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HA ch19
heart and neck vessels
46
Nursing
Graduate
07/29/2013

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Term
murmur
Definition
turbulent blood flow and collision currents
Term
conditions resulting in murmur
Definition
1. velocity of blood increases (exercise/ thyrotoxicosis)
2. viscosity of blood decreases
3. structural defects in valves
Term
characteristics of sound
Definition
1. frequency (pitch)
2. intensity (loudness)
3. duration
4. timing
Term
S1
Definition
first heart sound
beginning of systole
pumping phase
loudest at apex
Term
S2
Definition
second heart sound
end of systole, beginning of diastole
filling phase
loudest at base
Term
P wave
QRS complex
T wave
Definition
depolarization of atria
depolarization of ventricles
repolarization of ventricles
Term
in the resting adult, the heart normally pumps
Definition
4 to 6 L of blood per minute
Term
cardiac output =
Definition
Stroke Volume (volume of blood in each systole) x Rate (beats per minute)
Term
preload
Definition
venous return that builds during diastole
how much ventricle muscle is stretched at end of diastole just before contraction
Term
afterload
Definition
opposing pressure the ventricle must generate to open the aortic valve against the higher aortic pressure
resistance against which the ventricle must pump its blood
Term
carotid artery is located
Definition
in the groove between the trachea and the sternomastoid muscle, medial to and along side that muscle
Term
internal jugular
external jugular
Definition
lies deep and medial to sternomastoid muscle, usually not visible
more superficial, lies lateral to the sternomastoid muscle above the clavicle
Term
fetal heart beats at
Definition
3 weeks gestation
Term
in pregnancy blood volume
Definition
increases 30 to 40%
with most rapid expansion in second trimester
= increase SV, CO and pulse rate of 10-15 more beats per minute
Term
in pregnancy
despite increased CO
Definition
arterial blood pressure decreases as a result of peripheral vasodilation
drops to lowest in second trimester and rises after that (back to baseline)
Term
hemodynamic changes with aging
Definition
increase in systolic blood pressure - stiffening of large arteries
size of heart does not increase but LV wall thickness increases
rising systolic with relatively constant diastolic pressure increases the pulse pressure
Term
factors of CVD
cardiovascular heart disease
Definition
High BP - Hypertension - Stage 1 (140/90)
smoking
serum cholesterol - high LDL's
obesity
type 2 diabetes
Term
dysrhythmias
Definition
abnormal rhythm
increases with age
Term
bruit
Definition
blowing, swishing sound indicating blood flow turbulence
turbulence due to a local vascular cause such as atherosclerotic narrowing
Term
CVP
Central Venous Pressure
Definition
can be assessed from the jugular veins and judge the heart's efficiency as a pump
Term
angle of Louis
Definition
sternal angle
normal jugular venous pulsation is 2 cm or less above the sternal angle
Term
apical pulse
Definition
apex beat
PMI - point of maximal impulse
5th intercostal space, at or medial to midclavicular line
Term
5 auscultatory areas
Definition
aortic area - 2nd right ICS
pulmonic area - 2nd left ICS
Erb's point
Tricuspid area - left lower sternal border
Mitral area - 5th ICS at left midclavicular line
Term
S1 coincides with the
Definition
carotid artery pulse
the R wave (upstroke of QRS complex) if the person is on an ECG monitor
Term
Splitting of S2
Definition
normal phenomenon in some, occurs near end of inspiration
inspiration separates the timing of the two valves closure (aortic and pulm)
heard only in the pulmonic valve area, 2nd left ICS
holding breath will cause split to go away
Term
S2 split occurs
Definition
about every 4th heart beat, fading in with inhalation and fading out with exhalation
Term
rolled on the left side
Definition
listen with the bell at the apex for the presence of any diastolic filling sounds (S3 or S4)
Term
pathologic S3
Definition
ventricular gallop
occurs with heart failure and volume overload
Term
pathologic S4
Definition
atrial gallop
occurs with CAD
Term
may be heard only when the person is leaning forward in the sitting position
Definition
murmur of aortic regurgitation
Term
congenital heart defects
Definition
Patent Ductus Arteriosus (PDA)
Atrial Septal Defect (ASD)
Ventricular Septal Defect (VSD)
Tetralogy of Fallot
Coarctation of the Aorta
Term
Patent Ductus Arteriosus
Definition
persistence of the channel joining left pulmonary artery to aorta
S: no symptoms in early childhood
O: wide pulse pressure; continuous murmur heard in systole and diastole is called a machinery murmur
Term
Atrial Septal Defect
Definition
abnormal opening in atrial septum, left to right shunt, large increase in pulmonary blood flow
S: remarkably well tolerated, symptoms in infants rare, growth and development normal, children and adults have mild fatigue and DOE (dyspnea on exertion)
Term
Ventricular Septal Defect
Definition
abnormal opening in septum between ventricles, usually subaortic area
S: small defects are asymptomatic, large have poor growth, slow weight gain; later look pale, thin; may have feeding problems, frequent respiratory infections
O: loud, harsh holosystolic murmur, best heard at left lower sternal border
Term
Tetralogy of Fallot
four components
Definition
1. right ventricular outflow stenosis
2. VSD
3. Right ventricular hypertrophy
4. overriding aorta
result: shunts a lot of venous blood directly into aorta away from pulmonary system, blood never gets oxygenated
Term
Tetralogy of Fallot
subjective
objective
Definition
S: severe cyanosis, not in first months of life but develops; cyanosis with crying and exertion, DOE
O: systolic, loud, crescendo-decrescendo
Term
Coarctation of the Aorta
description
Definition
severe narrowing of descending aorta, usually at the jxn of the ductus arteriosus and the aortic arch, just distal to the origin of the left subclavian artery
results: increased workload on left ventricle
Term
Coarctation of the Aorta
subjective
objective
Definition
S: first few months symptoms of heart failure develop
O: upper extremity HTN over 20 mm Hg higher than lower extremities measures is a hallmark of coarctation; absent or greatly diminished femoral pulses; systolic murmur is heard best at the left sternal border, radiating to the back
Term
Aortic Stenosis
subjective
objective
murmur
Definition
S: fatigue, DOE, palpitation, dizziness, fainting, anginal pain, chest pain
O: pallor, slow diminished radial pulse, thrill in systole
Murmur: loud, harsh, midsystolic, crescendo-decrescendo, loudest at 2nd right ICS, radiates widely to the side of neck, down left sternal border or apex
Term
Aortic Stenosis
description
Definition
calcification of aortic valve cusps restricts forward flow of blood during systole, LV hypertrophy develops
Term
Mitral Regurgitation
description
Definition
stream of blood regurgitates back into LA during systole through incompetent mitral valve
Term
Mitral Regurgitation
subjective
mumur
Definition
S: fatigue, palpitation, orthopnea, PND
murmur: pansystolic, best heard at apex, radiates well to left axilla
Term
Mitral Stenosis
description
Definition
calcified mitral valve will not open properly, impedes forward flow of blood into LV during diastole
LA enlarged and LA pressure increased
Term
Mitral Stenosis
subjective
murmur
Definition
S: fatigue, palpitations, DOE, orthopnea (difficulty breathing lying down)
murmur: low pitched diastolic rumble, best heard at apex, with person in left lateral position
Term
Aortic Regurgitation
description
Definition
stream of blood regurgitates back through incompetent aortic valve into LV during diastole. LV dilation and hypertrophy due to increased LV stroke vol. Rapid ejection of large SV into poorly filled aorta, then rapid runoff in diastole
Term
Aortic Regurgitation
subjective
murmur
Definition
S: only minor symptoms for many years, rapid deterioration, DOE, PND, angina, dizziness
murmur: soft high pitched, blowing diastolic, decrescendo, best heard at 3rd left ICS at base, as person sits up and leans forward
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