3000 Cardiovascular Assessment

Question 1

Describe the key components of a cardiac assessment.

Answer 1

A cardiac assessment includes evaluating hands for skin color, sweat, capillary refill, and skin creases; examining the chest for bony structures, skin color, implantable devices, scars, and bruising; and assessing heart sounds by auscultating the four regions corresponding to each heart valve.

Question 2

Explain the significance of skin color and capillary refill in a cardiac assessment.

Answer 2

Skin color can indicate circulation issues, while capillary refill time helps assess peripheral perfusion; prolonged refill may suggest poor blood flow.

Question 3

How should you assess for edema in the legs during a cardiovascular assessment?

Answer 3

Inspect the legs for deformity and skin changes, palpate calf muscles for tenderness, and check for swelling or pitting nature of the edema.

Question 4

Define the normal heart sounds and their significance in a cardiovascular assessment.

Answer 4

Normal heart sounds include S1 (‘lub’) from the closure of the mitral and tricuspid valves, and S2 (‘dub’) from the closure of the aortic and pulmonary valves; abnormal sounds may indicate heart failure.

Question 5

Do you know the locations for auscultating heart sounds?

Answer 5

The aortic region is at the 2nd intercostal space right of the sternum, the pulmonary region is at the 2nd intercostal space left of the sternum, the tricuspid region is at the 4th intercostal space left of the sternum, and the mitral region is at the 5th intercostal space left of the sternum on the mid-clavicular line.

Question 6

Explain how blood pressure measurements can be affected by external factors.

Answer 6

Factors impacting blood pressure measurements include cuff size, patient support, cuff placement over clothing, stethoscope positioning, arm level, and crossed legs.

Question 7

What tips can improve the accuracy of blood pressure readings?

Answer 7

To improve accuracy, remove clothing, use the correct cuff size, support the arm and back, uncross legs, ensure the patient is at rest and not talking, and control variables like the same operator and arm.

Question 8

How can non-invasive blood pressure (NIBP) measurements be misleading?

Answer 8

NIBP can overestimate systolic blood pressure in hypotension and underestimate it in hypertension, and may be affected by arrhythmias, shivering, tremors, and movement.

Question 9

Describe the importance of electrode placement in ECG monitoring.

Answer 9

Electrode placement is crucial as movement can alter the heart’s electrical picture, leading to differences in serial ECG readings.

Question 10

What is the significance of a third heart sound in adults?

Answer 10

A third heart sound in adults over 30 years is typically abnormal and may indicate heart failure, while it can be normal in children and teens.

Question 11

Describe the significance of precordial leads in identifying right ventricular infarction (RVI).

Answer 11

Precordial leads are recommended in inferior STEMI to detect changes indicative of right ventricular infarction.

Question 12

Explain the relationship between preload and right ventricular function.

Answer 12

The right side of the heart is dependent on preload, making it a preload-sensitive condition where medications that lower preload should be used with caution.

Question 13

How does occlusion of the right coronary artery affect the heart?

Answer 13

Occlusion of the right coronary artery above the right ventricular branches can lead to inferior STEMI with right ventricular infarction.

Question 14

Define the V4R lead and its purpose in diagnosing RVI.

Answer 14

The V4R lead is placed in the same position as V4 but on the right side (5th intercostal space mid-clavicular line) to assess for right ventricular involvement.

Question 15

What ST elevation measurement in V4R is diagnostic for right ventricular involvement?

Answer 15

ST elevation greater than 0.5mm in V4R is diagnostic for right ventricular involvement.

Question 16

Identify the key features of a posterior myocardial infarction on an ECG.

Answer 16

Key features include horizontal ST depression, tall broad R waves (>30ms), and upright/positive T waves.

Question 17

How can posterior myocardial infarction be assessed using reciprocal leads?

Answer 17

Reciprocal leads V1-V3 should be examined for ST depression, as posterior myocardial infarction is not directly visualized by a standard 12 lead ECG.

Question 18

Explain the placement of leads for assessing posterior myocardial infarction.

Answer 18

Leads V4, V5, V6 are placed on the posterior chest wall, with V4-V7 on the left posterior auxiliary line and V5-V8 at the tip of the left scapula.

Question 19

What are common causes of artifact in ECG readings?

Answer 19

Common causes include loose lead artifact from hair or sweat, wandering baseline due to movement or breathing, and electromagnetic interference from devices.

Question 20

Differentiate between OMI and NOMI.

Answer 20

OMI refers to total occlusion, while NOMI indicates no occlusion but active cell death.

Question 21

Describe Wellens syndrome and its ECG characteristics.

Answer 21

Wellens syndrome is characterized by transient occlusion of the left anterior descending artery with spontaneous reperfusion, showing biphasic or deeply inverted T waves in V2 and V3.

Question 22

What are the two types of T wave abnormalities in Wellens syndrome?

Answer 22

Type A shows initially positive T waves, while Type B features deeply symmetrical T waves.

Question 23

Explain the De Winter T waves and their significance.

Answer 23

De Winter T waves indicate LADA occlusion, characterized by upsloping ST depression in precordial leads and peaked anterior T waves.

Question 24

What does the HEART score assess?

Answer 24

The HEART score assesses the likelihood of having a major adverse cardiac event (MACE) in the next 6 weeks.

Question 25

List the components of MACE as defined in the HEART score.

Answer 25

MACE includes total death, acute myocardial infarction, stroke, hospitalization due to heart failure, and revascularization.

Question 26

Identify risk factors for atherosclerosis disease.

Answer 26

Risk factors include hypercholesterolemia, hypertension, diabetes, cigarette smoking, positive family history, and obesity.

Question 27

What are some other potential causes of chest pain besides ACS?

Answer 27

Other causes include aortic dissection, chest infection, pneumothorax, pulmonary embolism, esophageal spasms, and other conditions.

Question 28

Describe the condition known as acute aortic dissection.

Answer 28

Acute aortic dissection is a serious condition characterized by a tear in the inner layer of the aorta, leading to severe pain, alteration in pulses and blood pressure, limb ischemia, tachycardia, pulmonary symptoms, skin changes, shock, syncopal episodes, and neurological deficits.

Question 29

Explain the difference between Type A and Type B aortic dissections.

Answer 29

Type A aortic dissection involves the ascending aorta and presents with chest pain, upper arm pulse deficits, and focal neurological deficits due to cerebral ischemia. Type B involves the descending aorta, presenting with posterior chest or back pain, abdominal pain, lower limb ischemia, and potential neurological deficits from spinal ischemia.

Question 30

Define troponin testing and its significance in cardiac health.

Answer 30

Troponin testing measures the levels of troponin C, I, and T in the blood, which are released when cardiac myocytes are inflamed or die. Elevated levels can indicate various cardiac conditions, including myocardial contusion, coronary artery spasm, and aortic dissection.

Question 31

How does aortic aneurism develop and what are its risks?

Answer 31

Aortic aneurism develops as a localized dilation of the arterial wall of the aorta due to vessel weakness or sustained high pressure, progressively enlarging until it may rupture, posing significant health risks.

Question 32

What are the clinical features of acute aortic dissection?

Answer 32

Clinical features include severe pain (sudden onset), alteration in pulses and/or blood pressure, limb ischemia, tachycardia, pulmonary symptoms, skin changes (pale, clammy), shock, syncopal episodes, and neurological deficits.

Question 33

Describe the purpose of a chest X-ray in hospital assessments.

Answer 33

A chest X-ray is used to assess heart size, detect atrophy, and identify heart failure.

Question 34

Explain the role of echocardiography in cardiac assessment.

Answer 34

Echocardiography uses ultrasound to evaluate heart structures and function, including blood flow, chamber issues, and heart valve lesions.

Question 35

What is the significance of coronary angiogram in cardiac diagnostics?

Answer 35

Coronary angiogram involves injecting liquid contrast dye into the artery to visualize coronary blood flow through X-ray imaging, helping to identify blockages or abnormalities.

Question 36

How does a coronary CT angiogram differ from a traditional coronary angiogram?

Answer 36

A coronary CT angiogram is a less invasive method that uses a CT scanner to visualize arterial blood flow through the heart, compared to the more invasive traditional coronary angiogram.

Question 37

List conditions associated with elevated troponin levels in the absence of acute coronary syndrome.

Answer 37

Conditions include myocardial contusion, coronary artery spasm, cardio-invasive procedures, congestive heart failure, aortic dissection, aortic valve disease, hypertrophic cardiomyopathy, arrhythmias, Takotsubo cardiomyopathy, and inflammatory cardiac diseases.

Question 38

What is costochondritis and what symptoms does it cause?

Answer 38

Costochondritis is a viral infection that causes deep muscular pain and chest pain.

Question 39

Describe the symptoms of anxiety as they relate to cardiac health.

Answer 39

Anxiety can manifest with symptoms that may mimic cardiac issues, such as chest pain, palpitations, and shortness of breath, potentially complicating the assessment of actual cardiac conditions.

Question 40

What are the potential skin changes observed in acute aortic dissection?

Answer 40

Skin changes may include pallor and clamminess, indicating shock or compromised blood flow.

Question 41

How can limb ischemia present in cases of acute aortic dissection?

Answer 41

Limb ischemia can present as pain, weakness, or numbness in the affected limbs due to reduced blood flow resulting from the dissection.

Question 42

Explain the significance of tachycardia in acute aortic dissection.

Answer 42

Tachycardia, or an increased heart rate, is a common response to pain and shock in acute aortic dissection, indicating the body's stress response and potential cardiovascular compromise.