cardio Flashcards
What position should the patient be at for a cardio exam?
45 degrees
exposure of the patient
exposed from waist upwards
where do you palpate the radial artery
between
tendon of flexor carpi radialis
and
tendon of brachioradialis
what rate counts as bradycardia and tachycardia
bradycardia = <60 bpm
tachycardia = >100 bpm
what to comment on when assessing pulse
rate and rhythm
where do you palpate the ulnar artery
between
flexor digitorum superficialis
and
flexor carpi ulnaris
where do you palpate the brachial artery
medial to biceps tendon
how to position arm during brachial artery palpation
flex arm to find tendon
then fully extend to assess pulse
from which arteries can character and volume be assessed
only from central arteries eg common carotid
where do you palpate the common carotid artery
between
medial border of sternocleidomastoid muscle
and
lateral border of thyroid cartilage
where do you palpate the apex beat
5th intercostal space at left mid clavicular line
(align middle finger here, then other fingers above and below)
- first identify sternal angle and palpates left 2nd rib down to 5th rib, and then onto the 5th intercostal space at the mid clavicular line
where should you start palpating for the apex beat
from lateral side towards midclavicular line
what causes a displaced apex beat
cardiomegaly
causes of an absent apex beat
obesity
pericardial effusion
pleural effusion
emphysema
what is a precordial impulse
Precordial impulses are pulsations originating from the heart or great vessels that are visible or palpable on the anterior chest wall
what is a parasternal heave
a precordial impulse that can be palpated
where to place hand for parasternal heave
place heel of hand parallel to left sternal edge to palpate for heaves
what causes parasternal heaves
right ventricular hypertrophy - would feel heel of hand being lifted with each systole
what is a thrill
palpable vibration caused by turbulent blood flow through heart valves
how and where to place hand for thrills
horizontally across chest wall, at each of the heart valves
which sides of the stethoscope do you use for each of the valves
diaphragm
- aortic
- pulmonary
- tricuspid
bell
- mitral
location of aortic valve
right sternal border, 2nd ICS
location of pulmonary valve
left sternal border, 2nd ICS
location of tricuspid valve
left 5th costo-sternal border
location of mitral valve
left 5th ICS at midclavicular line (at apex beat)
causes of ejection systolic murmur
aortic stenosis
pulmonary stenosis
aortic sclerosis
hypertrophic obstructive cardiomyopathy (HOCM)
atrial septal defect
what murmur is heard with aortic stenosis
ejection systolic murmur
how to assess for aortic stenosis
auscultate the carotid arteries
using diaphragm
WHILST PATIENT HOLDS THEIR BREATH
what murmur is heard with aortic regurgitation
early diastolic murmur
how to assess for aortic regurgitation
sit patient forward
and auscultate over aortic area
using diaphragm
in EXPIRATION
which examinations require the left lateral decubitus position
mitral valve regurgitation
mitral stenosis
how to assess for mitral valve regurgitation
auscultate the mitral area
in left lateral decubitus position
using diaphragm
during EXPIRATION
auscultate into axilla to identify radiation of the murmur
what murmur is heard for mitral valve regurgitation
pan systolic murmur
what murmur is heard for mitral stenosis
mid diastolic murmur
how to assess for mitral stenosis
auscultate the mitral area
in left lateral decubitus position
using bell
during EXPIRATION
where is the femoral pulse palpated
at the mid inguinal point (midpoint between ASIS and pubic symphysis)
where is popliteal pulse felt
inferior region of popliteal fossa
how to assess for popliteal pulse
place thumbs on tibial tuberosity
passively flex the knee to 30 degrees
curl fingers into popliteal fossa
(this compresses the popliteal artery against the tibia)
where is the posterior tibial pulse felt
posterior to the medial malleulos of the tibia
what to remember when palpating posterior tibial pulse
palpate to confirm its presence
then compare pulse between the 2 feet
where is the dorsal pedis pulse felt
on the dorsum of the foot
- lateral to extensor hallucis longus tendon
- over the 2nd and 3rd cuneiform bones
borders of the heart
right upper:
3rd CC, 1cm from sternal edge
left upper:
2nd ICS, 2.5cm from sternal edge
right lower:
6th CC, 1 cm from sternal edge
left lower:
5th ICS, mid clavicular line
which pulse is the strongest pulse
carotid pusle
which pulse is used for assessment of character and volume and diagnosis of underlying heart disease
carotid artery pulse
where is superficial temporal artery assessed
in front of tragus of ear
what is the terminal branch of external carotid artery
superficial temporal artery
where is subclavian artery assessed
in supraclavicular fossa region
- at the angle between the clavicle and sternocleidomastoid
differentiate type A and B aortic dissection
type A = severe chest pain, anterior and posterior
type B = back pain, followed by chest and abdominal pain
