cardiac lecture 5 Flashcards
2+ is normal
Blood flowing there artery is much more turbulent in bruits as opposed to just flowing through an open artery you can have a bruits in any artery so any of these locations anywhere can have a bruits all we are concerned about are carotids that’s part of our cardiac exams
Why would there be an increase in jugular venous pressure what’s causing that? Volume! So you have a poor heart that’s not pumping efficiently so all that fluid is backing up and you see it in the veins
Taking pt sitting here to assess the level of fluid overload your going to palpate on that liver…the liver is one of our biggest organs and all that blood flow is going to come up through your aorta and into jugular vein and so what happens is…you watch this jugular venous pressure rise
Pt will be on exam table and tilt head over and you will see jugular vein and as you palpate up on liver and force blood flow up your going to see jugular vein is going to rise and it will come back down. The reason it comes back down is because your heart is pumping and it will pump all the extra blood away for someone who has heart failure once you press and you have blood flow up the heart can’t compensate and it stays and its that level of elevation that you then measure and that’s the reflux of it…its not able to compensate and pump away…this happens a lot if a heart failure clinic
Ankle brachial index this is where you have a systolic blood pressure in the leg and a brachial systolic blood pressure and your comparing them and the reason for that is…blood flowing is up here as well as flowing down there and that’s another assessment of peripheral vascular disease so your measuring the flow btwn the two
Ankle brachial index this is where you have a systolic blood pressure in the leg and a brachial systolic blood pressure and your comparing them and the reason for that is…blood flowing is up here as well as flowing down there and that’s another assessment of peripheral vascular disease so your measuring the flow btwn the two
Closure of mitral and
tricuspid valves during start of systole
S1
Closure of aortic and
pulmonic valves during end of systole
S2
________________
Inflamed, roughened pericardial
membranes no longer slide noiselessly
Pericardial friction rubs
________
Extra or unusual sounds, can be normal
in kids, teens, pregnancy
Valvular disease:Stenosis, Regurgitation/insufficiency
Murmurs
Grading of Murmurs
__________:Very faint; have to listen hard
Grade 1
Grading of murmurs
____________:Very, very loud; don’t need stethoscope on
chest
Grade 6
Pale
Punched-out ulcers
Painful distally
Elevation hurts
Arterial Insufficiency
Black/blue
Painless
Elevation helps
Venous Insufficiency
Vascular Exam: Inspection
Inspect extremities for signs of arterial or
venous insufficiency
Skin discoloration or mottling
Dry, scaly skin
Hair loss
Poor nail growth
Ulceration
Varicose veins (venous)
Edema (venous)
Vascular Exam: Palpation: Pulses
Carotids (if not done in
cardiac exam)
Bilateral dorsalis pedis
+/- posterior tibial +/-
popliteal
Radials +/- brachials
Note warmth of extremities
Grading Pulse Intensity
0-Absent
1+:diminished
2+:normal
3+increased
4:bounding
Bruits can be anywhere
Vascular Exam: Palpation
Capillary refill time
Press nail bed for several seconds
Release
Color should return within 2 seconds
Vascular Exam: Palpation: Edema
Measuring edema—how _____, how high
Can also track weight loss from diuresis
how deep
