Cardiovascular System PP

Question 1

What do we inspect in the precordium?

Answer 1

We inspect for apical impulse and any heaves or lifts (hyperdynamic or LVH).

Question 2

When does a heave/lift occur?

Answer 2

With ventricular hypertrophy, like in pulmonic valve disease, pulmonic HYT, and chronic lung disease.

Question 3

What do you palpate for in the precordium?

Answer 3

thrills and PMI

Question 4

What is a thrill?

Answer 4

palpable vibration, like the throat of a purring kitty. It means turbulent blood flow and accompanies a loud murmur.

Question 5

What is a bruit, what does it sound like, and what is it’s probable cause?

Answer 5

a murmur that sounds like a blowing, swooshing sound. It indicates blood flow turbulence in a vessel. Probable cause is arthersclerosis.

Question 6

Do we percuss the chest?

Answer 6

NO, because of CXR and other imaging studies

Question 7

What are the 5 loci we auscultate for the heart?

Answer 7

Aortic, pulmonic, Erb’s point, tricuspid, and mitral.

Question 8

What is Erb’s point?

Answer 8

Where the 4 loci we auscultate of the heart are heard simultaneously, in the center

Question 9

How do we auscultate for the CV system?

Answer 9

systematically. Sitting then lying, diaphragm then bell, rate, and rythm.

Question 10

Define a pulse deficit

Answer 10

Difference between apical and radial pulses.

Question 11

How is a pulse deficit obtained?

Answer 11

Noted by auscultating the apical beat and palpating the radial pulse at the same time and counting in a serial measurement. Record any differences between the 2 pulses. Subtract the radial from the apical.

Question 12

A pulse deficit indicates?

Answer 12

a weak contraction of the ventricles and occurs with A-fib, premature beats, and heart failure.

Question 13

What else do we auscultate, aside from the norm, when assessing the CV system?

Answer 13

Prosthetic valves and pacemakers

Question 14

What is a mechanical heart valve and what is its advantage?

Answer 14

A mechanical heart valve made of man-made materials. They don’t wear out.

Question 15

What is a biological heart valve?

Answer 15

They’re made from tissue taken from animals or human cadavers. Treated with preservatives and sterilized for human implantation. May need to be replaced every 10-15 yrs.

Question 16

During auscultation what does a pericardial friction rub (pericarditis) sound like and what does the pt do?

Answer 16

scratchy (like sandpaper rubbed), LLSB (lower left sternal border) aka apex. The pt leans forward and holds breath during expiration.

Question 17

What causes pericarditis and how is it heard best?

Answer 17

inflammation of the pericardium. Heard best with diaphragm.

Question 18

What are the 2 main neck vessels we examine in CV assessment?

Answer 18

The carotid aa. and jugular vv.

Question 19

How can we assess for central venous pressure and why do we do it?

Answer 19

From the jugular vv., to assess for heart’s efficiency as a pump.

Question 20

Why is the internal jugular vv. most reliable for assessment of CVP?

Answer 20

Because it is attached more directly to the S. VC

Question 21

Which neck vessel is palpable and which isn’t?

Answer 21

The internal jugular isn’t and the carotid pulse is

Question 22

How do we assess Jugular Venous DIstention (JVD)?

Answer 22

HOB 30-45 degree, no pillow.

Question 23

What is JVD?

Answer 23

Jugular venous distention happens with increased pressure in the vena cava, resulting in a bulge on the side of the neck.

Question 24

What is HJR and when do we assess for it?

Answer 24

Hepatojugular reflex is assessed when JVD is elevated or you suspect CHF.

Question 25

How do we test for HJR?

Answer 25

Watch the level of the jugular pulsation as you push with your hand. This empties venous blood out of the liver sinusoids and adds its volume to the venous system temporarily. If heart is healthy, jugular vv. will rise for a few secs and then recede to prev. level

Question 26

List vascular system components

Question 27

List arterial system components

Question 28

We palpate _______ and score from 0-4+ which means....

Answer 28

Bilaterally. 0 absent 1+ weak 2+ normal 3+ increased 4+ bounding

Question 29

Locate dorsalis pedis pulse

Answer 29

on the dorsum of the foot in the first intermetatarsal space just lateral to the extensor tendon of the great toe

Question 30

Locate posterior tibial pulse

Answer 30

can be felt behind and below the medial malleolus.

Question 31

Locate popliteal pulse

Answer 31

a diamond-shaped space behind the knee joint

Question 32

Name 1+-4+ pitting edemas and describe them

Answer 32

1+ Mild pitting, slight indentation, no perceptible swelling of the leg​ 2+ Moderate pitting, indentation subsides gradually​ 3+ Deep pitting, indentation remains for a short time, leg looks swollen​ 4+ Very deep pitting, indentation lasts a long time, leg is very swollen

Question 33

Why does a pitting edema form?

Answer 33

due to slow, long CV problems

Question 34

Where can bruits be heard in auscultation?

Answer 34

Aortic bruit in the center. renal bilaterally, iliac bilaterally in lower abdomen

Question 35

What is PIH and when does it occur?

Answer 35

pregnancy-induced HYT, common after 2nd trimester, if systolic >30mm/Hg or diastolic >15mm/Hg

Question 36

Pregnancy increases HR, blood volume, C.O., and _____?

Answer 36

edema which leads to varicosities

Question 37

WHat are 2 CV developmental complications that can occur in infants?

Answer 37

Patent ductus arteriosus (PDA) and Patent foramen ovale (PFO).

Question 38

What is PDA?

Answer 38

A persistent opening between the 2 major blood vessels leading from the heart. Usually Requires immediate intervention.

Question 39

What is PFO?

Answer 39

patent foramen ovale is an opening of ovale which causes backflow "hole in heart".

Question 40

What is a sinus arrhythmia?

Answer 40

a variation of normal sinus rhythm that characteristically presents with an irregular rate in which the change in the R-R interval is greater than 0.12 seconds.

Question 41

What is a Holter?

Answer 41

a small, wearable device that records the heart's rhythm.

Question 42

What is an EST?

Answer 42

exercise stress test

Question 43

Chemical stress test

Answer 43

with dobutamine and Adenosine to stimulate the heart​

Question 44

Define patency

Answer 44

the condition of being open, expanded, or unobstructed.

Question 45

Allen test

Answer 45

radial and ulnar a. patency to evaluate collateral circulation

Question 46

Homan's test

Answer 46

aka dorsiflexion sign test. A physical examination procedure used to test for DVT.

Question 47

Allen test steps

Answer 47

1. Occlude both ulnar and radial arteries of one hand while pt. makes a fist several times​ 2. Hand should blanch.​ 3. Ask pt. to open hand, then release pressure on the ulnar artery while maintaining pressure on radial.​ 4. If color returns to normal in 2-5 seconds, then circulation is adequate. If not, then there is not adequate circulation

Question 48

Define ABI, list steps:

Answer 48

Ankle-Brachial Index:​ 1. Take systolic pressure of dorsalis pedis or posterior tibialis arteries via doppler​ 2. Take systolic pressure of brachial artery​ 3. Divide results: ankle over arm.​ 4. Normal result: 1.0 to 1.2 ---- ankle pressure should be greater than or equal to brachial pressure – indicating no flow reduction.​ 5. Abnormal result – if ABI is less than .9 or 90% --- Peripheral Vascular Disease​

Question 49

CHF (what, causes, s/s?)

Answer 49

Congestive heart failure has no treatment but can be controlled. Caused by AMI, HTN, valvular disease, and thyroid disease. S/S range in severity depending on CHF.

Question 50

Arterial signs of decay

Question 51

venous signs of decay

Question 52

precordium

Answer 52

ant. chest over heart and great vessels

Question 53

List the anatomy of the heart starting with the SVC and ending with Aorta (12)

Answer 53

1. SVC and IVC 2. RA 3. TV 4. RV 5. PV 6. PA 7. PV 8. LA 9. MV 10. LV 11. AV 12. Aorta

Question 54

Layers of the heart

Answer 54

pericardium epicardium myocardium endocardium