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NURS518 > Cardio & Peripheral Vascular > Flashcards

Cardio & Peripheral Vascular Flashcards

1
Q

Anatomically, where would you expect to find the point of maximal impulse (PMI)?

A

The PMI is found in the 5th intercostal space or medial to the left midclavicular line a the cardiac apex.

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2
Q

When might you find the PMI in the xiphoid or epigastric area, and why?

A

In COPD the PMI may be in the xiphoid or epigastric area due to right ventricular hypertrophy (RVH).

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3
Q

What is the normal diameter of the PMI?

A

Normal PMI is 1 to 2.5cm

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4
Q

What does a PMI of >2.5cm indicate?

A

Left ventricular hypertrophy (LVH)
Often seen in HTN or dilated cardiomyopathy.

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5
Q

What does a PMI of >10cm lateral to the midsternal line indicate?

A

Left ventricular hypertrophy (LVH) and ventricular dilation from an MI or heart failure.

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6
Q

What valves are considered atrioventricular (AV) valves?

A

Mitral and tricuspid values due to their location

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7
Q

What are the semilunar valves?

A

The aortic and pulmonic valves due to leaflets shaped like half-moons.

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8
Q

What is S3 caused by?

A

Abrupt deceleration of inflow across the mitral valve.

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9
Q

What is S4 caused by?

A

Increased left ventricular end-diastolic stiffness decreases compliance.

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10
Q

What is the period of ventricular contraction?

A

Systole

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11
Q

What is ventricular relaxation

A

Diastole

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12
Q

What produces S1?

A

Closure of the mitral and tricuspid valve in the right side of the heart.

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13
Q

What produces S2?

A

Closure of the aortic and pulmonic valves.

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14
Q

What is a pathological opening snap? When would you hear this?

A

If valve motion is restricted, as in mitral stenosis, the opening of the mitral valve may be audible as a pathological opening snap (OS).

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15
Q

True or False
An S3 gallop usually indicated pathology is older adults.

A

True.

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16
Q

What is the most feared complication of carotid artery palpation?

A

The dislodgement of an atherosclerotic plaque

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17
Q

What is a heart murmur?

A

Turbulent blood flow, usually indicating valvular heart disease or “innocent” flow murmur (in young adults).

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18
Q

Anatomically, where is the aortic area when auscultating?

What heart sounds would you expect to hear here?

A

Aortic Area:
2nd right intercostal space (base of the heart)
S2 louder than S1 and may split with respiration

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19
Q

Anatomically, where is the pulmonic area when auscultating?

What heart sound is heard best here?

A

Pulmonic Area:
2nd left intercostal space
S2 heard best

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20
Q

Anatomically, where is Erb’s point when auscultating?

What heart sound would you expect to hear here?

A

Erb’s Point:
3rd left intercostal space
S1 and S2 heard equally

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21
Q

Anatomically, where is the tricuspid area when auscultating?

What heart sound would you expect to hear here?

A

Tricuspid Area:
4th and 5th left intercostal space
Right-sided S3 best heard (louder on inspiration)

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22
Q

Anatomically, where is the mitral area when auscultating?

What heart sound would you expect to hear here?

A

Mitral Area:
5th left intercostal space at the midclavicular line (apex)
S1 heard best
Right-sided S4 best heard (louder on inspiration)

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23
Q

What is the volume of blood ejected from each ventricle in 1 minute? The product of HR and stroke volume (SV).

A

Cardiac Output (CO)

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24
Q

What is ejection fraction (EF)? What is EF normally?

A

EF is the percent of ventricular volume ejected during each heartbeat. Normal EF is 60%.

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25
Q

The load that stretches the cardiac muscle before contraction is known as?

A

Preload

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26
Q

The degree of vascular resistance to ventricle contraction is known as?

A

Afterload

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27
Q

Causes of decreased right ventricular (RV) preload include?

A

Exhalation
Dehydration
Pooling of blood in the capillary bed or venous system

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28
Q

Is JVP estimated from the external or internal jugular?

A

Internal jugular - the most direct channel into the right atrium and superior vena cava.

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29
Q

What can JVP predict?

A

Elevations in fluid volume

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30
Q

What is the most common cause of elevated JVP?

A

Heart Failure

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31
Q

When would you expect to see JVP fall?

A

Blood loss
Decreased venous vascular tone

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32
Q

What causes jugular venous pulsations?

A

Changing pressures in the right atrium (RA) during diastole and systole produce oscillations of filling and emptying in the jugular vein.

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33
Q

In JVP pulsations what does “a” stand for?

What would prominent a waves indicate?

What would absent a waves indicate?

A

a = atrial contraction

Abnormally prominent cannon a waves occur in increased resistance to right atrial contraction - as seen in tricuspid stenosis, severe heart block, SVT, junctional tachycardia, pulmonary hypertension, and pulmonic stenosis.

Absent a waves signal afib.

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34
Q

Anterior chest pain, often tearing or ripping and radiating into the back or neck is characteristic of?

A

Aortic dissection

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35
Q

Unstable angina, non-ST elevation MI and ST elevation MI can be classified under the umbrella term _____?

A

Acute Coronary Syndrome

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36
Q

______ is the most common symptom of coronary heart disease.

A

Chest pain

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37
Q

Dyspnea that occurs in the supine position and improves with sitting up and/or sleeping with pillows is known as?

a) orthopnea
b) dyspnea
c) paroxysmal nocturnal dyspnea
d) palpitations

A

a) orthopnea

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38
Q

Sudden dyspnea occurs in _____?

a) pulmonary embolism
b) spontaneous pneumothorax
c) anxiety
d) all of the above

A

d) all of the above

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39
Q

What is paroxysmal nocturnal dyspnea?

A

Nighttime episodes of dyspnea that wakes you up

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40
Q

A patient presents with periorbital puffiness, weight gain, and dependent edema. What is the most likely diagnosis?

a) Anasarca
b) Paroxysmal Nocturnal Dyspnea
c) Nephrotic Syndrome
d) Live Failure

A

c) Nephrotic Syndrome

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41
Q

Anatomically, where is the JVP usually measured from?

A

The JVP is measured in the vertical distance above the sternal angle (angle of Louis), the bony ridge located around T4 adjacent to the 2nd rib where the manubrium joins the body of the sternum.

42
Q

When does the JVP appear elevated on expiration but veins collapse on inspiration?

A

In obstructive lung disease - this does not indicate heart failure.

43
Q

At what measurement in cm above the sternal angle is the JVP considered elevated?

a) 2.5cm
b) 3cm
c) 4cm
d) 1cm

A

b) 3cm (or more than 8cm in total distance above the right atrium)

44
Q

True or False
Bruits do not correlate with clinically significant underlying disease.

A

True.

45
Q

Why is it essential to auscultate the carotid arteries before palpation?

A

Palpation could result in the dislodgement of an atherosclerotic plaque, resulting in a stroke.

46
Q

What are bruits?
What causes bruits?

A

A bruit is a murmur-like sound arising from turbulent arterial blood flow.

Bruits are usually caused by atherosclerotic luminal stenosis.

47
Q

Palpation of the ______ provides valuable info about cardiac function, specifically valve stenosis and regurgitation.

a) carotid pulse
b) internal jugular pulse
c) external jugular pulse
d) radial pulse

A

a) carotid pulse

48
Q

A tortious and kinked carotid artery may produce a ______________.

a) bilateral pulsatile bulge
b) unilateral pulsatile bulge
c) bilateral thrill
d) unilateral thrill

A

b) unilateral pulsatile bulge

49
Q

The carotid pulse is small, thready, or weak in ______________.

A

Cardiogenic shock

50
Q

The carotid pulse is bounding with a delayed upstroke in ____________.

A

Aortic stenosis

51
Q

True or False

Thrills in aortic stenosis are transmitted into the carotid arteries from the suprasternal notch or 2nd right intercostal space.

A

True

52
Q

In pulsus alternans is the rhythm regular or irregular? Why?

A

In pulsus alternans the rhythm is regular but the force of the arterial pulse alternates because of alternating strong and weak ventricular contractions.

53
Q

What does pulsus alternans almost always indicate?

A

Pulsus alternans almost always indicates severe left ventricular dysfunction.

Use the BP cuff to listen to Jorotkoff sounds - alternating loud and soft Korotkoff sounds or sudden doubling of the HR as the cuff pressure declines.

Placing the patient in the upright position may accentuate this finding.

54
Q

What position is best to listen for mitral stenosis?

What does mitral stenosis sound like?

A

In the left lateral decubitus position listen at the apex with the BELL of the stethoscope.

A low-pitched extra S3, opening snap, and diastolic rumble may be heard if mitral stenosis is present.

55
Q

What position is best to listen for aortic regurgitation?

What does aortic regurgitation sound like?

A

Sitting, leaning forward, after a full exhalation, listen down the left sternal border and at the apex with the stethoscope’s DIAPHRAGM.

A soft decrescendo, a higher-pitched diastolic murmur may be heard if aortic regurgitation is present.

56
Q

Where is S1 heard best? When is it diminished?

Where is S2 heard best? When is it diminished?

A

S1 is usually louder at the apex and diminished in 1st-degree heart block.

S2 is usually louder at the base and is diminished in aortic stenosis.

57
Q

Why is palpation of the carotid artery during auscultation an invaluable aid to the timing of sounds and murmurs?

A

Carotid upstroke always occurs in systole immediately after S1.

Sounds or murmurs coinciding with the upstroke are systolic.

Sound or murmurs following the carotid upstroke at diastolic.

58
Q

On palpation, what are heaves and what causes them?

A

Heaves are caused by sustained impulses that rhythmically lift your fingers - produced by enlarged ventricles and occasionally by ventricle aneurysms.

59
Q

On palpation, what are thrills? What causes them?

A

Thrills are buzzing or vibratory sensations caused by underlying TURBULENT BLOOD FLOW. If present, auscultate the same area for murmurs.

60
Q

What are the 4 anatomical areas to palpate?

A

1) The 2nd right intercostal space - aortic area
2) The 2nd left intercoastal space - pulmonic area
3) Along the sternal border
4) The apex

61
Q

How do you palpate for S3 or S4?

A

Place the patient in left lateral decubitus position, palpate the cardiac apex gently with one finger as the patient exhales and briefly stops breathing.

A brief early to mid-diastolic impulse represents a palpable S3.

An outward movement just before S1 signifies a palpable S4.

62
Q

What does the PMI represent?

A

The PMI represents the brief early pulsation of the left ventricle as it moves anteriorly during systole and contacts the chest wall.

63
Q

Where is the pulmonary artery area What does a pulsation here indicate?

A

The left 2nd interspace.

A prominent pulsation here often accompanies dilation or increased flow in the pulmonic artery. A palpable S2 or pulmonary artery tap suggests pulmonary hypertension.

64
Q

Where is the aortic outflow area? What does a pulsation here indicate?

A

The right 2nd interspace.
Pulsations suggest aneurysmal aorta.

65
Q

What is the diaphragm of the stethoscope best used for?

A

The diaphragm is better for picking up relatively high-pitched sounds of S1 and S2, the aortic and mitral regurgitation murmurs, and pericardial friction rubs.

66
Q

What is the bell of the stethoscope best used for?

A

The bell is more sensitive to low-pitched sounds of S3 and S4 and the murmur of mitral stenosis. *Apply lightly, with just enough pressure to produce an air seal.

67
Q

On auscultation, when is systole?

A

Systole is the interval between S1 and S2.

S1 falls before the carotid upstroke.

S2 follows the carotid upstroke.

68
Q

On auscultation, when is diastole?

A

Diastole is the interval between S3 and S4.

69
Q

What are the 5 heart anatomical locations to auscultate? What heart sounds are best heard at each location?

A

1) The 2nd RIGHT interspace - the AORTIC AREA (base) - S2 is louder than S1 and may split with respiration

2) The 2nd LEFT interspace - the PULMONIC AREA - S2 best heard

3) The 3rd LEFT interspace - ERB’s POINT - S1 and S2 heard equally

4) The 4th and 5th LEFT interspace - TRICUSPID AREA - right-sided S3 best heard (louder on inspiration)

5) The 5th LEFT interspace at MCL - MITRAL AREA (apex) - S1 best heard and right-sided S4 best heard (louder on inspiration)

70
Q

What do jugular veins reflect in terms of blood flow through the heart?

A

Jugular veins reflect right atrial pressure (central venous pressure)

71
Q

Are murmurs that coincide with the carotid pulse are systolic or diastolic?

A

Systolic

72
Q

What does expiratory splitting suggest?

A

A valvular abnormality

73
Q

What is the most common extra heart sound?

A

The systolic click of mitral valve prolapse3

74
Q

What does persistent splitting result from?

A

Delayed closure of the pulmonic valve or early closure of the aortic valve.

75
Q

What do diastolic murmurs suggest?

A

Valvular heart disease

76
Q

What murmur is accentuated in the left lateral decubitus position?

A

The presystolic murmur of mitral stenosis
Also left-sided S3 and S4

77
Q

What murmur is best heard leaning forward?

A

The soft early diastolic decrescendo murmur of aortic regurgitation.

78
Q

What murmur is distinguished from all other murmurs by an increase in intensity during squatting-to-standing action (strain phase of Valsalva maneuver) and a decrease in intensity during standing-to-squatting action?

A

The systolic murmur of hypertrophic obstructive cardiomyopathy

79
Q

Do right-sided murmurs increase/decrease with inspiration/expiration?

A

increase
inspiration

Right-sided murmurs INCREASE with INSPIRATION

80
Q

Do left-sided murmurs increase/decrease with inspiration/expiration?

A

increase
expiration

Left-sided murmurs INCREASE with EXPIRATION.

81
Q

Midsystolic murmurs typically arise from blood flow across the _______ valves.

A

semilunar (aortic and pulmonic)

82
Q

Pansystolic (holosystolic) murmurs often occur with ___________ flow across the _______ valves.

A

regurgitant (backward)
AV valves (mitral and tricuspid)

83
Q

Middiastolic murmurs reflect _______flow across the ________ valves.

A

turbulent
AV valves (mitral and tricuspid)

84
Q

Early diastolic murmurs typically reflect ______ flow across incompetent ______ valves.

A

regurgitant (backward)
semilunar valves (aortic and pulmonic)

85
Q

What is a bisferiens pules? In what conditions would you see this type of pulse in?

A

Bisferiens pulse is an increased arterial pulse with a double systolic peak, detected during moderate compression of the artery. Causes include pure aortic regurgitation, combined aortic stenosis and regurgitation, and hypertrophic cardiomyopathy.

86
Q

What is bigeminal pulse?

A

A bigeminal pulse may mimic pulsus alternans. A bigeminal pulse is caused by a normal beat alternating with a premature contraction. The stroke volume of the premature beat is diminished in relation to that of the normal beats and the pulse varies in amplitude accordingly.

87
Q

What is a paradoxical pulse? In what conditions might this occur?

A

A paradoxical pulse may be detected by a palpable decrease in the pulse amplitude on quiet inspiration. A BP cuff may be needed; systolic pressure decreased by >10-12 mm HG during inspiration. A paradoxical pulse occurs in pericardial tamponade, exacerbations of asthma and COPD, and constrictive pericarditis.

88
Q

What are the classical descriptors of the normal left ventricular PMI? Location, diameter, amplitude, duration.

A

Location: 4th or 5th intercostal space at the MCL
Diameter: discrete, less than 2cm
Amplitude: brisk and tapping
Duration: <2/3 of systole

89
Q

What is pulsus tardus?

A

Pulsus tardus refers to sluggish pulses suggestive of aortic stenosis or low cardiac output.

90
Q

What does an enlarged epitrochlear node suggest?

A

Local or distal infection or is associated with lymphadenopathy.

91
Q

What is poikilothermia?

A

Poikilothermia is the relative hypothermia of one extremity as compared with another, seen in PVD

92
Q

What is Homan sign?

A

Discomfort behind the knee with forced dorsiflexion of the foot

93
Q

How do you calculate the ankle-brachial index (ABI)?

A

The ratio of BP measurements in foot and arms

Right ABI = highest pressure in right foot divided by the highest pressure in both arms

Left ABI = highest pressure in left foot divided by the highest pressure in both arms

94
Q

What are 3 common concerning cardiovascular symptoms?

A

chest pain
palpitations
SOB, orthopnea, or PND

95
Q

How would you assess for pitting edema?

A

Press with thumb for at least 5 seconds over dorsal feet, behind each medial malleolus, and over shins.

96
Q

Describe how pulses are graded.

A

0: absent and not palpable
1: diminished, weaker than expected
2: brisk, normal pulse
3: bounding (possible aortic insufficency)

96
Q

How should you position a patient for the majority of the cardiovascular assessment? Where should you stand?

A

Supine with HOB elevated 30 degrees. Examiner stands on the patients right side.

97
Q

Which pulse is rarely palpable? The carotid or internal jugular?

A

The internal jugular pulse

98
Q

If ventricular impulse heave or left your fingers on palpation, what does this suggest?

A

Ventricular dilatation

99
Q

What are some mechanisms for developing edema?

A

Plasma volume from sodium retention
Altered capillary dynamics resulting in net filtration
Inadequate removal of filtered lymph fluid
Lymphatic or venous obstruction
Increased capillary permeability

NURS518 (5 decks)

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