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Questions and Answers
What is stroke volume?
What is the normal pacemaker of the heart known as?
sinoatrial (SA) node
Match the following heart sounds with their corresponding valves:
First Heart Sound (S1) = Mitral and Tricuspid Valves Second Heart Sound (S2) = Aortic and Pulmonic Valves
Continuous murmur is generated by interrupted forward flow of blood.
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What are the objectives of assessing heart and neck vessels?
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The heart is a muscle that pumps blood through a network of over 60,000 miles of blood vessels.
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What is the primary function of the tricuspid valve?
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The ______ is responsible for supplying the heart with the oxygen needed to perform effectively.
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Match the layers of arteries and veins with their descriptions:
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What is the significance of a positive family history in cardiovascular disease risk assessment?
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Which of the following are genetically linked cardiac disorders? Select all that apply.
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Changes in skin texture, color, or temperature are not relevant in cardiovascular risk assessment.
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Anemia increases the heart's workload and may lead to ________________.
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What is the adult heart rate range in beats per minute (BPM)?
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Which of the following factors can contribute to the development of a systolic murmur during pregnancy?
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Chest pain is always initially treated as cardiac in origin in adults.
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A palpitation is characterized by the sensation of the heart ________ or ________ beats.
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Match the following risk factors with their categorization:
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What is intensity related to in sound?
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What distinguishes one sound from another?
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Intense sounds are described as ___?
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A bruit suggests carotid _____.
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What is auscultated for in the jugular veins?
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How is a thrill defined in the context of palpation?
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What should be assessed when palpating the carotid artery?
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During palpation of the neck, unequal pulses suggest sinus bradycardia.
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A rocking movement during cardiac assessment is known as a __________.
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Do you use street drugs such as cocaine?
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Do you drink alcohol? How many glasses a day?
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What is your job?
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Are you currently working? How many hours a day do you usually work?
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What do you do when you feel upset, angry, frustrated, or stressed out?
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How has your cardiovascular problem affected your sex life?
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Do you belong to any church or community groups?
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Study Notes
Objectives of Health Assessment
- Assess heart and neck vessels
- Locate and auscultate over five specific areas of the heart to listen for corresponding heart sounds
- Identify normal and abnormal findings of heart sounds
- Develop a systematic approach
- Listen selectively and specifically
- Identify the timing of sounds in relation to the cardiac cycle
- Understand and utilize patient positioning and respiratory maneuvers to evaluate findings
Structure and Function of the Heart
- The heart is a cone-shaped muscle, about 12 cm long and 9 cm wide
- Weighs 250-390g in adult males and 200-275g in adult females
- Pumps blood throughout the circulatory system
- Has four chambers: right atrium, right ventricle, left atrium, and left ventricle
Anatomy and Physiology of the Heart
- Right side:
- Right atrium: receives deoxygenated blood from superior and inferior vena cava
- Tricuspid valve: between right atrium and right ventricle
- Right ventricle: pumps blood into pulmonary circuit
- Pulmonary semilunar valve: between right ventricle and main pulmonary artery
- Left side:
- Left atrium: receives oxygenated blood from lungs through pulmonary veins
- Mitral valve: between left atrium and left ventricle
- Left ventricle: pumps oxygenated blood through systemic circulation
- Aortic valve: between left ventricle and aorta
Layers of the Heart
- Endocardium: inner layer, smooth and thin
- Myocardium: middle and thickest layer, heart muscle
- Epicardium: outer layer, contains main coronary blood vessels
- Pericardium: sac that surrounds the heart and roots of great vessels
Pulmonary and Systemic Circulation
- Pulmonary circulation: involves blood vessels that circulate blood through lungs and back to the heart
- Systemic circulation: supplies oxygen to every cell in the body through arterial system and returns deoxygenated blood to the heart through venous system
Coronary Circulation
- Supplies the heart with oxygen needed to perform its function
- Consists of right and left coronary arteries and coronary sinus and cardiac veins
###Layers of Arteries and Veins
- Arteries: have three coats (tunica intima, tunica media, and tunica adventitia) and carry oxygenated blood away from the left heart
- Arterioles: carry blood to capillaries and control blood flow
- Capillaries: single layer of microscopic endothelial cells that connect arterial and venous systems
- Veins: have same three layers as arteries, but thinner and with less elastic and collagenous tissue and smooth muscle
- Venules: smallest veins, consisting of endothelium and thin tunica adventitia
Mechanisms of Heart Sounds
- The cardiac cycle comprises the systolic and diastolic phases
- The cardiac cycle includes the valves, hemodynamic events within the heart, and the conduction system working together
- Ventricular diastole: begins with the fling phase, during which the pressure in the ventricles is less than that of the atria
- Cardiac output: controlled by the internal pacemaker of the heart and the autonomic nervous system
- Stroke volume: the volume of blood pumped out of the left ventricle during each systolic cardiac contraction
Heart Valves
- The first heart sound (S1) marks the beginning of systole and results from the closure of the mitral and tricuspid valves
- The second heart sound (S2) marks the end of systole and results from the closure of the aortic and pulmonic valves
- Extra heart sounds:
- Early ejection click: high-pitched, short systolic sound occurring shortly after S1
- Midsystolic ejection click: high-pitched, short sound found in mitral valve prolapse (MVP)
- Opening snap (diastolic): short, high-pitched sound occurring 0.05 to 0.14 second after S2
- S3 gallop rhythm: sounds like "lub dub dah" and is best heard at the apex
- S4 gallop rhythm: also called atrial gallop, occurs immediately before the S1 and sounds like "ta-lub dub"
Murmurs
- Defined as a series of audible, prolonged blowing or whooshing sound that signifies turbulent blood flow often caused by a valvular defect
- Murmurs are characterized in terms of quality, frequency, duration, configuration, placement in the cardiac cycle, and location of sound
- Continuous sounds: sounds that are heard during both systole and diastole
- Venous hum: a low-pitched sound heard over the right internal jugular vein in the supraclavicular area
- Friction rub: a high-pitched, scratchy, leathery sound generated when the inflamed parietal and visceral pericardial layers rub together### Blood Pressure Measurement
- Phase 1: loud, clear, tapping sound when blood starts to flow through the artery
- Phase 2: swishing sound as blood flows through the artery
- Phase 3: thumping sound as blood flows through the artery, but cuff pressure is still high enough to occlude flow during diastole
- Phase 4: softer, blowing, muffled sound as cuff pressure is released
- Phase 5: silence when cuff pressure is released enough to allow normal blood flow
Interaction with Other Body Systems
- Respiratory System: works closely with cardiovascular system to supply oxygen and remove carbon dioxide
- Exchange of gases in respiratory system requires circulatory system to transport gases
- Respiratory and cardiac rates increase during exercise to meet oxygen needs
- Disease in one system can affect the other (e.g. COPD can lead to right-sided CHF)
- Endocrine System: sympathetic nervous system activation leads to epinephrine and norepinephrine release, which increases heart rate and contractility
- Nervous System: regulates heart rate through medulla oblongata, cerebrum, and hypothalamus
- Autonomic nervous system (sympathetic and parasympathetic) affects heart rate
Developmental, Cultural, and Ethnic Variations
- Infants: foramen ovale and ductus arteriosus close after birth, allowing heart to function as a double pump
- Normal heart rate: 120-160 BPM
- Children: heart lies more horizontally, apical impulse is at 4th intercostal space, and heart sounds are louder
- Sinus arrhythmia with respiratory variations is common
- Innocent murmurs and physiological S3 are common findings
- Pregnant Women: cardiac workload increases, leading to systolic murmurs and changes in apical impulse
- BP is usually lower during first and second trimesters, and heart rate is slightly higher
- Older Adults: changes in BP are common, including postural (orthostatic) hypotension and auscultatory gaps
Health History
- Biographical Data: age, gender, ethnic background, occupation, and support/financial status
- Age: risk for cardiovascular disease increases with age
- Gender: men have a greater incidence of cardiovascular disease than women
- Ethnic background: African American men have a high incidence of HTN
- Current Health Status: chief complaint, symptoms, and medical history
- Chest pain: most common presenting cardiac symptom, may be cardiac, respiratory, gastrointestinal, musculoskeletal, or psychogenic in nature
- Palpitations, syncope, edema, fatigue, and extremity changes are other symptoms that may signal cardiovascular problems
- Risk Factors for Coronary Artery Disease: uncontrollable, controllable, and contributing factors
- Uncontrollable: age, sex, heredity, and race
- Controllable: smoking, cholesterol, hypertension, physical inactivity, obesity, and diabetes
- Contributing: stress, homocysteine levels, and type A personality### Cardiovascular Disease Risk Factors and Assessment
Symptoms of Left-Sided CHF
- GI upset and RUQ pain may accompany right-sided CHF
- COPD can result in cardiac involvement, such as pulmonary hypertension and right-sided CHF
Reproductive Health and Cardiovascular Disease
- Increases CAD risk
- Oral contraceptives/estrogen supplements are associated with thrombus formation
- HRT is associated with increased risk of cardiovascular disease
Musculoskeletal and Neurological Associations
- Muscle weakness secondary to decreased use
- Intermittent claudication is associated with arterial insufficiency
- Syncopal attacks may signal vascular problems or cardiac arrhythmias
- Behavioral changes, such as confusion, decreased attention span, or loss of memory, may occur due to hypoxia and impaired cerebral circulation
Lymphatic/Hematologic and Cardiovascular Disease
- Anemia increases the heart's workload
- Polycythemia increases risk for thrombus, hypertension, and cardiopulmonary disease
Psychosocial Profile and Cardiovascular Disease
- Identifying risk factors is essential in developing an effective plan of care
- Chronic cardiovascular disease can affect a patient's lifestyle, forcing them to make changes to adapt to the illness
Risk Factors and Questions to Ask
- Health practices and beliefs
- Yearly physicals
- Compliance with treatment program
- Medications taken and reasons why
- Activities
- Typical day
- Activity level and correlation with energy level
- Nutrition and weight patterns
- Obesity as a risk factor for CAD
- Diet high in cholesterol and sodium
- Gastrointestinal
- GI upset and RUQ pain
- Anorexia, loss of appetite, or nausea
- Musculoskeletal
- Muscle weakness
- Intermittent claudication
- Neurological
- Syncopal attacks
- Behavioral changes
Physical Assessment
- Approach
- Assess for physical signs in every system
- Perform assessment in three positions: sitting, supine, and left lateral recumbent
- Tools
- Stethoscope with diaphragm for high-pitched sounds and bell for low-pitched sounds
- Sphygmomanometer scale, metric ruler, thermometer, and marking pen
- Performing general survey
- General appearance
- Weight distribution and muscle composition
- Facial expression
- Posture or assumed position of comfort
- Dress and grooming
- Body stature
- Muscle wasting
- Abnormal movements
Vital Signs
- BP: measurements greater than 120/80 may indicate hypertension
- Pulse: strength of pulse may reflect vascular system
- Respiratory rate: changes in respiratory rate and pattern may occur with chest pain
- Temperature: elevated temperature may indicate infectious disease process
- Weight and height: accurate measurements helpful in planning treatment and monitoring fluid retention
Intensity and Grading of Pulse
- Palpation done using fingertips
- Intensity of pulse graded on a scale of 0 to 4+
- 0: no palpable pulse
- 1+: faint, but detectable pulse
- 2+: slightly more diminished pulse than normal
- 3+: normal pulse
- 4+: bounding pulse
Performing a Head-to-Toe Physical Assessment
- Cardiovascular system can affect every other body system
- Inspect for changes in each body system that might signal a cardiovascular problem
- Neck
- Inspect carotid and jugular venous systems for pulsations
- Measure jugular venous pressure (JVP)
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Description
Test your knowledge of the heart's structure and function with these questions on stroke volume, pacemakers, heart sounds, and more.
