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Cardiac Assessment Flashcards

1
Q
A

ventricular fibrillation

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2
Q
A

sinus rhythm with 1st degree AV block

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3
Q
A

Paroxysmal atrial tachycardia

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4
Q
A

atrial fibrillation

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5
Q
A

ventricular tachycardia

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6
Q
A

atrial flutter

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7
Q
A

sinus bradycardia

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8
Q

Heart - order of exam

A

Inspect, Palpate, Percuss, Auscultate

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9
Q

Heart - what should you inspect?

A

apical pulse (tangential light)

skin - cyanosis and venous distention

nail beds - capillary refill and cyanosis

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10
Q

Apical pulse - location

A

5th ICSMCL

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11
Q

Heart - palpation

A

Precordium: apex, LSB, base, RSB

apical impulse/PMI

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12
Q

How should a normal apical impulse feel?

A

gentle, brief pulsation

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13
Q

“Heave” or “Lift”

A

vigorous apical pulse to palpation

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14
Q

“Thrill”

A

fine, palpable, rushing vibration

usually at base or 2nd RICS or 2nd LICS

AKA “palable murmur”

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15
Q

What else should you palpate as you feel the precordium?

A

Carotid artery

(carotid pulse and S1 should occur simultaneously)

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16
Q

Heart percussion - why?

A

to estimate the size of the heart (in abscence of Xray)

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17
Q

Normal heart size measurments (from MSL)

A

5-7 cm @ 5th ICS

4-6 cm @ 4th ICS

3-4 cm @ 3rd ICS

1-3 cm @ 2nd ICS

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18
Q

Ausculation - 5 areas

A

aortic (2nd RICSRSB)

pulmonic (2nd LICSLSB)

2nd pulmonic (3rd LICSLSB)

tricuspid (4th LICSLSB)

mitral (5th LICSLSB)

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19
Q

Auscultation - what positions?

A

sitting (slightly leaning forward)

supine

left lateral

right lateral if right rotated heart

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20
Q

Best position to hear high pitched murmurs (diaphragm)

A

sitting

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21
Q

Best position to hear low pitched filling sounds (bell)

A

left lateral recumbant

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22
Q

Ausculation - 5 components to assess

A

rate/rhythm

S1

systole

diastole

S2

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23
Q

Next step if heart rate irregular…

A
  1. is there a pattern?
  2. compare BPM with radial pulse and note any pulse deficit
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24
Q

S1 assessment

A
  1. breathe normally, then hold breath on expiration
  2. listen for S1 while palpating carotid
  3. Evaluate for intensity, variations, splitting and effects of respirations
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25
What are you listening for during systole? diastole?
Extra heart sounds/murmurs
26
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.
27
What is S1 and where is it best heard?
beginning of systole apex (louder, longer than S2)
28
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)
29
Significance of S3 and S4
S3 normal (children/athletes) or pathologic (ex. CHF) S4 always pathologic
30
Heart murmurs - 8 characteristics
1. timing/duration 2. pitch 3. intensity 4. pattern 5. quality 6. location 7. radiation 8. respiratory phase variations
31
32
What kind of pain? substernal provoked by effort, emotion, eating relieved by rest +/- NG diaphoresis occassionally nausea
cardiac pain
33
What kind of pain? precipitated by breathing or coughing "sharp" present with respiration, absent with breath holding
pleural
34
What kind of pain? burning, substernal occasional radiation to shoulder nocturnal, laying flat relieved by food unrelated to activity
esophageal
35
What kind of pain? almost always infradiaphragmatic and epigastric nocturnal daytime attacks relieved by food unrelated to activity
peptic ulcer
36
What kind of pain? usually under right scapula prolonged often occurs after eating will trigger angina more than mimic it
biliary
37
What kind of pain? usually lasts for hours local tenderness and/or pain with movement
arthritis/bursitis
38
What kind of pain? associated with injury provoked by activity persists after activity painful on palpation and/or movement
cervical
39
What kind of pain? intensified or provoked with movement, particularly twisting or bending long-lasting often associated with focal tenderness
musculoskeletal (chest)
40
What kind of pain? associated with/after anxiety poorly described intermammary
psychoneurotic
41
Cholesterol levels
Total \<200 LDL \<100 (\<70 if prev.MI or DM) HDL \>40 Triglycerides \<150
42
Murmur intensity scale
I - barely audible II - quiet but clearly audible III - moderately loud IV - loud, associated with thrill V - very loud, thrill easily palpated VI - very loud, audible with stethoscope off chest, visible thrill
43
mitral regurgitation
44
tricuspid regurgitation
45
mitral valve prolapse
46
pulmonic regurg
47
aortic regurg
48
VSD
49
intense, grating rubbing, machine-like sound overlies cardiac sounds more distinct toward apex can occur in systole and diastole
pericardial friction rub
50
Jugular vein finding heart failure
distenstion \>3cm above the sternal angle when at 45 degrees
51
S3 - cause and sound
SLOSH' ing in S1 S2 S3 regurgitation of blood
52
S4 - cause and sound
a STIFF' wall S4 S1 S2 pressure wave as atria contract, ventricles are stiff
53
Order of palpation - peripheral arteries
Carotid Brachial Radial Femoral Popliteal Dorasalis Pedis Posterior tibial
54
How to assess for a bruit
Listen over arteries with bell Carotid, subclavian, renal, iliac, femoral, abdominal aorta For carotid, hold breath so resp don't interfere
55
Two ways to confirm JVP
1. hepatojugular reflex 2. hand veins
56
If suspect venous obstruction and insufficiency, assess extremities for 4 signs
1. signs of thrombosis (red, thick, swelling, tenderness) 2. Homan's sign 3. Edema 4. Varicose veins
57
If varicose veins, how can you check system competency?
Stand on toes 10 times in succession, if system is competent the pressure will disappear in a few seconds
58
ischemic ulcer
59
varicose veins
60
thrombophlebitis
61
venous stasis ulcer
62
alteration of a pulsation of small amplitude and large amplitude, normal rhythm
pulsus alternans (ex. Left ventricular failure esp. if slow)
63
pulse with two main peaks, best felt in carotid artery
pulsus biferians
64
normal pulsation followed by a premature contraction
bigeminal pulse
65
large pulse that is readily palpable, not easily obliterated
bounding pulse (exercise, anxiety, fever, hyperthyroid, atherosclerosis)
66
pulse decreased amplitude during inspiration, increased amplitude during expiration
pulsus paradoxus
67
greater amplitude and faster rise to summit, sudden decrease
Corrigan pulse (water hammer) PDA, aortic regurg
68
69
Right or left sided heart failure? peripheral edema ascites weight gain JVD
Right
70
Right or left sided heart failure? dyspnea cyanosis clubbing crackles
left sided
71

Advanced Assessment (5 decks)

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