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cardiac cycle phases
diastole and systole
S over D- Contract over Relax. During diastole, the ventricles relax and fill with blood.
S over D--Contract over Relax. During systole, blood is pumped from the ventricles and fills the pulmonary and systemic arteries
the first heart sound
S1 closure of the AV valves contributes to the first heart sound (S1) and signals the beginning of systole
second heart sound
S2 When pressure falls below pressure in the aorta, some blood flows backward toward the ventricle, causing the aortic valve to swing shut. This closure of the semilunar valves causes the second heart sound (S2) and signals the end of systole.
It takes ____minutes for blood to travel the cardiovascular circuit
The heart weighs _____ oz., and is the size of your_____.
11; fist
Where is the heart?
It extends from the 2nd to the 5th ICS, from the R border of the sternum to the midclavicular line.
Shape of the heart
Upside down triangle
Top of the heart is the _______, bottom of the heart is the _______, which points down to the_____.
Base; apex; left
Structure of the Heart (VVVCAA)
1)Veins 2)Ventricles 3) Valves (AV & Semilunar) 4) Conduction System 5) Atrium 6) Artery
What are the four chambers of the heart?
Right & Left atria and ventricles
What is the functions of the four chambers of the heart?
Double pump
What are the atria?
They are the top chambers on both sides of the heart. R and L atria pump blood to the ventricles
What keeps blood moving along the pulmonic and systemic circuit?
Shifting pressure gradients
cardiac cycle
Rhythmic movement of blood through the heart, with 2 phases.
S = Contract D = Relax
Sistole over diastole = Contraction over relaxation= pumping blood to the pulmonic & systemic circuits over filling up w/blood
R ventricle pumps blood to the _____________circuit.
L ventricle pumps blood to the _______________circuit
Two AV valves (T & M)
Tricuspid and Mitral
Two Semilunar Valves (P & A)
Pulmonic and aortic
Conduction System of heart
SA node-->AV node-->bundle of His-->purkinje fiber
Gas exchange takes place in the __________________beds of all body _________________.
capillary; tissues
Cardiac Sound Characteristics (RRPI&DT)
Rate (60-100 Normal) Rhythm (regular, irregular, regularly irregular) Pitch (high, med., low) Intensity (soft to loud, graded "1-6") Duration Timing
Why we hear "Lub-Dup"
Opening and closing of valves
What is a murmur?
turbulent flow w/in the heart
What is a bruit (pron. bruey)?
turbulent flow outside the heart in arteries
What can cause turbulent flow in the heart?
1) Increased flow thru normal valves 2) Reg flow through narrow valves or vessels 3) Reg flow into dialated chamber 4) Back-flo 5) Shunting (to somewhere else) 6) Viscosity of blood decreases
Systole (S1)
the "working/contraction phase" of the heart Mitral and Tricuspid (Atrioventricular) valves close Pressure in ventricles becomes greater than the pressure in the atria Closure of the AV valves causes the first sound.
Diastole (S2)
Closure of SL valves causes the 2nd heart sound restoring/ refilling phase aortic and pulmonic (semilunar) valves closed, mitral and tricuspid (AV) valves open
Where do you auscultate for cardiac valve sounds?
Where the sounds are best heard, not over the actual anatomical locations. The sound radiates in the direction of the blood flow. 2nd R ICS- Aortic valve area 2nd L ICS- Pulmonic valve area 3rd L ICS- Erb's point (landmark-won't hear here) L lower sternal border- tricuspid valve area 5th ICS at L midclavicular line- mitral valve area
Which parts of the stethoscope is used for high-pitched sounds?
Which part of the stethoscope is used for lower pitched sounds?
What do you tell your patient before you auscultate for cardiac sounds?
"I always listen to the heart in a # of places on the chest. Just because I am listening a long time, it does not necessarily mean that something is wrong."
Subjective Questions for Heart/Neck Exam I
1) Chest pain? 2) Dyspnea? (Difficulty breathing) 3) Orthopnea (breathe better when sitting or standing) 4) Cough 5) Fatigue (or fatigue w/any exercise) 6) Cyanosis or pallor
Subjective Questions for Heart/Neck Exam II
1) Edema 2) Nocturia (urination @ night) 3) Palpitation 4) Changes in Extremities 5) Past cardiac history/family cardiac history 6) Personal habits which are risk factors?
Carotid artery is located between the _____ and the _____.
sternomastoid muscle; trachea
Neck exam (2 things to do)
1) Palpate carotid arteries turn head toward examiner 2) Auscultate for bruit (swishing sound-turbulent flow outside the heart in arteries)
Cardiac chest exam Inspection (SARH)
S- Symmetry A- Apical pulsations (very thin person) R- Retractions H- Heaves or lifts
Cardiac Exam- Auscultate in which 3 positions?
1) Supine 2) L lateral 3) Sitting up, leaning forward
Auscultate at 5 Locations (APETM)
1) Aortic- 2nd R ICS@ Sternal Border 2) Pulmonic- 2nd L ICS @ Sternal Border 3) Erb's point- 3rd L ICS @ Sternal Border (landmark-won't hear anything here) 4) Tricuspid- 5th L ICS @ Sternal Border (nipple line) 5) Mitral- 5th L ICS @ Midclavicular Line
You auscultate the heart for_________and __________.
rate; rhythm
Auscultate heart to identify____________and ___________.
S1 (systole) and S2 (diastole)
Systole (S1)
1) is produced by AV valve closure 2) is heard loudest at the apex 3) is quieter at the base 4) coincides with the carotid artery pulse
Diastole (S2)
Is produced by semilunar valve closure is louder than systole (S1) Loudest component is aortic Heard loudest/best at base Quieter at apex
Auscultatory positions (4)
1) Supine-lying on the back 2) Sitting 3) Left lateral recumbent 4) Standing
Artery walls
are strong and stretch w/systole(S1), and recoil w/diastole (S2)
Arteries from the Aorta (BCS)
Brachial, Common carotid, subclavian
Arteries and Veins
Arteries- Carry blood away from heart Veins- Carry deoxygenated blood to heart
Lymphatic structures (NTTS)
1)Nodes 2) Tonsils 3) Thymus 4) Spleen
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