cardiac Flashcards
where is the aortic valve
2nd right ICS, RSB
where is the pulmonic valve
2nd left ICS, LSB
where is erbs point
3rd left ICS, LSB
can only be heard in left lateral recumbent position
where is the tricuspid valve
4th left ICS, LSB
s2 indicates
closing of aortic and pulmonic valves
beginning of diastole
s1 indicates
closing of tricuspid and mitral valves
s1>s2 at apex, s2 >s1 at base
beginning of systole
s2 indicates
closing of aortic and pulmonic valves
expiration - s2 is single
inspiration - s2 is made of 2 component sounds (A2 louder than P2)
split s2 in expiration - may be pathologic
s3 indicates
ventricular gallop
“kentucky”
normal in young, healthy adults & pregnant women
abnormal in >40 yo - means LV failure/systolic dysfunction
heard best at apex in L lateral postion
s4 indicates
atrial gallop
due to resistance to ventricular filling or diastolic dysfunction
(stiffness)
not heard in rhythm with AV dysfunction
heard best at apex w patient in L lateral position
use the bell
systolic murmur
between s1 - s2
diastolic murmur
between s2 - s1
technique for hearing murmurs
have pt sit up, lean forward, and exhale
where is the base and apex and PMI
base - top
apex - bottom
PMI (point of maximal impulse) - at apex
PMI
point of maximal impulse
at apex
5th ICS, LML
helpful when delinating the L lateral border
helpful in evaluating HTN and CHF
when are benign murmurs common?
pregnancy, anemia, fever
typically dissappear during adulthood
murmur characteristics
timing
duration
pitch
intensity
pattern
quality
location
radiation
respiratory phase variants
murmur intensity
grade I - barely audible in quiet room
grade ii - quiet but clearly audible
grade III - moderately loud
grade IV - loud, associated with thrill
grade V - very loud, thrill easily palpable
grade VI - very loud, audible with stethoscope off chest, thrill palpable and visible
aortic stenosis
diamond shaped
systoic
radiation to neck
medium pitch
harsh
can have narrow pulse pressure
mitral regurgitation
holosystolic
harsh
medium-high
radiates to left axilla or base
best heart with diaphragm
displaced PMI
mitral stenosis
rumbling and low pitch
heard best at apex in left lateral position
aortic regurgitation
decrescendo
diastolic
loud and high pitch
heard best with diaphragm
lateral displaced PMI
wide pulse pressure
geriatric considerations
- increased SBP
- more prominent superficial veins
- thicker endocardium
- sclerotic valves, aortic stenosis
- increased collagen formation, increased heart stiffness, decreased stroke volume, decreased cardiac output
- slower vascular response
- increased vagal tone causes decreased resting HR
- increased risk for aortic aneurysm
- s4 common due to increased ventricular rigidity (collagen)
pregnancy considerations
- CV changes
- increased blood volume by 1600 to 2000ml, returns to normal 3-4 weeks postpartum
- HR increases week 7, 20% elevation
- CO increases at week 10 and peaks at 50% at 25-32 weeks
- PMI may be displaced
- aortocaval syndrome (hypotensive when supine)
arterial insufficiency
often caused by intermittent claudication
caused by exercise, relieved by rest
tropic changes - thick skin & nails, dryness, decreased hair growth
“punched-out” appearance of ulcers
cool extremities
important peds assessment consideration
auscultate in 2 locations
palpate liver span in cardiac assessment
characteristics of benign murmurs
low grade
goes away with position change
systolic
fever, anemia, distress
still’s murmur
very common in preschool/school age children
musical, vibratory murmur
early to mid systole
left lower sternal border
goes away w carotid pressure & position change
often accentuated by increased CO (fever)
venous hum
common in preschool/school age
soft, hollow, continuous murmur “breath sounds/whoosh”
louder during diastole
best heard under clavicle
goes away with manuevers that affect venous return (lying supine, JV compression)
pulmonary flow murmur
low-grade soft ejection murmur
left upper sternal borders
peds cardiac red flags
diastolic murmur
extra heart sounds (s3/s4) but S3 can be normal
murmurs in children with syndromes
infants with cyanosis, poor growth, poor feeding, dyspnea at rest
unequal pulses
older children with dyspnea, chest pain w exercise, dizziness, SOB
venous insufficiency
heavy, boggy pressure
relieved by walking or elevation
pain is best in am, increases w dependence of extremities
wounds are shallow, superficial, irregular in shape
homan’s sign
sharply dorsiflex the foot. calf pain may indicate thrombophlebitis
ankle-brachial index
ankle blood pressure/arm blood pressure
(use highest of both arms, ankles)
helps assess for peripheral arterial disease
ankle-brachial index
ankle blood pressure/arm blood pressure
(use highest of both arms, ankles)
helps assess for peripheral arterial disease
