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Advanced Assessment > Cardiac Assessment > Flashcards

Cardiac Assessment Flashcards

1
Q
A

ventricular fibrillation

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2
Q
A

sinus rhythm with 1st degree AV block

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3
Q
A

Paroxysmal atrial tachycardia

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4
Q
A

atrial fibrillation

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5
Q
A

ventricular tachycardia

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6
Q
A

atrial flutter

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7
Q
A

sinus bradycardia

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8
Q

Heart - order of exam

A

Inspect, Palpate, Percuss, Auscultate

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9
Q

Heart - what should you inspect?

A

apical pulse (tangential light)

skin - cyanosis and venous distention

nail beds - capillary refill and cyanosis

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10
Q

Apical pulse - location

A

5th ICSMCL

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11
Q

Heart - palpation

A

Precordium: apex, LSB, base, RSB

apical impulse/PMI

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12
Q

How should a normal apical impulse feel?

A

gentle, brief pulsation

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13
Q

“Heave” or “Lift”

A

vigorous apical pulse to palpation

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14
Q

“Thrill”

A

fine, palpable, rushing vibration

usually at base or 2nd RICS or 2nd LICS

AKA “palable murmur”

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15
Q

What else should you palpate as you feel the precordium?

A

Carotid artery

(carotid pulse and S1 should occur simultaneously)

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16
Q

Heart percussion - why?

A

to estimate the size of the heart (in abscence of Xray)

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17
Q

Normal heart size measurments (from MSL)

A

5-7 cm @ 5th ICS

4-6 cm @ 4th ICS

3-4 cm @ 3rd ICS

1-3 cm @ 2nd ICS

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18
Q

Ausculation - 5 areas

A

aortic (2nd RICSRSB)

pulmonic (2nd LICSLSB)

2nd pulmonic (3rd LICSLSB)

tricuspid (4th LICSLSB)

mitral (5th LICSLSB)

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19
Q

Auscultation - what positions?

A

sitting (slightly leaning forward)

supine

left lateral

right lateral if right rotated heart

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20
Q

Best position to hear high pitched murmurs (diaphragm)

A

sitting

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21
Q

Best position to hear low pitched filling sounds (bell)

A

left lateral recumbant

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22
Q

Ausculation - 5 components to assess

A

rate/rhythm

S1

systole

diastole

S2

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23
Q

Next step if heart rate irregular…

A
  1. is there a pattern?
  2. compare BPM with radial pulse and note any pulse deficit
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24
Q

S1 assessment

A
  1. breathe normally, then hold breath on expiration
  2. listen for S1 while palpating carotid
  3. Evaluate for intensity, variations, splitting and effects of respirations
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25
Q

What are you listening for during systole? diastole?

A

Extra heart sounds/murmurs

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26
Q

How do you evaluate for a split S2 and where is it best heard?

A

Inhale deeply and listen for S2 to become two sounds. Best heard at pulmonic site.

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27
Q

What is S1 and where is it best heard?

A

beginning of systole

apex (louder, longer than S2)

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28
Q

What is S2 and where is it best heard?

A

end of systole

best heard in the aortic and pulmonic areas (lounder than S1 at the base)

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29
Q

Significance of S3 and S4

A

S3 normal (children/athletes) or pathologic (ex. CHF)

S4 always pathologic

30
Q

Heart murmurs - 8 characteristics

A
  1. timing/duration
  2. pitch
  3. intensity
  4. pattern
  5. quality
  6. location
  7. radiation
  8. respiratory phase variations
31
Q
A
32
Q

What kind of pain?

substernal

provoked by effort, emotion, eating

relieved by rest +/- NG

diaphoresis

occassionally nausea

A

cardiac pain

33
Q

What kind of pain?

precipitated by breathing or coughing

“sharp”

present with respiration, absent with breath holding

A

pleural

34
Q

What kind of pain?

burning, substernal

occasional radiation to shoulder

nocturnal, laying flat

relieved by food

unrelated to activity

A

esophageal

35
Q

What kind of pain?

almost always infradiaphragmatic and epigastric

nocturnal

daytime attacks relieved by food

unrelated to activity

A

peptic ulcer

36
Q

What kind of pain?

usually under right scapula

prolonged

often occurs after eating

will trigger angina more than mimic it

A

biliary

37
Q

What kind of pain?

usually lasts for hours

local tenderness and/or pain with movement

A

arthritis/bursitis

38
Q

What kind of pain?

associated with injury

provoked by activity

persists after activity

painful on palpation and/or movement

A

cervical

39
Q

What kind of pain?

intensified or provoked with movement, particularly twisting or bending

long-lasting

often associated with focal tenderness

A

musculoskeletal (chest)

40
Q

What kind of pain?

associated with/after anxiety

poorly described

intermammary

A

psychoneurotic

41
Q

Cholesterol levels

A

Total <200

LDL <100 (<70 if prev.MI or DM)

HDL >40

Triglycerides <150

42
Q

Murmur intensity scale

A

I - barely audible

II - quiet but clearly audible

III - moderately loud

IV - loud, associated with thrill

V - very loud, thrill easily palpated

VI - very loud, audible with stethoscope off chest, visible thrill

43
Q
A

mitral regurgitation

44
Q
A

tricuspid regurgitation

45
Q
A

mitral valve prolapse

46
Q
A

pulmonic regurg

47
Q
A

aortic regurg

48
Q
A

VSD

49
Q

intense, grating

rubbing, machine-like sound

overlies cardiac sounds

more distinct toward apex

can occur in systole and diastole

A

pericardial friction rub

50
Q

Jugular vein finding heart failure

A

distenstion >3cm above the sternal angle when at 45 degrees

51
Q

S3 - cause and sound

A

SLOSH’ ing in

S1 S2 S3

regurgitation of blood

52
Q

S4 - cause and sound

A

a STIFF’ wall

S4 S1 S2

pressure wave as atria contract, ventricles are stiff

53
Q

Order of palpation - peripheral arteries

A

Carotid

Brachial

Radial

Femoral

Popliteal

Dorasalis Pedis

Posterior tibial

54
Q

How to assess for a bruit

A

Listen over arteries with bell

Carotid, subclavian, renal, iliac, femoral, abdominal aorta

For carotid, hold breath so resp don’t interfere

55
Q

Two ways to confirm JVP

A
  1. hepatojugular reflex
  2. hand veins
56
Q

If suspect venous obstruction and insufficiency, assess extremities for 4 signs

A
  1. signs of thrombosis (red, thick, swelling, tenderness)
  2. Homan’s sign
  3. Edema
  4. Varicose veins
57
Q

If varicose veins, how can you check system competency?

A

Stand on toes 10 times in succession, if system is competent the pressure will disappear in a few seconds

58
Q
A

ischemic ulcer

59
Q
A

varicose veins

60
Q
A

thrombophlebitis

61
Q
A

venous stasis ulcer

62
Q

alteration of a pulsation of small amplitude and large amplitude, normal rhythm

A

pulsus alternans (ex. Left ventricular failure esp. if slow)

63
Q

pulse with two main peaks, best felt in carotid artery

A

pulsus biferians

64
Q

normal pulsation followed by a premature contraction

A

bigeminal pulse

65
Q

large pulse that is readily palpable, not easily obliterated

A

bounding pulse

(exercise, anxiety, fever, hyperthyroid, atherosclerosis)

66
Q

pulse decreased amplitude during inspiration, increased amplitude during expiration

A

pulsus paradoxus

67
Q

greater amplitude and faster rise to summit, sudden decrease

A

Corrigan pulse (water hammer)

PDA, aortic regurg

68
Q
A
69
Q

Right or left sided heart failure?

peripheral edema

ascites

weight gain

JVD

A

Right

70
Q

Right or left sided heart failure?

dyspnea

cyanosis

clubbing

crackles

A

left sided

71
Q
A

Advanced Assessment (5 decks)

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