Download Slide 1

Cardiac- Human
The heart is a muscular organ found in all vertebrates that is responsible for
pumping blood throughout the blood vessels by repeated, rhythmic contractions.
The term cardiac (as in cardiology) means "related to the heart" and comes from
the Greek kardia, for "heart”.
Your heart is actually a double pump. The right side of the heart is made up of the
right atrium (upper chamber) and the right ventricle (lower chamber). The right side
receives blood that is low in oxygen from all the veins in the body, and then it
pumps that blood through the pulmonary artery to the lungs, where it will become
re-oxygenated. The left side of the heart consists of the left atrium (upper chamber)
and the left ventricle (lower chamber). The left side of the heart receives this
oxygen-rich blood from the lungs, which it then pumps through the aorta to the
body.
•
•
•
•
Fun facts about your heart!
By the time you turn 70, your heart will have
beat some two-and-a-half billion times
(figuring on an average of 70 beats per
minute.)
The left lung is smaller than the right lung to
make room for the heart.
Women’s hearts beat faster than men’s.
According to German researchers, the risk of
heart attack is higher on Monday than any
other day of the week.
• Most people think the heart is located on the left side but it is actually
located almost in the center of the chest, between the lungs. It's tipped
slightly so that a part of it sticks out and taps against the left side of the
chest, which is what makes it seem as though it is located there.
• Your heart beats about 100,000 times in one day, 35 million times in a
year, and more than 2.5 billion times during an average life span.
• Even at rest, the muscles of the heart work hard—twice as hard as the leg
muscles of a person sprinting.
• The aorta, the largest artery in the body, is almost the diameter of a
garden hose. Capillaries, on the other hand, are so small that it takes ten
of them to equal the thickness of a human hair.
RISK FACTORS
•Do you smoke?
•Drink alcohol?
•What is your caffeine intake per day?
•Do you use prescription or recreational
drugs?
•Do you exercise?
•Describe your dietary patterns.
MEDICATIONS
Are you taking prescription medications
to treat blood pressure or irregular heart
rhythm?
LIFESTYLE
•What physical demands or
emotional stress exists?
FAMILY HISTORY
•Heart Disease
•DM
•High Cholesterol
•Hypertension
•Stroke
•Rheumatic Heart Disease
PERSONAL HISTORY
•Congestive heart
failure
•Congenital heart
disease
•Coronary artery
disease
•Dysrhythmias
•murmurs
OTHER RISK FACTORS
•Preexisting DM
•Lung disease
•Obesity
•Hypertension
A Cardiac Assessment
Inspection and Palpation
Blood Pressure and pulse are two most prominent numbers when
initiating a cardiac assessment. They are the identifiers an individual’s
cardiovascular health, and used to assess the immediate health of the
heart organ.
1. Blood Pressure
Normal
Prehypertension
Hypertension
Stage 1 (Mild)
Stage 2 (Moderate
to Severe)
Systolic Diastolic
(mmHg)
<120
120-39
<80
80-89
140-59
90-99
>160
>100
2. Pulse (beats per minute)
Infants 120-160
Toddlers 90-140
Preschooler 80-110 School age 75-100
Adolescent 60-90
Adult 60-100
A Cardiac Assessment
Inspection and Palpation
Blood pressure (BP) is the
•force exerted on walls of an artery
•pulsing blood under pressure from heart
•blood flows throughout circulatory system due to pressure changes
•from area of high pressure to area of low pressure
Systolic pressure – the blood pressure measured during
ventricular contraction (systole). The higher of the two
measurements. This pressure produces the first sound
(S1),
characterized by a “lubb.”
Diastolic pressure – the measure of pressure between
contractions, pressure falls below that in the aorta and
pulmonary artery, allowing these valves to close. As the
valves close, the second heart sound (S2) is heard,
“dubb,” in
a normal heart.
Factors influencing
Age
Gender
Activity
BP:
Stress
Ethnicity
Medications Smoking
Weight
Daily Routine
The pulse - beats per minute (bpm) of the heart.
Palpation – the technique used in a physical examination to feel for
relevant factors. It is what is perceivable by touch.
Texture, Elasticity
Rhythm
Consistencies
Rate
Location on body
Size
Strength of
0 =
1+ =
2+ =
3+ =
4+ =
the Pulse - 0 – 4+
Absent, not palpable
Pulse diminished, thready, barely palpable
Expected, normal
Full pulse, increased, easy to palpate
Strong, bounding pulse (may be abnormal)
The Electrocardiogram (ECG)
• reflects electrical activity of the conduction system of the heart
• monitors regularity and path of electrical impulses of conduction
system
• does not reflect muscular work of the heart
• normal sequence is called normal sinus rhythm (NSR)
•NSR begins at the sinoatrial (SA) node . . . the PR interval
•Through atrioventricular (AV) node, Bundle of His, Purkinje fibers
•QRS complex = electrical impulse through ventricles, followed by
contraction
•QT interval represents ventricular depolarization/repolarization
Pulse Determination
Blood Pressure Determination
Possible system imbalances include:
• Tachycardia
• Bradycardia
• Dysrhythmias
Possible system imbalances include:
• Hypertension
• Hypotension
• Orthostatic hypotension
Heart Sounds
Locations to Hear Heart Sounds
The bell is held lightly, and the diaphragm is pressed
firmly against the skin of the chest wall. This enhances
the faint low-frequency vibrations from ventricular and
atrial gallops.
The high-pitched murmurs of aortic regurgitation and
some cases of mitral regurgitation are better heard with
the use of the diaphragm to filter out the low-frequency
components of other distracting heart sounds.
•
The 4 percordial areas are examined with diaphragm, including:
•
Aortic region (between the 2nd and 3rd intercostal spaces at the
right sternal border) (RUSB – right upper sternal border).
•
Pulmonic region (between the 2nd and 3rd intercostal spaces at the left sternal
border) (LUSB – left upper sternal border).
•
Tricuspid region (between the 3rd, 4th, 5th, and 6th intercostal spaces at the left
sternal border) (LLSB – left lower sternal border).
•
Mitral region (near the apex of the heard between the 5th and 6th intercostal
spaces in the mid-clavicular line) (apex of the heart).
Cardiac cycle related to sounds & values:
Normal heart sounds are associated with heart valves closing, causing changes in blood flow
Common:
S1 : The first heart tone, or S1, forms the "lubb" of "lubb-dub" or "lubb-dup”
It is caused by the sudden block of reverse blood flow due to closure of the atrioventricular valves
S2: The second heart tone, or S2, forms the "dub" of "lubb-dub" or "lubb-dup”
It is caused by the sudden block of reversing blood flow due to closure of the aortic valve and
pulmonary valve at the end of ventricular systole
Not so common:
S3: Also called a protodiastolic gallop, ventricular gallop, or informally the "Kentucky" gallop
(S1=ken; S2=tuc; S3=ky). It occurs at the beginning of diastole after S2 and is lower in pitch than S1
or S2 as it is not of valvular origin. The third heart sound is benign in youth and some trained athletes.
Later in life it may signal cardiac problems like a failing left ventricle as in dilated congestive heart
failure (CHF).
S3 is thought to be caused by the oscillation inrushing blood from the atria.
S4: The rare fourth heart sound is sometimes audible in healthy children and again in trained athletes.
Is called a presystolic gallop or atrial gallop.
This gallop is produced by the sound of blood being forced into a stiff/hypertrophic ventricle. It is a
sign of a pathologic state. Producing a rhythm sometimes referred to as the "Tennessee" gallop
where S4 represents the "tenn-" syllable.
Animations of sounds and figures go here
http://www.openheartsurgery.com/heart_sounds.html
http://blaufuss.org/
What is a Murmur?
• It maybe a normal or abnormal sound
that is heard secondary to turbulent
blood flow.
• Characteristics of Murmurs:
– Timing
– Intensity
– frequency
– location
27
Heart Murmurs
What causes a heart murmur?
Heart murmurs may be caused by a number of factors or diseases, including:
• defective heart valves
• holes in the heart walls
• pregnancy
• fever
• anemia (a decrease in the red cells in the blood)
What are the different types of murmurs?
All murmurs are analyzed for pitch, loudness, and duration. They are also
graded according to their intensity (on a scale of one to six, with one being
very faint and six being very loud).
Types of murmurs include:
systolic murmur - occurs during a heart muscle contraction. Systolic murmurs
are divided into ejection murmurs (due to blood flow through a narrowed
vessel or irregular valve) and regurgitant murmurs.
diastolic murmur - occurs during heart muscle relaxation between beats.
Diastolic murmurs are due to a narrowing of the mitral or tricuspid valves,
or regurgitation of the aortic or pulmonary valves.
continuous murmur - occurs throughout the cardiac cycle.
Aortic Stenosis
Echocardiography
11/12/02
Lubna Piracha, D.O.
30
Acoustic Cardiography
Acoustic cardiography has been developed much more recently. This
diagnostic technique consists of recording and algorithmically interpreting
contemporaneous digital ECG and cardiac acoustical data. This is accomplished by
using electrodes placed in the same positions as those used for a standard
electrocardiogram (ECG). However, in the V3 and V4 precordial positions it employs
dual-purpose sensors that simultaneously acquire ECG and sound data from each
of these locations.
Example of an Acoustic Cardiographic Tracing and Report.
An acoustic cardiographic recording that includes a 12-lead ECG is shown. Below the ECG is a simultaneous sound tracing that reveals both an S3
and an S4. A segment of this sound tracing is also shown near the top right corner of the report and this segment includes labelling of the S3 and
S4. At the top left of the report is the printed algorithmic interpretation of both the ECG and the heart sound findings. The ECG findings include an
anterior myocardial infarction and evidence of left ventricular hypertrophy. The three dimensional image of the heart in the top right corner of the
report indicates the location of the myocardial infarction in black ink. Immediately below the image of the heart is a horizontal bar graph that
indicates the relative strength of the ECG evidence for the left ventricular hypertrophy. Abbreviations: int – interval; LVH – left ventricular
hypertrophy; mV – millivolt; S3 – third heart sound; S4 – fourth heart sound; EMAT – electromechanical activation time; LVST – left ventricular
systolic time.
Time-Frequency Analysis of Heart Sounds
The figure presents a schematic of a single heart beat showing a simultaneous
ECG and sound recording in the time domain (upper two traces) as well as the
wavelet filter based time-frequency representation of the heart sound recording
(scalogram).
Abbreviations: P – ECG P wave; Q – ECG Q wave; T – ECG T wave; S1 – First heart
sound; M – Mitral component; T – Tricuspic component; S2 – Second heart
sound; A – Aortic component; P – Pulmonary component; S3 –Third heart sound;
S4 – Fourth heart sound.
Time-frequency analysis of heart sounds for a subject with a systolic murmur.
Illustrate the 2D and 3D scalogram views for a few beats from the acoustic cardiography rhythm strip shown above.
Since murmurs have higher frequency components than diastolic heart sounds, they do not have to be high in intensity
to be detected by the human ear.