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Questions and Answers
What is the primary function of the myocardium in the heart?
What is the primary function of the myocardium in the heart?
Which structure separates the atria from the ventricles?
Which structure separates the atria from the ventricles?
During which phase of the heart's cycle do the atrioventricular valves open?
During which phase of the heart's cycle do the atrioventricular valves open?
What type of blood does the right atrium receive?
What type of blood does the right atrium receive?
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What is the role of the semilunar valves in the heart?
What is the role of the semilunar valves in the heart?
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What is the primary factor that determines cardiac output (CO)?
What is the primary factor that determines cardiac output (CO)?
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What does preload refer to in the context of heart function?
What does preload refer to in the context of heart function?
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Which of the following conditions is commonly associated with aging in the cardiovascular system?
Which of the following conditions is commonly associated with aging in the cardiovascular system?
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What is the primary function of the venous system?
What is the primary function of the venous system?
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What mechanism aids venous return in the circulatory system?
What mechanism aids venous return in the circulatory system?
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What characterizes the arteries in the peripheral vascular system?
What characterizes the arteries in the peripheral vascular system?
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Which vessel connects the deep and superficial venous systems?
Which vessel connects the deep and superficial venous systems?
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What is a significant consequence of arterial obstruction?
What is a significant consequence of arterial obstruction?
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What does a 4+ pulse amplitude indicate?
What does a 4+ pulse amplitude indicate?
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What is the expected time for color to return to the feet after dangling them?
What is the expected time for color to return to the feet after dangling them?
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Which of the following conditions is associated with venous overload?
Which of the following conditions is associated with venous overload?
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What does pitting edema grade 3+ indicate?
What does pitting edema grade 3+ indicate?
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During the assessment for arterial deficits, what observation would indicate arterial insufficiency?
During the assessment for arterial deficits, what observation would indicate arterial insufficiency?
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Which of the following pulse locations is NOT assessed bilaterally?
Which of the following pulse locations is NOT assessed bilaterally?
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What does the presence of arrhythmias like atrial fibrillation indicate?
What does the presence of arrhythmias like atrial fibrillation indicate?
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What does a 1+ pitting edema signify?
What does a 1+ pitting edema signify?
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What is one of the primary functions of the lymphatic system?
What is one of the primary functions of the lymphatic system?
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Which of the following conditions could indicate a problem in the lymphatic system?
Which of the following conditions could indicate a problem in the lymphatic system?
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What should be assessed for dyspnea during a cardiac examination?
What should be assessed for dyspnea during a cardiac examination?
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Which of the following symptoms is associated with poor circulation to the lower extremities?
Which of the following symptoms is associated with poor circulation to the lower extremities?
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Which diagnostic tool is commonly used in cardiovascular disease assessment?
Which diagnostic tool is commonly used in cardiovascular disease assessment?
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What lifestyle habit is NOT mentioned as a risk factor for cardiovascular disease?
What lifestyle habit is NOT mentioned as a risk factor for cardiovascular disease?
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What is a potential reason for pallor in the legs during a subjective assessment?
What is a potential reason for pallor in the legs during a subjective assessment?
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Which observation would NOT be part of an objective cardiac assessment?
Which observation would NOT be part of an objective cardiac assessment?
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What occurs during ventricular diastole?
What occurs during ventricular diastole?
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What heart sound corresponds with the closure of the AV valves?
What heart sound corresponds with the closure of the AV valves?
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What happens during the 'atrial kick' of late diastole?
What happens during the 'atrial kick' of late diastole?
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What is indicated by a split S2 heart sound?
What is indicated by a split S2 heart sound?
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What does the T wave represent in an electrocardiogram?
What does the T wave represent in an electrocardiogram?
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Which of the following statements about heart murmurs is true?
Which of the following statements about heart murmurs is true?
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What role does the SA Node play in cardiac function?
What role does the SA Node play in cardiac function?
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What is the primary function of depolarization in the heart?
What is the primary function of depolarization in the heart?
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What is a common cause for S3 heart sound?
What is a common cause for S3 heart sound?
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What is a key characteristic of the PR interval on an ECG?
What is a key characteristic of the PR interval on an ECG?
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Study Notes
Cardiovascular System Location
- The heart is located in the mediastinum, between the 2nd and 5th intercostal space, from the right sternal border to the left midclavicular line
- Precordium refers to the area over the heart
Heart Wall
- The heart is surrounded by the fibrous pericardium, which protects the heart
- The pericardium has two layers: parietal and visceral (epicardium)
- Pericardial fluid is located between the layers, allowing for friction-free movement of the heart
Heart Wall Layers
- Myocardium is the muscular wall of the heart, responsible for pumping action, and has a high oxygen demand
- Endocardium is the layer of endothelial tissue lining the inner surface of heart chambers
Heart Chambers
- The heart has four chambers: two atria and two ventricles
- The chambers are separated by valves and a septum
- Atria receive blood from major blood vessels and pump it into the ventricles
- The right atrium receives unoxygenated blood from the body through the superior and inferior vena cava
- The left atrium receives oxygenated blood from the lungs through the pulmonary veins
- Ventricles receive blood from atria and eject it into vessels leaving the heart
- The right ventricle pumps unoxygenated blood to the lungs via the pulmonary artery
- The left ventricle pumps oxygenated blood to the body via the aorta
Heart Valves
- Heart valves are unidirectional in a healthy heart, preventing backflow of blood
- Atrioventricular valves (AV) separate atria and ventricles
- Tricuspid valve is on the right
- Mitral (bicuspid) valve is on the left
- They open during heart filling (diastole) and close with ventricular contraction (systole)
- Semilunar valves (SL) separate ventricles from arteries
- Pulmonic valve is on the right
- Aortic valve is on the left
- They open during ventricular contraction/rising pressure within ventricles (systole) and close with ventricular relaxation
Cardiac Cycle
- Ventricular filling/Diastole:
- Ventricles relax and fill with blood
- Early diastole: blood rushes into ventricles from atria through AV valves (75% ventricular volume)
- Late diastole: atrial kick (contraction of atria) pushes the last blood into ventricles (25% ventricular volume)
- Ventricular Systole:
- Ventricular pressure rises higher than atrial pressure, closing AV valves (S1 sound)
- Ventricles contract, forcing blood into pulmonary and systemic circulation through open SL valves
- Ventricular pressure falls, closing SL valves (S2 sound)
Heart Sounds
- S1: Closure of AV valves, beginning of systole, loudest at the apex of the heart
- S2: Closure of semilunar valves, end of systole, loudest at the base of the heart
- Split S2: during inspiration right side venous return increases, delaying pulmonic valve closure; left side blood return decreases, hastening aortic valve closure
Extra Heart Sounds
- S3: Heard right after S2, early diastole, due to vibrations caused by ventricular overload
- S4: Heard just before S1, end of diastole, due to blood pushed by atrial kick into a non-compliant ventricle
Murmurs
- Turbulent blood flow due to increased velocity, decreased viscosity, valve defects, or unusual openings in heart chambers
- Stenosis: narrowing of a valve
- Regurgitation: incompetent valve
Electrical Conduction System
- SA Node: initiates electrical impulse (pacemaker)
- Impulse travels to atria
- AV Node: slows conduction slightly to allow atrial contraction
- Impulse travels through Bundle of His, bundle branches, and Purkinje fibers to ventricles
Electrical Impulse Conduction Terms
- Depolarization: spread of electrical current, causes contraction (systole)
- Repolarization: cells return to negative charge, heart at rest (diastole)
- Diastole: heart chambers are at rest
- Systole: pumping of the heart (mostly refers to ventricles)
ECG Interpretation
- P wave: atrial depolarization
- PR interval: time for impulse to travel from atria to ventricles
- QRS complex: ventricular depolarization
- T wave: ventricular repolarization
Cardiac Output
- Amount of blood ejected per minute
- Usually 4-6 liters per minute
- Calculated as stroke volume x heart rate
Preload
- Amount of blood available to flow into ventricles during diastole (venous return)
- Represents ventricular stretching before contraction
Afterload
- Pressure the heart must push against during ventricular contraction (systole)
Carotid Artery
- Carries blood directly from the aorta to the head (brain)
- Located in the groove between the trachea and sternomastoid muscle
Jugular Veins
- Carry unoxygenated blood directly into the superior vena cava
- Indicate pressures on the right side of the heart
Hemodynamic Changes with Aging
- Stiffening of arteries causes increased systolic blood pressure
- Increased left ventricular size
- Increased pulse pressure (diastolic stays the same, systolic increases due to increased afterload)
- Decreased ability of heart to increase cardiac output with exercise and stress
- Increased risk of dysrhythmias and cardiovascular disease
Peripheral Vascular System
- Arteries: carry oxygen-rich blood to the system
- Arterial walls are strong, elastic, and contain smooth muscle
- Pulse is generated due to expanding and recoiling of arteries with pressure wave
- Obstruction causes ischemia to tissues below
- Veins: carry deoxygenated blood back to the heart
- Low pressure system
- Venous return depends on: contraction of skeletal muscles, intraluminal valves, and pressure changes with respiration
- Thinner walls, can dilate to accommodate greater volume
Arterial Pulses
- Palpable when artery lies close to body surface
- Brachial, radial, ulnar, femoral, popliteal, dorsalis pedis, posterior tibial
Veins
- Deep veins (e.g. femoral and popliteal): carry 90% of venous return from lower extremities
- Superficial veins (e.g. great and small saphenous): most susceptible to stasis
- Perforators: connect deep and superficial veins
Lymphatic System
- Extensive vascular network that drains lymph from tissues and returns it to venous circulation
- Functions: conserves plasma proteins, plays a major role in immune system, lipid absorption from intestine
Lymph Nodes
- Important in the immune system
- Cells within nodes engulf debris and bacteria, producing an antigen response
- Swelling and tenderness of nodes indicates local inflammation
- Only superficial nodes are accessible for examination
- Generally not palpable in healthy adults
Subjective Assessment (Cardiac)
- Chest pain: COLDSPA acronym used for assessment
- Dyspnea:
- Exertion (DOE): dyspnea with exertion
- PND: dyspnea awakening from sleep
- Orthopnea: dyspnea when lying down
- Cough: productive or non-productive
- Fatigue
- Cyanosis or pallor
- Edema: swelling equal bilaterally or unilateral, disappears after rest
- Nocturia: excessive urination at night
Subjective Assessment (Cardiac)
- History of:
- Cardiovascular disease: heart attack, CHF, arrhythmias, valvular problems
- Family history of cardiovascular disease: heart attack or stroke before age 50
- Diagnostics: EKG, cardiac catheterization
- Cardiac surgery
Subjective Assessment (Cardiac)
- History of:
- Hypertension
- Diabetes
- Bacterial or viral infections
Subjective Assessment (Cardiac)
- Personal health habits:
- Smoking
- Nutrition
- Exercise
- Alcohol/drug use
- Medications: prescription and over-the-counter
Subjective Assessment (Peripheral Vascular)
- Circulation: cold, numbness, pallor in legs, hair loss, edema (bilateral or unilateral, claudication (pain with walking)
- Skin changes: color, texture, venous bulging, sores (location)
Objective Assessment (Cardiac)
- Inspection:
- Whole body for color
- Extremities for edema and color
- Periorbital edema
- Neck vessels:
- JVD: jugular vein distention, assess with head elevated 30-45 degrees
- Carotid arteries
Objective Assessment (Cardiac)
- Palpation:
- Carotid artery: medial to sternomastoid muscle, gently! bilaterally
- Extremities: color, hair distribution, size, symmetry, swelling, venous pattern, rashes, scars, ulcers, superficial veins
Objective Assessment (Peripheral Vascular)
- Pulses: bilaterally
- Radial, brachial, femoral, popliteal, dorsalis pedis, posterior tibial
- Use Doppler if needed
- Assess rate, rhythm, symmetry, and amplitude
Pulse Amplitude Grading
- 4+: bounding
- 3+: increased
- 2+: brisk, expected
- 1+: diminished, weaker than expected
- 0: absent, unable to palpate
Objective Assessment (Peripheral Vascular)
- Lymph Nodes: bilaterally
- Epitrochlear
- Inguinal
Assessing Arterial Deficit in Lower Extremities
- Raise legs 12 inches for 30 seconds, wiggle feet for 30 seconds
- Observe for color change (should become paler)
- Sit up and dangle legs, note time for color to return (should be 10 seconds or less)
- Note time for superficial veins to fill (should be 15 seconds or less)
- Extreme pallor and/or dark red-bluish color indicates arterial insufficiency
Objective Assessment (Peripheral Vascular)
- Lower extremity:
- Sensation: check for arterial insufficiency and diabetic neuropathy
- Edema: press firmly and look for pitting (depression)
- 1+: mild pitting
- 2+: moderate pitting
- 3+: deep pitting, leg appears swollen
- 4+: very deep pitting, leg obviously swollen
Edema
- Venous overload due to right heart failure, vein occlusion, lymphatic problems, fluid and electrolyte imbalance, or nutritional disturbances.
Abnormalities: Congestive Heart Failure
- Inability of heart to effectively pump blood
- Left-sided failure: pulmonary edema
- Right-sided failure: distended neck veins, peripheral edema
- Patients may have both left and right heart failure.
Abnormalities: Arrhythmias
- Atrial fibrillation
- Ventricular tachycardia
- Ventricular fibrillation
Abnormalities: Valve Problems
- Stenosis: narrowing of valve
- Regurgitation: incompetent (leaky) valve
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Description
Explore the essential components of the cardiovascular system, including the heart's location, structure, and function. This quiz covers the heart walls, the layers, and the four heart chambers involved in blood circulation. Test your knowledge on the anatomy and physiology of the heart.
