Cardiovascular Exam - Part 1 Flashcards
(22 cards)
Stethoscope
Anterior and inferior
Diaphragm for high-pitched
Bell for low-bitched
Sinus tachycardia
Regular rate at 100-180
Fever, exercise, emotion, pain, anemia, CHF, volume depltion/shock, thyrotoxicosis, drugs
SInus bradycardia
and SVT
Regular rate at <50-60
Athleticism, drugs, sinus node pathology
SVT
Regular at 150-250
Sudden onset and resolution
May stop with cough or carotid massage
A fib
Sinus arrhythmia
A fib - Irregularly irrgular…usually fast
Rate speeding during inspiration but no clinical significance
Small and weak pulses
Large, bdounig pulses
Low pulse pressure (SBP-DBP)…CHF, hypovolemia, severe aortic stenosis
High pulse pressure, hyperdynamic state and aortic insufficiency
Pulsus alternans
Bigeminal pulse
Regular rhythm, alternating strong and weak pulse, left ventricular failure
Rhythmically irregular rhythm, alternating strong and premature beats…PACs and PVCs
Paradoxical pulse
Dec in pulse amplitude or in SBP by more than 10 mmHg during inspiration
Cardiac tamponade, constrictive pericarditis, COPD< severe asthma
Orthostatic hypotension
Fall in SBP by 20 upon rising
Hypovolemia, drugs, prolong bed rest, autonomic neuropathy
JVP - waves
Direct connection to the right atrium
AXVY
Atrial contraction
Atrial relaxaton
Venous filling
Atrial emptying
JVP
Normal form 6-8 cm H2O
JVD vs. JVP
JVD is from external veins
JVP and pulse waves
A fib - Lose A
Tricuspid stenosis/pulm HTN/right sided HF - very pronounced A bc atrium contracting against resistance
Tricuspid regurgitation - high V
Hypetrophies
Concentric - hypertrophic cardiomyopathy (pressure)
Dilated cardiomyopathy (volume overload)
Systole and diastole
Systole - ventricular conctraction…S1 - closing of mitral and tricuspid…opening of aortic and pulm
Diastole - ventricular relaxation..closing of A and P=S2…opening of M and T
Phase 1 D - rapid filling of V
Phase 2 D - atrial contraction
PMI
Not shifted…hypertrophic…very strong
Lateral - dilated and weak PMI that fills your palm
Accentuated S1
Diminished S1
Varying S1
Hyperdynamic state - exercise, anemia, hyperthyroid…ONLY sign for mitral stenosis
Diminished S1 - delayed conduction from A to V…poor ventricular contraction (CHF)…calcified and immbole mitral valve (MR)
Varying S1 - complete heart block or irregular rhythm (a fib)
Physiologic split of S2
Right sided heart activites are slightly longer than left
During inspiration, right sided act are even longer—-
Neg intrathoracic pressure increases blood flow to Rt atrium
—Lung expansion increases pulmonary hangout interval
Splitting of S2
Physiologic in inspiration (A2 then P2)
Wide in RBBB, pulomonic steonisis, pulm HTN
Paradoxial (in exp rather than ins) in LBBB and aortic stenosis
Fixed (equal in both expiration and inspiration) in ASD and right ventricular failure
INcreased A2 and P2
A2 - HTN, dilated aoritc root
P2 - pulm HTN< dialted pulm artery, ASD
Decreased A2
Decreased P2
A2 - calcific aortic stenosis
Dec P2 - Aging (inc AP diameter of chest) or pulmonic steoniss
S3
End of the rapid filling phase of diastole
Ventricles are expanded and walls tensed…sudden halt of blood mass against ventricular walls
Low -pitched short and faint sound (use bell)
At the apex or yphoid
Normal S3 in children, adolescents, last timerster of preg, anemia, febrile, and hyperthyroid
ABnoraml S3 denotes serious myocardila dysfunction
Basically means a dilated LV - MI or volume overload
S4
Sudden tensiing of ventricular musculature and chordae tendinaea
During atrium contraction at end of diastole
Indicative of dec ventricular compliance (inc stiffness)
Low pitch and low instensity
At apex of LLSB
Normal S4 in atheletes
Normally in long standing HTN
