Cardiovascular Exam Flashcards Preview

Physical Diagnosis > Cardiovascular Exam > Flashcards

Flashcards in Cardiovascular Exam Deck (23):
1

Chest Wall Heart Landmarks

(5)

 

  1. Aortic valve
  2. Pulmonic valve
  3. Tricuspid valve
  4. Mitral valve
  5. Base and apex
     

A image thumb
2

Common Cardiovascular Symptoms

(5)

  1. Chest pain
  2. Palpitations
  3. "Difficulty breathing": shortness of breath,dyspnea,orthopnea,or paroxysmal nocturnal dyspnea.
  4. Swelling or edema
  5. Syncope

3

Cardiovascular Health History Questions

(8)

  1. Do you have chestpain, and if so where, please describe?
  2. Is it related to exertion, how many flights of stairs can you walk?
  3. Does the pain radiate?
  4. Does it wake you up at night?
  5. Do you have SOB, sweating, nausea, or palpitations?
  6. What makes the pain better, or worse?
  7. Have you noted any swelling?
  8. Coronary artery risks?

4

Blood Pressure Procedure

(5)

  1. Select cuff. Proper cuff size is essential to obtain an accurate reading.
  2. Inflate the cuff 20 to 30 mmHg above the estimated systolic pressure.
  3. Release the pressure slowly, no greater than 5 mmHg per second.
  4. Record the blood pressure as systolic over diastolic (120/70).
  5. Blood pressure should be taken in both arms on the first encounter. 

5

Pulse Procedure

(5)

  1. Compress the radial artery with your index and middle fingers.
  2. Note whether the pulse is regular or irregular.
  3. Count the pulse for 15 seconds and multiply by 4.
  4. Count for a full minute if the pulse is irregular.
  5. Record the rate and rhythm. 

6

Cardiovascular Exam Components (besides vitals)

(3)

  1. Estimate central venous pressure
  2. Assess carotid pulse
  3. Cardiac Exam

7

Central Venous Pressure

(define, 5 step procedure, results)

Definition: Estimate of jugular venous pressure

Procedure:

  1. Position the patient supine with the head of the table elevated 30 degrees.
  2. Use side lighting to observe for venous pulsations in the neck
  3. Sternal angle is used as a reference point
  4. RA is approximately 5-7 cm lateral and inferior to this point
  5. Estimate the height of the external jugular venous column in reference to the sternal angle

Results:

  • Normal venous column should be no more than 2-3 cm above the sternal angle
  • If the measurement is 4 cm or greater, central venous pressure is elevated

 

A image thumb
8

Carotid Pulse Assessment

(technical note, results)

Avoid compressing both carotids at same time, this could cause syncope, or lead to bradycardia

Results:

  • Small, thready or weak pulse in cardiogenic shock
  • Bounding pulse in aortic insufficiency

9

Ascultation for Bruits

(indication, 3 step procedure)

Indication: middle aged or older pt, to assess for risk of stroke

Procedure:

  1. Place the bell of the stethoscope over each carotid artery in turn.
  2. Ask the patient to stop breathing momentarily.
  3. Listen for a blowing or whosshing sound--a bruit. Do not be confused by heart sounds or murmurs transmitted from the chest. 

10

Point of Maximum Impulse

(2 step procedure)

  1. Palpate for the point of maximal impulse (PMI or apical pulse)
    • It is normally located in the 4th or 5th left intercostal space just medial to the midclavicular line and is less than the size of a quarter.
  2. Note the location, size, and quality of the impulse

11

Basic Cardiac Asculatation

(5 steps)

  1. Listen with the diaphragm at the right 2nd interspace near the sternum (aortic area).
  2. Listen with the diaphragm at the left 2nd interspace near the sternum (pulmonic area).
  3. Listen with the diaphragm at the left 3rd, 4th, and 5th interspaces near the sternum (tricuspid area).
  4. Listen with the diaphragm at the apex (PMI) (mitral area).
  5. Then listen with the bell at the exact same spots you did above.

12

Heart Murmuer Intensity Gradation

  1  Barely audible

  2  Soft but easily heard

  3  Loud without a thrill

  4  Loud with a thrill

  5  Loud with minimal contact between stethoscope and chest

  6  Loud with no contact between stethoscope and

             chest

 

¢

13

Maneuvers that Accentuate Heart Sounds

(describe 2)

  1. S3 and mitral valve murmur accentuation
    • Have the patient roll on their left side.
    • Listen with the bell at the apex.
    • This position brings out S3 and mitral murmurs.
  2. Aortic murmur accentuation
    • Have the patient sit up, lean forward, and hold their breath in exhalation.
    • Listen with the diaphragm at the left 3rd and 4th interspace near the sternum.
    • This position brings out aortic murmurs. 

14

Heart Sounds

(name and describe 2)

S1:

  • LUB
  • Mitral and tricuspid valves close.
  • Start of systole.
  • Corresponds with carotid pulse.

S2:

  • DUB
  • Aortic and pulmonic valves close
  • Start of diastole.

 

15

Clicks

 

  • Occur only during systole
  • Distinguished from S1 and S2 by their higher pitch and briefer duration
     

https://www.youtube.com/watch?v=PsmGx2XMxF8  

16

S3

  • Occurs during passive diastolic ventricular filling
  • Indicates serious ventricular dysfunction in adults
  • In children, it can be normal

https://www.youtube.com/watch?v=C-D547YO1iQ

17

S4

  1. Caused by atrial contraction, near the end of diastole
  2. S4 is heard much more often than S3 and indicates a lesser degree of ventricular dysfunction, usually diastolic
  3. S4 is absent in atrial fibrillation but is almost always present in active myocardial ischemia or soon after MI
  4. S3, with or without S4, is usual in significant systolic LV dysfunction
  5. S4 without S3 is usual in diastolic LV dysfunction

https://www.youtube.com/watch?v=3z5S5G8HSIo

18

Opening Snap

  1. An opening snap may occur in early diastole in mitral stenosis or, rarely, in tricuspid stenosis
  2. Mitral opening snap is very high pitched, brief, and heard best with the diaphragm of the stethoscope

https://www.youtube.com/watch?v=E0fDFsmVQfY

19

Systolic Murmurs

  • Divided into ejection, regurgitant, and shunt murmurs
  • Ejection murmurs are due to turbulent forward flow through narrowed or irregular valves or outflow tracts

Aortic or pulmonic stenosis:

https://www.youtube.com/watch?v=Gbk2465HO98

https://www.youtube.com/watch?v=SWW1PTL9Jbw

20

Regurgitant Murmurs

  • Retrograde or abnormal flow into chambers that are at lower resistance
  • Mitral or tricuspid regurgitation, ventral septal defects

http://www.merckmanuals.com/professional/resources/multimedia/name/audio.html

21

Diastolic Murmurs

(list 2)

  1. mitral stenosis
  2. aortic regurgitation

22

Attributes of Murmurs

(6, one c 4 specifics)

  1. Shape:
    • Crescendo murmur (Grows louder) - MS
    • Decrescendo murmur (Grows softer) - AR
    • Crescendo-decrescendo murmur (louder- softer) - AS
    • Plateau murmur (Same intensity) - MS
  2. Location, where does it originate?
  3. Radiation
  4. Intensity
  5. Pitch
  6. Quality

23

Innocent Murmur

  • Located 2-4 LT interspace between the LT sternal border and apex
  • Little radiation, variable quality, soft to medium pitch, intensity soft
  • Crescendo-Decrescendo or “diamond “ shape