Cardiac Assessment Flashcards
ventricular fibrillation
sinus rhythm with 1st degree AV block
Paroxysmal atrial tachycardia
atrial fibrillation
ventricular tachycardia
atrial flutter
sinus bradycardia
Heart - order of exam
Inspect, Palpate, Percuss, Auscultate
Heart - what should you inspect?
apical pulse (tangential light)
skin - cyanosis and venous distention
nail beds - capillary refill and cyanosis
Apical pulse - location
5th ICSMCL
Heart - palpation
Precordium: apex, LSB, base, RSB
apical impulse/PMI
How should a normal apical impulse feel?
gentle, brief pulsation
“Heave” or “Lift”
vigorous apical pulse to palpation
“Thrill”
fine, palpable, rushing vibration
usually at base or 2nd RICS or 2nd LICS
AKA “palable murmur”
What else should you palpate as you feel the precordium?
Carotid artery
(carotid pulse and S1 should occur simultaneously)
Heart percussion - why?
to estimate the size of the heart (in abscence of Xray)
Normal heart size measurments (from MSL)
5-7 cm @ 5th ICS
4-6 cm @ 4th ICS
3-4 cm @ 3rd ICS
1-3 cm @ 2nd ICS
Ausculation - 5 areas
aortic (2nd RICSRSB)
pulmonic (2nd LICSLSB)
2nd pulmonic (3rd LICSLSB)
tricuspid (4th LICSLSB)
mitral (5th LICSLSB)
Auscultation - what positions?
sitting (slightly leaning forward)
supine
left lateral
right lateral if right rotated heart
Best position to hear high pitched murmurs (diaphragm)
sitting
Best position to hear low pitched filling sounds (bell)
left lateral recumbant
Ausculation - 5 components to assess
rate/rhythm
S1
systole
diastole
S2
Next step if heart rate irregular…
- is there a pattern?
- compare BPM with radial pulse and note any pulse deficit
S1 assessment
- breathe normally, then hold breath on expiration
- listen for S1 while palpating carotid
- Evaluate for intensity, variations, splitting and effects of respirations
What are you listening for during systole? diastole?
Extra heart sounds/murmurs
How do you evaluate for a split S2 and where is it best heard?
Inhale deeply and listen for S2 to become two sounds. Best heard at pulmonic site.
What is S1 and where is it best heard?
beginning of systole
apex (louder, longer than S2)
What is S2 and where is it best heard?
end of systole
best heard in the aortic and pulmonic areas (lounder than S1 at the base)