Cardiac Lab Flashcards
Can both Auscultatory and Oscillometric both measure resting and exercise BP?
No! Auscultatory can do both but Oscilometric can only do resting.
How do you determine pulse pressure?
Systolic pressure – Diastolic pressure
Values for Pulse Pressure
Normal: 30-50 mm Hg
Abnormal: >60 mm Hg
What would an abnormal Pulse Pressure indicate?
Congestive Heart Failure
What would need to be seen for someone to have Orthostatic Hypotension?
Any of these at 1 or 3 minutes:
* SBP drop of 15-20 mm Hg
* DBP drop of 10 mm Hg
* Any Symptoms!
Supine to Stand
Effects of aging from a child to adult on BP and HR
BP rises, heart rates lowers
What does rate pressure product measure? How do you calculate it?
- Indirectly measures myocardial consumption
- RPP = HR x SBP
How would you perform a JVD Test?
- Position the patient in supine with an incline of the head of the table to 45 degrees
- Observe for venous palpations in the neck between the clavicular and sternal heads of the SCM
- Rotate the head away, the internal jugular vein is lateral to SCM
- Look for a rapid, double (sometimes triple) wave with each heartbeat
- Identify the highest point of pulsation. Using a horizontal line measure vertically from the sternal angle
- Add distance to 5 cm and Document value
- Observe the venous pressure changes with respiration; normally a drop with inspiration.
Normal and abnormal for JVD
Normal: Less than 3-4 cm; central venous pressure of 5 cm of water
Abnormal: value greater than 4 cm.
How and Where should you ascultate the heart sounds?
- Pt should be supine with the head of the table slightly elevated
- Always examine from the patients right side.
- Aortic: Diaphram; 2nd Right interspace near sternum
- Pulmonic: Diaphram; 2nd Left interspace near sternum
- Tricuspid: Diaphram; 5th Left interspace near the sternum
- Mitral: Diaphram; Near 5th intercostals just medial to midclavicular line
Physiology of heart sounds
Blood flow across valves are silent (unless they are narrow; called stenosis). Valves make sound when they slam shut. Intensity depends on pressure with it slams shut.
S1 Heart Sound
- Closure of Mitral and Tricuspid valves
- Occurs right after QRS complex
- Beginning of systole
- Best heard over Mitral area
- Normal S1[LUB] is louder than S2 in this location
S2 Heart Sound
- Closure of Aortic and Pulmonic valves
- Occurs at end of systole and beginning of diastole (respiratory split; A2 & P2-inhalation)
- Best heard over Aortic area
- Aortic and pulmonary valves close after isometric relaxation period
- Normal S2 [DUB] is louder and has higher pitch than S1 in this area
S3 Heart Sound
- Rapid ventricular filling from atrium during diastole
- Occurs at early diastole
- Normal for children and young adults
- Over 30 years abnormal – CHF
- Also called Ventricular Diastolic Gallop
- Follows S2
- Best heard with Bell over mitral area in supine or rolled to left
SLOSH-ing-in
Can be abnormal or normal
How should you position a patient to be able to better hear abnormal heart sounds?
- Flip from diaphram to the bell and listen on the mitral
- If nothing: have them rotate to the left, still using bell at mitral
- If nothing: have them sit up, lean forward and hold their breath in exhalation (listening with the diaphram at the left 3rd and 4th interspace near the sternum and apex
S4 Heart Sound
- Associated with diminished ventricular compliance
– Possible MI
– Ventricular Hypertrophy (long Hx HTN) - Heard late in diastole; precedes S1
- Also called Atrial Diastolic Gallop
- Best heard with Bell over mitral area in supine
A-STIFF-wall
Aortic Regurgitation
- The sound produced as the blood flows retrograde back into the left ventricle.
- Blowing and best heard over left 3rd and 4th intercostal area
- Have patient sit and lean forward and hold breath after exhalation
Diastolic Murmur
Mitral Regurgitation
- Mitral valve regurgitation is usually either a congenital condition or a consequence of rheumatic heart disease, or papillary muscle dysfunction secondary to acute or prior myocardial infarction.
- This murmur is usually best heard at the apex (Mitral area).
- “blowing”
Systolic Murmur
Friction Rub
- The sound is caused by the heart beating against an inflamed pericardium or pleura of the lungs. This sound is usually continuous, and heard diffusely near the low tricuspid area and xiphoid area.
- It is louder when the patient sits up and leans forward.
- If the rub completely disappears when the patient holds his breath it is more likely due to pleural, not pericardial, origin.
