Cardio examination Flashcards
Evaluation-What are you looking for in their ‘History’?
● Chest pain, palpitations, shortness of breath (SOB)
➤ Palpitations: awareness by patient of abnormal HR
● General fatigue and weakness
● Dizziness, syncope: due to inadequate cerebral blood flow
● Edema: especially in dependent body parts and lower extremities
● Sudden weight gain
Major risk factors
smoking history, diet, activity level
Nonmodifiable risk factors
- Age
◦ Males: >45 years
◦ Females: >55 years - Family history of cardiac event
- Race
◦ African American - Sex
◦ Male >female
◦ After menopause,
modifiable risk factors
- Cigarette smoking
- Hypertension
◦ >140/90 mmHg → increased risk - Hyperlipidemia
◦ Absence of CAD and fewer than 2 risk factors: LDL should be
<160 mg/dL
◦ Absence of CAD and more than 2 risk factors: LDL should be
<130 mg/dL
◦ Presence of CAD: LDL should be <100 mg/dL
◦ HDL should be
▪ >40 mg/dL for males
▪ >50 mg/dL for females
◦ Triglycerides should be <150 mg/dL - Sedentary lifestyle
◦ <30 min of exercise, 3 times/wk
modifiable risk factors
- Obesity: increased risk if
◦ BMI >30
◦ Waist circumference
▪ >40 in (>102 cm) for males
▪ >35 in (>89 cm) for females - Diabetes: increased risk if
◦ HbA1C >7%
Physical examination for cardiovascular system
Skin examination
Look for decreased O2 saturation and decreased CO
Presentation of decreased O2 saturation and CO
● Cyanosis: blue color of skin, nail beds, lips, and tongue
● Pallor: washed-out, white appearance
➤ Anemia, internal hemorrhage
● Diaphoresis: excessive sweating and cool, clammy skin
Other reasons to check the skin during cardiac examination
■ Bilateral peripheral edema: congestive heart failure (CHF), RV failure
■ Unilateral peripheral edema: thrombophlebitis, lymphedema, deep vein thrombosis
(DVT)
abnormal rhythm
palpate 1-2 minutes
normal rhythm
palpate 30 seconds
Sites to take pulse
radial artery, carotid artery, temporal artery, brachial artery, femo-
ral artery, popliteal fossa, dorsalis pedis artery, posterior tibial artery, apical pulse
point (over the apex of the heart)
apical pulse
point of maximal impulse
Patient supine, palpate at 5th intercostal space, midclavicular vertical line
Most accurate
Used when peripheral pulses are weak or imperceptible, or when other sites
are not accessible or are difficult to palpate
Displaced upward with pregnancy or high diaphragm
Displaced laterally with CHF, cardiomyopathy, or ischemic heart disease
radial pulse
most common site
Palpate radial artery at distal radius at the base of the thumb
carotid pulse
Palpate carotid artery on either side of the lower neck between the trachea and
sternocleidomastoid muscle
Assess one side at a time to reduce the risk of reflex drop of pulse rate or blood
pressure due to stimulation of baroreceptors
temporal pulse
used by anesthesiologist for monitoring during surgery
Palpate temporal artery superior and lateral to the eye (over the temporal
bone)
brachial pulse
typically used to measure BP
Palpate brachial artery medial aspect of the antecubital fossa; elbow should be
slightly flexed and supported
femoral pulse
used to monitor lower-extremity circulation and during cardiac
arrest
Typically examined with patient supine lying
Palpate femoral artery inferior to inguinal ligament, midway between the
anterior superior iliac spine and pubic symphysis
popliteal pulse
popliteal artery is deep and, therefore, difficult to palpate at
times
Used to monitor lower-extremity circulation
Typically examined with patient in prone position with knee flexed
Palpate popliteal artery inferior aspect of popliteal fossa
dorsal pedis
used to monitor foot circulation
Palpate dorsalis pedis artery, or dorsal, medial aspect of foot lateral to the
tendon of extensor hallucis longus; ankle is slightly dorsiflexed
posterior tibial pulse
used to monitor foot circulation; weak or absent pulse
indicative of arterial disease
Palpate posterior tibial artery inferior to medial malleolus
Pulse 0
0 Absent, not palpable
Pulse 1+
1+ Diminished, barely palpable
Pulse 2+
2+ Normal, easily palpable
Pulse 3+
3+ Full pulse, increased strength
