closing of the tricuspid and mitral valves
opening of the aortic and pulmonary valves
ventricular contraction (high pressure)
S1 sound (high-pitched)
closing of the aortic and pulmonary valves
opening of the tricuspid and mitral valves
ventricular relaxation/filling (low pressure)
S2 sound (low-pitched)
Normal Sinus Rhythm - 60-100bpm
What is the inherent rate of the SA node?
What is the inherent rate of the AV node?
What happens if both the SA & AV nodes fail? (escape rhythm)
There is still some inherent rhythm set by the Bundle of Hiss and bundle branches, but it is slow (30-40bpm) and doesn’t progress in the normal direction/coordination.
<30bpm (escape rhythm)
What are 5 important questions to ask in your cardio Hx?
- Pain (chest, arm, back, neck, jaw - on exertion?)
- Syncope, dizziness, lightheaded?
- SOB, DOE, PND, orthopnea?
Orthostatic hypotension is dx at:
> 20mm fall in systolic BP
General appearance to look for in CV dz?
Acute distress, ease of breathing, cyanosis, alertness, mobility, weight loss.
Syndromes - Turners, Marfans, Downs.
Assess peripheral pulses for:
rate & rhythm
variations - beat to beat, with respiration
Assess carotid pulse:
auscultate for murmurs and carotid bruits
What questions would you ask a pt with palpitations?
SOB dizziness syncope weakness (pain - but less likely in women)
Variation of heart rate that occurs during respiration:
Respiratory Sinus Arrhythmia (RSA)
Where would you auscultate the aortic valve?
2nd intercostal space RIGHT of the sternum
Where would you auscultate the pulmonary valve?
2nd intercostal space LEFT of the sternum
Where would you auscultate the tricuspid valve/RV?
lower left half of the sternum and parasternal area
Where would you auscultate the mitral valve/LV?
5th intercostal space at/just medial to the midclavicular line
What is Erb’s point?
point where S2 is best auscultated, located at 3rd intercostal space left of the sternum
Are S3 and S4 heart sounds normal?
What does each signify?
Not in adults. S3 may be normal in kids.
S3 sound is d/t noncompliant, dilated ventricle, heard in early diastole.
S4 sound is d/t augmented ventricular filling caused by atrial filling, heard in late diastole.
Turbulent blood flow through a valve or outflow tract:
Ejection murmur (systolic)
Sound d/t retrograde or abnormal flow:
Regurgitant murmur (systolic)
Sound d/t abnormal openings btw vessels/chambers:
Shunt murmur (systolic)
Are diastolic murmurs ever normal?
Why might you hear one?
D/t aortic/pulmonary regurgitation w/relaxation, or mitral/tricuspid valve stenosis.
What causes a pericardial friction rub?
Inflamed visceral and pericardial pleural friction, causes a high-pitched squeaking. “ziplock bag of mayonnaise”
What are three additional things to check if you suspect cardiovascular issues?
Liver (abdomen, spleen, abd aorta)
Legs (edema, veins, ulcers)