial Blood Gas (ABG) or cannulating the radial artery for an arterial line. It ensures that if the radial artery is damaged or blocked, the ulnar artery can still provide enough blood to keep the hand alive.
Homan’s sign (outdated test, use doppler now): Forcefully dorsiflexing the foot (pulling toes toward the shin) with the knee extended. Calf pain = clot.
Types of Pulses: Radial, Ulnar, Femoral, Posterior Tibial, Dorsalis Pedis.
Pulsus paradoxus: Blood pressure drop with breath; Caused by tamponade or severe asthma
Pulsus alterans: Alternating strength of beats; indicates LHF

Overview: As long as heart contractility and rate are not compromised, blood circulates throughout the body and returns to the heart to restart the process.
Blood Flow Rate: Determined by pressure changes in the vessels, regulated by both intrinsic and extrinsic factors.
CO: blood flow per minute

Hypertension: Chronic increased pressure inside the vessels leads to rigidity in vessel walls, compromising blood supply and failing to meet oxygen demands, which forces the heart to work harder and pump faster.
- JNC 7 Guidelines: Released in 2002; used to define hypertension parameters.
- JNC 8 Guidelines: Released in 2014; modifications to medication management protocols.
  - Normal is <120/<80
  - preHTN is 120-139/80-90
  - Stage 1 HTN is 140-159/90-99
  - Stage 2 HTN is >160/>100
Coronary Artery Disease (CAD): Hyperlipidemia results from plaque formation within the vessels, where blood flow past plaques becomes impeded, causing turbulence and resistance. Dislodged plaques increase the risk of venous thromboembolism (VTE).
Valvular Heart Disease: Increased filling pressure can continue but valves may not respond appropriately. Non-opening valves lead to cardiogenic shock, while sticking or fluttering valves may cause turbulence or regurgitation.
- Murmurs: Auscultated turbulence is referred to as a murmur.
  - Systolic Murmur: Heard between S1 and S2; can indicate physiological (e.g., pregnancy) murmurs or valvular disease.
  - Diastolic Murmur: Heard between S2 and S1; indicates valvular heart disease.
Peripheral Vascular Disease: Decreased blood flow to the extremities may lead to neuropathy, lack of hair growth, lesion presence, edema in the lower extremities, and leg pain.