ECR Cardiovascular 12.5.12 Flashcards Preview

ECR 2012 > ECR Cardiovascular 12.5.12 > Flashcards

Flashcards in ECR Cardiovascular 12.5.12 Deck (53):
1

Where is the PMI (Point of maximum impulse)

5th intercostal space

Left Ventricle

2

What are common comlaints that would warrant a CV pathology?

Chest pain
Fatigue
Cough
Difficultly breathing (Dyspnea, Orthopenia, Paroxysal noctural dyspnea)

Loss of consiousness

3

What is orhopnea

lie down, positional breathing

4

What is Paroxysmal nocturnal dyspnea

lying down, aweaken by cough in the middle of night

5

4 steps of cardiac exam

Insection
Percussion
Palpation
Auscultation

6

Steps for vascular Exam

Pulses
Signs of arterior or venous insufficiency

7

What to look for in General Appearance

Level of concsiousness (aweake, alert, responsive to the environemnet

Signs of distress, labored breating, sweating, in pain, anxiety, cyanotic

Height and weight

8

What are four Vital Signs

BP
PUlse
RR
Temp

9

Cardiac Exam Components (3)

Inspect
Palpate
Ausculate

10

Pericardium

fibroserous sac surrounding heart and roots of great vessels (pericarditis if there is sac)

11

Myocardium

Chambers- Atria and Ventricles- supplies pumping energy

12

Endocardium

LINING OF HEART CHAMBERS and valves prevents thrombosis

13

What are the three chambers of the heart

1. Right/Left Atria- Reservoirs

2. Right/Left Ventricle- Pumps

3. Interatriala nd Interventricular septa- divide right/left heart chambers

14

What are the 4 valves of the heart

1. Tricuspid- separates Rt Atrium and Rt ventricle

2. Mitral valve- left atrium and left ventricle

3. Pulmonic valve- rt ventricle and pulmonary artery

4. Aortic-Valve- left ventricle and aorta

15

Where is the PMI

Point of Maximal impulse

5th intercostal space (midclavicular line (apex)

Precordum, wehre you hear heart beat, medial clavicule--> Left ventricle, Mitral region

16

Palpation: Heaves and Thrills

Palpate with side of hand of MCP joints for thrilsl (grade 4 or greater murmur) and heaves

17

WHen are heaves visible or palpable?

when chamber enlargemetn or hypertrophy is present and impacts the chest wall with cardiac motion

18

What are normal heart sounds?

S1/S2- most distinct, splitting

19

What are extra heart sounds?

Gallops S3/S4- more difficult to hear

Murmurs (Grade I-VI)

Friction rubs

20

Bell vs Diaphragm

Bell - smaller (low pitched sounds)

Diaphragm- sensitive to high pitched sounds

21

What happens during Systole

period of ventricular contraction to eject blood
Aortic and pulmonic valvaes open.
Mitral and Tricuspid valves close

22

What happens during Diastole

Period of Ventricular relaxation/ atria move blood to ventricle

Aortic and Pulmonic valves Closed.
Mitral and Tricuspid Valves Open

23

S1- 1st heart sound

Ass. with closure of mitral and tricuspid leaflets


(aortic and pulmonary open)

M1 an T1

24

which is louder during S1, M1 or T1?

M1 is louder and best heart at apex

T1 is best heard at lower LSB (lowe sternal border)

25

S2

Componnent of S2 include (arotic valve closure) and P3 (pulmonic alve closure)

26

Which is louder duing S2 (A2 or P2)?

A2 is louder than P2

A2 is heradn thorught the precordium

2 is heard best in 2nd and 3rd ICS on left close to sternum

27

What are the pulses tha tyou have to ausculate and palpate (5)

1. Carotid
2. Femoral
3. Popliteal
4. Posterior Tibila
5. Dorsalis Pedis

28

What are pulses and what do they mesure?

Measure of PERFUSION (blood flow oxygen) to a region

Arteries carry blood form heart/
Pulses measure arterial Pressure

29

How can perfusion be impaired

cardiac problem/heart failture

Arterial disease/ Atheriosclerosis

Traumatic Injury

30

Which pulses are central pulses. When are they lost?

Carotid
Femoral

Loss at SBP (systolic baseal pressure?_ <50

31

Which pulses are peripheral?

Brachial, radial
popliteal
posterior tibial
Dorsalis Pedis

32

What are the gradign for periphearl arteries?

3_= boudnign
2+ risk, expected (normal)
1+- diminished, weaker than expected
0- absent, unable to palpate

indicate whether it is equal bilaterally

33

Where do you ausculate for Bruits?

Temporal
Carotid
Abdominal aorta
Renal/iliac/femoral arteries

Indicated Turbulent Flow-
Transmitted murmurs
Obstructed arterial disease

Remember to HOLD BREATH

34

Other findings ass. with arterial insufficiency

Palor/cyanosis

Poor hair growth/skin atrophy

Impaired wound healting

Regional uscle pain with exertion (claudification) - insufficiency

Check the tem

35

venous insufficiency/edema

when examing lower extremeity, look for signs of venous insufficiency (problem returign BF to heart)

Inspect for varicose veins and skin findings ass with poor blood return (statis dermatitis, swelling)

36

Edema

Note for pitting
1( slight) - 4 (marked)

may indicate regional pathology (unilateral) or more significant cardiac patholgoy/heart failure (bilateral)

37

S3

heard after S2

Originates as blood hits the ventricular walls during ventricular filling (diastole)

38

When is S3 heard best?
What is cause for it

when listening over mitral area

Overload ofa non-compliant left ventricle
(LV hypertrophy)

39

what is S4

heard after S3, prior to S1

Originates as blood hits ventricualr walls during late ventricular filling (atrial kick)

40

when is S4 best heard

low pitch (bell) best heard when listenign over mitral area

Overlaod of a non-compliant left ventricule (LV hypertoprhy)

41

Which heart sounds are like Kentucky

S1, S2, S3

42

Which heart sounds are like Tennessee

S4 S1 S2 S3

43

How are murmurs different form S3 and S4

Cardiac murmurs are differentiated form ehart soudns by their longer duration

S3/S4- blood hitting ventricualr walls

Murmur- narrow valve orifice (stenosis)

44

What causes murmucs

forward flow thorugha narrowed valve orifice (stenosis)
High flow rate through normal or abnormal orifices
Backward flow through a valve that doesn't fully close (regurgitation or insufficiency)

45

When do you hear systolic murmuc?

between S1 and S2

46

When do you hear diastolic murmur

between S2 and S1

47

What is the gradign scale for murmurs

I-VI

48

Grade I1

faint, heard only by cardiologist

49

Grade II

quiet but heard immediately

50

III

moderately loud, no thrill

51

IV

loud, thrill present

52

V

very oud, heard with scope off of chest

53

VI

very oud, heard with /without scope