CV Assessment Flashcards
(32 cards)
1
Q
CV Fetal Changes
A
- Lungs are bypassed and blood is pumped through patent ductus arteriosus
- Both L and R ventricles pump into systemic circulation
2
Q
CV Newborn Changes
A
- Closure of ductus arteriosus w/in 24-48 hours
- Closure of foramen ovale from increased L vent pressure, causes L vent to increase in size
- Murmurs are common in 1st 48 hours
3
Q
CV Infant/Child Changes
A
- year 1 = L:R ventricle ratio = 2:1
- by age 7, the heart has reached its adult position
- S3/S4 common
4
Q
CV Pregnancy Changes
A
- increased blood volume by 40-50% (70% with twins) (mostly plasma)
- Left ventricle increases in thickness and mass
- Increased CO by 30-40%
- Heart is shifted horizontal with slight axis rotation
- SVR is decreased
- BP may be slightly decreased in 2nd tri
5
Q
CV Older Adult Changes
A
- heart decreases with age unless HTN/heart disease causes enlargement
- Valves fibrose and calcify
- Decreased SV and CO during exercise
- Delayed contractility
- Longer returns to normal HR; tachycardia not tolerated well
- SA node fibrosed –> ECG changes
- Apical impulse hard to find
- S4 common
6
Q
Cardiac Origin of Chest Pain Symptoms
A
- substernal
- specific and abrupt onset
- provoked by activity/emotion/eating
- relieved by rest/nitro
- disappears if cause is eliminated
- accompanied y diaphoresis
- may awaken from sleep
- forces patient to stop effort
- Pain often early in AM
- Greater liklihood in cold weather
7
Q
Signs of Pericardial Fluid
A
- decreased heart sounds
- non-visual of apical impulse
8
Q
PMI
A
- L 5th intercoastal, MCL (adults)
- L 4th intercoastal medial to nipple (children)
- point at which apical impulse is most readily felt or seen
9
Q
Heave or Lift
A
- if apical impulse is more vigorous than expected
- may indicate hypertrophy, increased CO
10
Q
Thrill
A
- fine, palpable, rushing vibration; palbaple murmur
- typically found in L or R intercostal
11
Q
Carotid Pulse
A
Synchronous with S1
-located medial to and below angle of jaw
12
Q
Aortic Valve area
A
2nd R intercoastal at sternal border
13
Q
Pulmonic Valve area
A
2nd L intercoastal at sternal border
14
Q
Tricuspid area
A
4th L intercoastal at sternal border
15
Q
Mitral
A
Apex, 5th L intercoastal at MCL
16
Q
S1
A
- closure of mitral and tricuspid valves (AV)
- coincides with beginning of systole
- longer duration
17
Q
S2
A
- closure of aortic and pulmonic valves (semilunar)
- coincides with beginning of diastole
18
Q
S3
A
- passive flow of blood from atria
- when easy to hear = S3 gallop or early diastolic gallop
- Heard during diastole
- ken-TUCK-y
- MR
19
Q
S4
A
- vigorous atrial ejection
- vibration in valves
- Often confused with S1 split
- presystolic gallop
- commonly heard in elderly pts
- due to increased resistance to vent filling
- TEN-nes-see
- AS & late MR
20
Q
Mitral Regurgitation
A
- Holosystolic
- Plateau shaped intensity
- high pitched
- harsh blowing
- may obliterate S2
- radiates from apex to base or L axilla
- thrill may be palpable
- S1 diminished
- S2 more intense with P2 accented
- S3 present
- S3-S4 gallop common in late dz
- “Hand grip technique”
21
Q
Aortic Stenosis
A
- Midsystolic Murmur
- Coarse
- Diamond shape
- crescendo-decrescendo
- L sternal border - apex
- S1 may disappear
- S2 soft or absent
- S4 palpable (L vent hypertrophy)
22
Q
Murmur Grading
A
I barely audible II quiet, but clearly audible III moderate IV loud, associated with thrill V loud, thrill easily palpable VI very loud, without stethoscope, thrill palpable and visible
23
Q
PR interval
A
0.12-0.2
24
Q
QRS
A
< 0.12
25
QT
< 0.48 ish
26
U wave
- small deflection after T wave (r/t purkinje fibers)
- Common in bradycardia
- Can be seen with electrolyte issues, hypothermia, hypothyroidism
27
Expected Pulse Grade
+2 in brachial pulses bilaterally
28
Normal JVP
3-4cm above sternal angle with HOB at 30 degrees
| 6-9 per presentation
29
1+ edema
2mm, disappears rapidly
30
2+ edema
4mm, disappears 10-15 secs
31
3+ edema
6mm; >1 minute
32
4+ edema
8 mm; lasts 2-5 minutes
