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Heart - Coggle Diagram

- - - - Aortic valve: 2nd right intercostal space
      - Pulmonic Valve: 2nd left intercostal space
      - Second pulmonic area: 3rd left intercostal space
      - Tricuspid area: 4th left intercostal space
      - Mitrial (apical) 5th left intercostal space at mid-clavicular line
    - - Pericardial friction rub: inflammation of pericardial sac causes roughening of parietal/visceral surfaces
        
        machine-like rubbing sound
        
        machine-like rubbing sound
        
        overlies cardiac cycle
      - Murmurs
        
        Causes:
        
        Valvular disease
        
        High output demands (fever, pregnancy)
        
        structural defect (congenital or aquired)
        
        diminished strength of mycardial conraction
        
        Persistence of fetal circulation
        
        Some benign, some pathological
- - - - Subjective: Fever, fatigue, sudden-onset CHF
      - Objective: murmur, Janeway lesion (small erythematous macules on palms soles); Osler nodes (painful, red raised leasions on tips of fingers/toes=septic emboli)
    - - Left sided: congestion
        in pulmonary circulation
        
        Subjective: fatigue, SOB, orthopnea
        
        Objective: acute pulmonary edema, crackles
      - Right-sided CHF: congestion
        in systemic circulation
        
        Subjective: Peripheral edema, weight gain
        
        Pitting dependent edema, JVD, hepatomegaly
    - - Subjective: Sharp/stabbing CP, pain worse with cough/deep breathing, lying flat; pain worse when supine, relieved by sitting up
      - Objective: Scratchy triphasic friction rub heard left of sernum
    - - Subjective: anxiety, CP, SOB, tachypnea
      - Objective: Beck's triad (JVD, hypotension, muffled heart sounds)
    - - Subjective: fatigue, tachypnea, hemoptysis, cough
      - Objective: pulmonary disease, wheezes/crackles, barrel chest, evidence of RHF, JVD, left parasternal systolic heave
    - - Subjective: Vague, fatigue, fever, palpitations, flu-like illness
      - Objective: cardiac enlargement, murmurs, gallops, pulsus alternans (alternation of strong and weak arterial pulse)
  - - - Subjective: fianting, transiet dizziness, seizure, angina
      - Objective: dysrhythmia, signs of CHF
  - - - Subjective: Recurrent Resp infections. If large: rapid breathing, poor growth, CHF
      - Objective: load, coarse murmur over left sternal border, left peristernal lift
    - - Four Cardiac defects
        
        Ventricular septal defect
        
        Pulmonic stenosis
        
        dextroposition of the aorta
        
        R ventricular hypertorphy
      - Subjective: Dyspnea with feeding, poor growth, parxysmal dyspnea
      - Objective: parasternal heave, precordial prominence, systolic ejection murmur, clubbing of fingers
    - - Subjective: fever, inflamed joints, painless rash, fatigue, sob
      - Objective: mitral regurg, cardiomegaly, friction rub, CHF
  - - - Subjective: palpitations, dependent edema, fatigue,
      - Objective: pleural effusion, arrhythmia, JVD, hepatomegaly, thickened left ventricle
- - - - Atrioventricular
        valves
        
        Tricuspid (separates RA from RV)
        
        mitral valve (separates LA vrom LV)
        
        Open during diastole, close during systole
      - Semilunar valves
        
        Pulmonic valve: separates RV from pulmonic artery
        
        Aortic valve: separates LV and aorta
        
        Open during systole, close during diastole
  - - - Birth changes: Closure of ductus arteriosus (from RA to Aorta) w/i 24-48 hr
        Mass of left ventricle increases in size
      - Horizontal lie
      - By 1 year, relative sizes of L:R= 2:1 (adult ratio)
      - Adult heart position reached by 7 YO
    - - Blood volume increases 50%
      - Left ventricle thickens
      - More horizontal lie with upward shift in diaphragm
    - - CO decreases by 30-40%
      - Endocardium thickens, myocardium less elastic
- - - - eval skin, lungs, liver
      - cyanosis may = congenital heart defects
    - - Hearts tones difficult to assess
      - HR vary while sleeping/eating
      - Murmurs common until 48 hrs old
  - - - Bulging precordium= enlarged heart
      - Auscultate
        
        Most murmurs are congenital
        
        acquired murmurs= Kawaskai disease
        
        Still murmur = "innocent" murmur. result of vigorous expulsion of blood form l ventricle to aorta
      - Heart disease
        
        weight gain/loss
        
        developmental delay
        
        cyanosis
        
        clubbing fingers/toes