cardiac assessment Flashcards
When conducting cardiac assessment, what do we want to review?
patient’s present illness
overview of general cardiovascular status
Examination of patient’s general health status
survey lifestyle for risk factors for CAD
If there is evidence of CAD or risk of heart disease, what do we always assume?
Chest pain is caused by MI until proven otherwise
What other non-pain symptoms can signal cardiac dysfunction?
dyspnea
palpitations
cough
fatigue
edema
ischemic leg pain
noctura
syncope
cyanosis
What are priorities during physical inspection?
General appearance
Examine the extremities
Estimate jugular distention
observe apical pulse
What do we look at for when assessing general appearance?
Central cyanosis (center of the body)
painful expressions
pallor, clubbing
body posture
signs of confusion/lethargy (Anxiety is first sign of confusion)
When examining the extremities, what might we see?
Peripheral cyanosis
What would pale, shiny legs with sparse hair growth mean?
arterial vascular disease
What are signs of venous disease?
Edematous limb with deep red rubber, brown discoloration, and frequently leg ulcerations
Why do we assess jugular vein?
Indicates signs of increased venous pressure
When does JVD occur?
when CVP is elevated
Where is the apical impulse?
Left ventricle contracts during systole and rotates forward
What are priorities for palpation?
Assess arterial pulse
Evaluate cap refill
Estimate edema
If blood pressure down by 20, and/or HR up up by 20, what does that mean?
patient is “orthostatic”
What does orthostatic mean?
Hypovolemic OR problem with ANS, or heart has problem adjusting to cardiac output
How many pairs of bilateral arterial pulses are there?
7
Carotid brachial radial ulnar popliteal dorsal pedis posterior tibial arteries
What is edema?
fluid accumulation in extravascular spaces of body
What are the 3 most common causes of orthostatic hypotension?
intravascular volume depletion (hypovolemia)
inadequate vascular vasoconstrictor mechanisms (heart has problems adjusting to cardiac output)
autonomic insufficiency (ANS issue)
What is the normal pulse pressure?
40mmHg
What is a narrow pulse pressure caused by?
Arterial vasoconstriction
What is a widened pulse pressure caused by?
Arterial vasodilation
What is S1?
First heart sound
Closure of mitral and tricuspid valves
“LUB”
What is S2
Second heart sound
Closure of aortic and pulmonic valves
Heard at 2nd intercostal space to right and left of sternum
“DUB”
What is Erb’s point?
S1 and S2 should sound equal
What is the mnemonic for valve
All People Eat Tacos Monday
Where is aortic valve heard?
2nd right ICS along sternal border
Where is pulmonic valve heard?
2nd left ICS along sternal border
Where is tricuspid valve heard?
4th left ICS along sternal border
Where is mitral valve heard
5th ICS at MCL
What are murmurs?
produced by turbulent blood flow through chambers of heart
What is S3 and S4?
Gallops and Rubs
When does S3 happen?
early diastole.
Lub da dub Lub da dub SLOSHing in SLOSHing in
What causes us to hear S3?
Ventricles overfilled by back pressure in veins.
Caused by fluid volume overload
What is S4
a STIFF wall
dee lub dub
What causes us to hear S4?
Hypomotion of heart and one wall is not expanding appropriately causing fluid volume overload
caused by improper wall motion
PRE-SYSTOLIC sound
What is pericardial friction rub?
Something is causing myocardium muscle to swell and rub against pericardium
Happens 2-7 days post MI or can be caused by pericarditis
