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Patient Assessment > Cardio Exam > Flashcards

Cardio Exam Flashcards

1
Q

Examining the Heart & Blood Vessels

A 
Anatomy of the Heart & Great Vessels
The heart as a pump (Blood Pressure)
Vital Signs: Blood Pressure & Heart Rate
Jugular venous pressure (JVP) and pulsations
Carotid pulse
Chest wall and apical impulse/PMI
Auscultation: S1 and S2; S3 and S4
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2
Q

Circulation of the Heart

A 
Superior & Inferior Vena Cavas
Right Atrium & Right Ventricle
Pulmonary Arteries
Pulmonary Vein
Left Atrium & Left Ventricle
Aorta & Aortic Arch
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3
Q

HPI for Chest Pain

A 
Location
Duration
Recurrent episodes
How often/ever before
Does any thing make it better?
Does any thing make it worse?
Description of pain
Does the pain occur at rest? With exertion? After eating? When you move? While sleeping? With stress? During sexual intercourse?
SOB
Palpitations
Nausea or vomiting
Cough 
Fever
Hemoptysis
Leg/Calf pain or swelling
Dizziness
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4
Q

Dyspnea for Chest Pain that you want to know

A 
DOE—dyspnea on exertion
PND– paroxysmal nocturnal dyspnea
Orthopnea
Leg swelling
Activity at the time of SOB
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5
Q

Fatigue and Cough for Chest Pain

A

Fatigue
Inability to keep up with peers
Associated symptoms– weakness in arm/leg
Medications

Cough
Onset/duration
Character
Hemoptysis

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6
Q

Syncope for Chest Pain

A 
Associated symptoms– SOB, LOC
What were you doing just prior to event
Incontinence
Black tarry stools
Warning of fainting
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7
Q

Palpitations for Cardio

A 
Description– skipping beats, fast, pain
Quality
Duration
Associated symptoms—chest pain etc
Caffeine use-red bulls, coffee
h/o thyroid disease
Tobacco/Alcohol/Drugs
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8
Q

LE Edema for Cardio

A 
One leg or both legs
Calf pain
Gradual or sudden onset
Decrease after a nights sleep
Reduced by elevation
h/o kidney, heart, or liver disease
Leg ulcers
Contraceptive use in women
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9
Q

Common symptoms of cardiovascular disorders in Older Adults

A 
Confusion/syncope
Palpitations
Cough/wheezes
Hemoptysis
SOB
Chest pain/tightness
Incontinence/impotence/heat intolerance
Fatigue
Leg edema
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10
Q

PMH for Cardio

A 
Cardiac surgery/hospitalizations
Rhythm disorder
Acute rheumatic fever
Unexplained fever
Swollen joints
Inflammatory rheumatism
St. Vitus dance
Chronic Illnesses
Hyperlipidemia
DM
HTN
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11
Q

Family History for Cardio

A 
Diabetes
Heart disease
Hyperlipidemia
HTN
Congenital heart defects, VSD
Sudden death
Family members with cardiac risk factors
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12
Q

Personal/ Social History for Cardio

A 
Employment
Tobacco use
Use of alcohol/drugs
Nutritional status
Personality assessment
Relaxation
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13
Q

The Heart as a Pump

A

Systole
* occurs when the ventricles contract
* right ventricle pumps blood into the
pulmonary arteries (pulmonic valve is
open)
* left ventricle pumps blood into the aorta
(aortic valve is open)
Diastole
* occurs when the ventricles relax
* blood flows from the right atrium into the
right ventricle (tricuspid valve is open)
* blood flows from the left atrium into the
left ventricle (mitral valve is open)

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14
Q

Stroke Volume and CO

A

Cardiac Output = stroke volume x heart rate

Stroke Volume: volume of blood pumped from one ventricle of the heart with each beat

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15
Q

Contractility

A

ability of the ventricles to contract during systole

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16
Q

Preload

A

end diastolic volume at the beginning of systole directly related to the stretch (Starling’s Law)

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17
Q

Afterload

A

the amount of resistance that the left side of the heart has to overcome to eject blood (Squeeze)

18
Q

Blood Pressure Equation

A

cardiac output x systemic vascular resistance= BP

19
Q

Vital Signs for Cardio

A

Temperature:
* Fever may increase heart rate & respirations
* Hypothermia may decrease heart rate & respirations
Pulse:
* Normal for Adults: 60 – 100 BPM
* Tachycardia: > 100 BPM
* Bradycardia: < 60 BPM
* In children there is a range based on age
Respirations:
* Normal for Adults: 12 – 20 per minute
* Tachypnea: > 20 per minute
* Agonal: irregular & may be slow or fast
Blood Pressure:
* Systolic 100 – 140
* Diastolic 60 – 80
* Variations can occur based on size

20
Q

Blood Pressure Measurements (4)

A

Direct Measurement: insertion of intra-arterial catheter (arterial line/A-line)
Indirect Measurement: BP cuff & stethoscope
Size of the cuff: too small/artificially elevated BP
Measurement by palpation: hold the arm at the level of the heart & palpate the brachial or radial artery, only identifies systolic BP

21
Q

Different types of Blood Pressures

A

Orthostatic Hypotension: lie the patient flat for 5 minutes & take a BP, then sit them up & repeat the BP. If there is a drop of >20 mmHg & the patient is dizzy or has a syncopal event then they are positive. Should also be repeated in the standing position if no symptoms occur.

Supravalvular Aortic Stenosis: difference in blood pressures of >20 mmHg between the arms

Coarctation of the Aorta: if BP is elevated in both arms take the BP in the legs & if lower may be an indication

Pulsus Paradoxus: deflate the cuff until pulses are heard in expiration only then until heard during inspiration. If the difference is >10 mmHg consider cardiac tamponade, pericardial effusion, constrictive pericarditis, asthma & emphysema

22
Q

Palpating the Pulse (rhythm and rate)

A

Palpate the radial artery on the volar surface radial aspect of the wrist with the 2nd, 3rd, & 4th fingers for rate, rhythm, contour, & amplitude of the pulse
Rate: count for 30 seconds & multiply by 2. Most accurate for regular rhythms.
Rhythm: regular, regularly irregular, or irregularly irregular (Afib) there may be a pulse deficit.

23
Q

General, Skin and Nail Inspection for Cardio

A

General Appearance: Is the patient in acute distress, labored breathing, accessory muscle use etc…
Skin: temperature, central or peripheral cyanosis, pallor, xanthomata present (hypercholesterol), erythema marginatum (acute rheumatic fever)
Nails: splinter hemorrhages (non-specific finding in infective endocarditis)

24
Q

Eye and Face Inspection for Cardio

A

Facies: wide set eyes, strabismus, low set ears, upturned nose, & hypoplasia of the mandible (supravalvular aortic stenosis), moon facies & wide set eyes (pulmonic stenosis), expressionless facies & puffy eyelids (hypothyroid/cardiomyopathy)

Eyes: xanthelasma (hypercholesterol), arcus senilus (hypercholesterol in <40 y/o), opacities in the cornea (sarcoidosis responsible for cor pulmonale or myocardial involvement), displacement of the lens ( Marfan’s Syndrome/aortic regurgitation), conjunctival hemorrhages (infective endocarditis), sausage link like vessels (hypertension)

25
Q

Neck, Mouth, Chest, Extremities Inspection for Cardio

A

Neck: webbing (Turners Syndrome/Coarctation of the aorta & Noonan’s syndrome/pulmonic stenosis)

Mouth: highly arched palate (congenital heart problems/MVP), palate petechiae (infective endocarditis)

Chest: Pectus excavatum & caranutum (Marfan’s syndrome/MVP), visible movements of the chest

Extremities: Extra phalanx, finger or toe (ASD), long slender fingers (Marfan’s syndrome/aortic regurgitation)

26
Q

Steps for Examining the Jugular Venous Pulse (JVP)

A

Elevate the head of the bed to 30-45 degrees
Turn the patient’s head gently to the left
Standing on the right side of the patient identify the topmost point of the venous pulsation using either the internal jugular vein (preferred) or external jugular vein
Place a centimeter ruler upright at the sterno-manubrial angle
Place a card or a tongue blade horizontally from the top of the JVP to the ruler making a right angle (90 degrees)
Measure the distance above the sternal angle in centimeters at 45 degrees the upper limit of normal is 4-5 cm at 30 degrees the upper limit of normal is 6 cm

27
Q

JVP

A

Jugular vein reflects the right atrial pressure

28
Q

JVP waves and descents

A

a wave (atria contract)
Reflects slight rise in atrial pressure that accompanies atrial contraction
Occurs before S1& the carotid pulse

x descent (atria relax)
Atrial relaxation & ventricles contract
v wave (venous filling)
Atria begin to fill
y descent (atria empties)
Blood flows into right ventricle
29
Q

Hepatojugular Reflex

A

Occurs because of the inability of the right side of the heart to accommodate increased venous return
Assesses right ventricular function
Performed with the patient lying flat in the bed, with their mouth open, & breathing normally
Observe the jugular height, press firmly under the right costal margin for 10-15 seconds
The jugular veins will remain distended during the entire period of compression in right ventricular failure or elevated pulmonary artery wedge pressure
The normal response is for the jugular veins to show a transient increase during the first few cardiac cycles followed by a fall to baseline levels during the latter part of compression

30
Q

Auscultate 5 positions

A
  1. Aortic – right 2nd ICS sternal border
  2. Pulmonic – left 2nd ICS sternal border
  3. Erb’s Point – left 3rd ICS sternal border
  4. Tricuspid – left 4th ICS sternal border
  5. Mitral – left 5th ICS mid-clavicular line
31
Q

Palpate 4 main cardiac areas

A

Aortic – right 2nd ICS sternal border
Pulmonic – left 2nd ICS sternal border
Tricuspid – left 4th ICS sternal border
Mitral – left 5th ICS mid-clavicular line

32
Q

Describing a Murmur (7)

A

Timing: systolic or diastolic
If the murmur coincides with the carotid upstroke it is systolic

Location: in which of the 5 areas is the murmur best heard

Radiation: does the murmur radiate to the neck, back, or axilla

Duration: how long does it occur for
Mid/pan/or late systolic
Early/mid/or late diastolic

Intensity: graded I-VI based on increased sound ( grades 4-6 must have a thrill with them)

Pitch: high, medium, or low

Quality: harsh, musical, soft, blowing, or rumbling
Relationship to Respiration
Relationship to Position

33
Q

Aortic Stenosis (Murmur)

A 
Best heard in the aortic area mid to mid-late systolic
Radiates to the neck
Crescendo/decrescendo shape
Medium pitch
Harsh
Decreased A2
Ejection click
S4
Narrow pulse pressure
Slow rising & delayed pulse
34
Q

Mitral Regurgitation (murmur)

A 
Best heard in the apex in early systole
Radiates to the axilla
Holosystolic/machinery type murmur
High pitched
Blowing type murmur
PMI is laterally displaced & diffuse
Decreased S1
S3
35
Q

Pulmonic Stenosis (murmur)

A 
Best heard in pulmonic area mid to mid-late systole
Radiates to the neck
Crescendo/decrescendo diamond shaped
Medium pitched
Harsh
Similar to aortic stenosis
36
Q

Tricuspid Regurgitation (murmur)

A 
Best heard in tricuspid area in early systole
Radiates to right of the sternum
Holosystolic
High pitched 
Blowing
37
Q

Ventral Septal Defect (VSD)

A 
Best heard in tricuspid area in early systole with muscular or non-restrictive pulmonary HTN & holosystolic with left to right shunt
Radiates to right of sternum
Holosystolic 
High pitch
Harsh
38
Q

Venous Hum (murmur)

A 
Heard best above the clavicle
Radiates to the right side of the neck
Continuous
High pitch
Roaring/humming
39
Q

Innocent Murmur

A 
Widespread
Minimal radiation
Diamond shaped
Medium pitch
Twanging/vibratory
40
Q

Mitral Stenosis- Diastolic murmur

A 
Heard best at the apex in mid diastolic
No radiation
Decrescendo
Low pitch
Rumbling
Increased S1
Opening snap
RV rock (RV impulse at left lower sternal border)
Presystolic accentuation
41
Q

Aortic Regurgitation- Diastolic Murmur

A

Best heard in aortic area in early diastole
No radiation
Decrescendo
High pitch
Blowing
S3
Laterally displaced PMI
Wide pulse pressure (Resting > 100 mmHg when normal isusually 30-40 mmHg)
Bounding pulses
Austin Flint Murmur – apical diastolic murmur in association with AR mimicking MS
Systolic ejection murmur

42
Q

Patent Ductus Arteriosus (PDA)– Continuous Murmur

A

Abnormal communication between the aorta & pulmonary artery
Occurs during the end of systole into diastole
Blowing
High pitched
Heard best at left upper sternal border near the left 2nd intercostal space
Most pronounced at S2

Patient Assessment (4 decks)

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