Cardio PE Flashcards
Jugular venous pressure and pulsation is an important index of the ______________ and ___________
right heart pressure and cardiac function
JVP=_____________ =
right atrial pressure = pressure in the venous system
What will changing pressures in the right atrium during diastole and systole produce?
oscillating filling and emptying in the jugular veins
What does a pulsation over the pulmonic area suggest?
pulmonary HTN
What does a pulsation over the aortic area suggest?
a dilated aorta
What are heaves?
are sustained impulses that rhythmically lift your fingers, usually produced by an enlarged right or left ventricle
What are thrills?
a buzzing or vibratory sensation caused by underlying turbulent flow. If present, auscultate the same area for murmurs.
If you palpate a thrill with an associated murmur, what does this change?
your murmur grade
The diaphragm is better for ________ sounds of _______
high pitched, S1 and S2
The bell is better for __________ of ___________ and the murmur of _________
low pitched, S3 and S4, mitral stenosis
In what positions do you auscultate the patient in?
Recumbent
Left lateral decubitus
Sitting forward
What are the 5 characteristics of a murmur?
Intensity / Grade
Duration
Location / radiation
Pitch
Configuration
Accumulation of fluid in the peritoneal cavity are associated with what?
JVP and LE edema. Patient will often describe increased abdominal girth and tightness
What is pitting edema?
fluid accumulation in the skin
What is non pitting edema?
lymphedema or myxedema
Internal Jugular pulsations
Rarely palpable
Pulsation eliminated with light pressure on veins just above clavicle
Height of pulsation lowers as the patient becomes more upright
Height of pulsation lowers with inspiration
Carotid pulsations
Always palpable
Pulsation NOT eliminated with light pressure on veins just above clavicle
Height of pulsations unchanged by inspiration and position of patient
During valsalva, AS will ______ and HCM murmur will______
soften or not change, become louder
Standing from squating position, AS will ____________ and HCM will __________
soften or not change, become louder
Squatting from a standing position, AS will __________ and HCM will
increase, become less intense
Isometric Handgrip
Make a fist with both hands and squeeze simultaneously for several repetitions
Increases blood pressure > increases afterload
Increase intensity of left sided regurgitation murmurs (MR, AR)
No effect on AS murmur intensity
Transient Arterial Occlusion
Transient compression of both arms by bilateral blood pressure cuff inflation to 20 mm Hg greater than peak systolic blood pressure x 20 seconds
-Increases blood pressure > increases afterload
-Increase intensity of left sided regurgitation murmurs (MR, AR)
-Useful in elderly individuals who are unable to perform adequate handgrip exercises.
Pulsus Alternans
The pulse remains regular, but the force of the arterial pulse alternates between strong and weak sounds
What are the two techniques for pulse alternans?
-Palpation of carotid or femoral artery - force of pulse will alternate between strong and weak
-While taking a blood pressure, the Korotkoff sounds will alternate between loud and soft
-Sitting up will accentuate the finding
Electrical alternans
beat to beat variation in QRS amplitude on EKG tracing
-Pericardial effusion/tamponade
Pulsus Paradoxus
A decrease in arterial pressure with inspiration
-Pericardial effusion/tamponade
