Blood Flow of Heart
Heart has 4 chambers right and left
Arteries goes away from heart
Vein goes to heart
The Right Atrium, receives "used blood" from the body.
Blood will be pushed through the tricuspid valve to the
Right Ventricle, the chamber which will pump to the lungs t
Heart Chambers
Heart has 4 chambers right and left
Chambers
Atrium
Ventricles
Heart Valves
4 Valves
Atrioventricular
-Tricuspid
-Mitral
Semilunar
-Aortic
-Pulmonic
The Great Vessels
Great vessels are the large vessels that bring blood to and from the heart. These are: Superior vena cava. Inferior vena cava. Pulmonary arteries.
Coronary Arteries
Common arteries for MI
Left side most severe
Normal ECG
P = Atrial depolarization
R-S = Ventricle Depolarization
T = Ventricle Repolarization
Health History PMH and FH
Past Medical History
DM
HTN - uncontrolled overtime = enlarge left ventricular - atherosclerosis , HF
Hyperlipidemia
Obesity
Renal failure
Pulmonary disease
Murmurs
Rheumatic fever - strep throat
Surgeries on heart or periphery
Family History- FH- heart a
Health History Life Style
Exercise
-Frequency, intensity, duration
-Changes in being out of shape
Tobacco
Type of tobacco; Pack year history; currently smoking?
EtOH and drug use
COCAINE
Medications - blood pressure medications
Diet
Fat, meat, salt, caffeine, whole grains, produce
Common Signs and Symptoms of the CV System
Chest pain
Shortness of breath
Palpitations - feel when heart beating
Edema - 3rd spacing of fluid
Weight gain-obesity or heart
failure because retaining fluid
Lower extremity pain - heart failure, peripheral tiusse
Nocturia - more than 2-3 times a night,
Problem Focused History Example: Chest Pain QUESTIONS?
Where does it hurt? - point where it hurts
When did it start?
How does it feel?
Does it radiate?
Is it constant or intermittent?
How long does it last?
What would you rate your pain
0-10 scale?
Any associated sxs (i.e. nausea, vomiting, diaphoresis, palpi
Problem Focused History Example: Chest Pain QUESTIONS??
Chest pain can be caused by SO many things
MI- crushing chest pain more in males and don't have diabetes
Left arm pain- heart attack
Women do not have chest pain as much as men do, more of NAUSEA
Pain relation to exercise- not getting enough oxygen
FOCUS
Common Diagnoses of the CV System HEART FAILURE
Heart failure
Diastolic vs Systolic; Left sided vs Right sided
Heart failure effect 1/5 people, 5 year survival rate
Main cause of HF is coronary heart disease
Left sided systolic most common heart failure
-thinking of left ventricular, heart is not contr
Common Diagnoses of the CV System
Coronary artery disease
Coronary artery disease
Angina pectoris - chest pain
Myocardial infarction - obstruction
Common Diagnoses of the CV System
Infectious and Inflammatory Conditions
Pericarditis - inflammation of pericardium
Myocarditis - inflammation of heart itself
Endocarditis - inflammation of lining of heart
Itis= inflammation
Common Diagnoses of the CV System VALVES
Valvular defects - regurgitations, 4 valves, purpose of these valves is to keep flow of blood in 1 direction, Maybe here a murmur meaning valves aren't closing properly
Arrhythmias - TWAVE, heartbeat too fast of too slow,
SA nodes- electrical conduction c
Cardiovascular Assessment
Inspection
Palpation
Percussion
Auscultation
Special Tests
ECG, echocardiogram, etc.
Inspection & Palpation: Apical Impulse
Normal = ~ 1cm; gentle & brief
= point of maximum impulse (PMI)
If displaced, may be sign of cardiomyopathy
Do they look like they are in distress general appearance
Apical impulse- point of maximum impulse of your heart, 5th intercostal space mid clavicu
Auscultation = Heart Sounds
S1
S1: closing of the mitral valve(LOUDER) and tricuspid - LUB (AV NODE)
S1 split closing of mitral and tricuspid valve
Auscultation = Heart Sounds
S2
S2: closing of the aortic valve(LOUDER) and pulmonic - DUB (semilunar node)
S2 split closing of aortic and pulmonic valves (inspiration)
Auscultation = Heart Sounds
S3
S3: deceleration of blood filling the ventricles- normal in young children, but thinking about fluid. Fluid overload, HF
Auscultation = Heart Sounds
S4
S4: atrial contraction - can be normal but also a sign of coronary artery disease (gallop)
Auscultation = Heart Sounds Murmurs and split sounds
Murmurs- swishing sounds , valves not closing and opening properly, letting blood back into valves in wrong direction
Bell can help here murmurs better
Split sounds - not sync normally
S1 split closing of mitral and tricuspid valve
S2 split closing of aor
Cardiac Auscultation Points
Aortic
Pulmonic
Tricuspid
Mitral
APTM
Heart Sounds relation with ECG
Normally not here s3 or s4
Fall in relation with ECG script
ECG relation with heart sounds
P = Atrial depolarization
R-S = Ventricle Depolarization
T = Ventricle Repolarization
HEART MURMUR
Grade 4 and above- you can palpate it, thrill vibratory feeling
Murmur- issue with the valves - causing blood to swish backwards and not 1 direction
Jugular Venous Distension
Sign of increase blood volume, HF
Filling of right atrium or moving blood into right atrium
Can increase central venous pressure
Place head 45 degrees not flat
Infants and Children
At birth:
Closure of ductus arteriosus
Closure of foramen ovale
If open can cause heart disease
S3 = benign
Murmurs common til ~ 48h
Sinus arrhythmia - variations of heart rate with inspiration(increase) and expiration(decrease)
Pregnant Women
Blood volume increases 40 - 50% from pre- pregnancy levels
Increased CO & HR
SEM-systolic ejection murmur over pulmonic region heard in 90% of pregnant women!
Pre-eclampsia - seeing hypertension in pregnant women, urine has protein. If not controlled then
Older Adults
May have decrease in myocardium size
LV wall thickens
? SV, CO, myocardial elasticity
May be more difficult to find apical impulse due to ? A/P diameter
S4 more common
Exercise may reverse or slow some age related changes
Heart disease is #1 cause of mort
Patient Education
Take some time during your exam to inform / remind your patient about the risks / benefits of certain lifestyle choices:
Primary Prevention
-Diet
-Exercise
-Smoking cessation
Secondary prevention
-Monitor BP, cholesterol, blood glucose
-Frequency of monit
Documenting normal findings
General - patient appears comfortable, in no apparent distress (NAD)
CV - S1 and S2 present, regular rate and rhythm, no spilt sounds, no S3 and S4, no murmurs or thrills
Lungs clear to auscultation (CTA) apical impulse noted at 5th ICS, MCL.
No lower ext
FLOW OF HEART!