Cardio vascular 1-2 L Flashcards
Basic complaints of CVS
*Pain: - coronarogenic (ischaemic) – angina pectoris
- non-coronarogenic - cardialgia
*Interruptions in the work of the heart and palpitation
*Shortness of breath (dyspnea), suffocation
*Edema
*Coughing, hemoptysis
*Headache
*Dizziness, flickering flies before the eyes
*Syncope
signs of heart attack
Heart attack signs and symptoms in men and women: Chest pain or discomfort; Shortness of breath; Pain or discomfort in the jaw, neck, back, arm, or shoulder; Feeling nauseous, light-headed, or unusually tired.
Distinguishing between
angina pectoris and cardialgia
– angina pectoris :
1-Quality/Character : Pressing, squeezing
2-Location : Retrosternal
3-Radiation : Left shoulder, scapula
4-Setting : Physical exercise
5-Nitroglycerin effect : Stops the pain
—-cardialgia:
1-Quality/Character : Pricking, nagging
2-Location : At the apex, in the shoulder, along the ribs
3-Radiation : No
4-Setting : Other reasons: no association with exercise. Ma be provoked by meals, movements
5-Nitroglycerin effect : No effect
explain the Dizziness, flickering flies before the eyes
- permanent or periodic
- relationship with changes in body
position, interruptions in the work of the
heart, relationship with the rise or fall of
blood pressure
explain the Syncope
- frequency of occurrence
- aggravating-alleviating factors:
stuffy room, unpleasant odors,
stress, menses, interruptions in the
work of the heart
explain the Physical examination of CVS
—-General information:
- Consciousness
- Position in bed (forced - AHF)
- The patient’s face
- Skin covers
- Subcutaneous fat
—-Local:
- Heart Area
- Vessel areas (arteries, veins, capillaries)
—Skin covers:
1-Colors of skin
- coffee with milk
- pale
- acrocyanosis
2-Skin rashes and formations:
xanthoma trophic changes , acrocyanosis , ulceration
—Subcutaneous fat :
*Degree of development by BMI
*Type of subcutaneous fat
*Presence of edema:
- legs: ankles, shins, feet;
- ascites (abdomen cavity),
- hydrothorax (pleural cavity)
Heart area examination
*Apex beat
*Cardiac (right ventricular) beat
*Epigastric pulsation
*Pulsation due to contractions of the abdominal
aorta
explain the Apex beat
Location in the V intercostal space, 1,5 cm medial to the
mediaclavicular line
*Mechanism: due to the impact of the apex of the heart on
the chest wall
*Pathology: “Negative push” - with adhesive
(constrictive) percarditis
explain the Cardiac (right ventricular) beat
*Location in the III - IV intercostal space to the left of the sternum extends to the epigastric region
*Mechanism - reduction of enlarged right ventricle
explain the Epigastric pulsation
Elevation and lowering of the anterior abdominal wall in the epigastric region, synchronous to the contractions of the heart
*Mechanism:
- pulsation of the heart (right ventricle)
- pulsation of the abdominal aorta
- pulsation of enlarged liver
explain Pulsation due to contractions of the
abdominal aorta
*Location - below the xiphoid process, with deep inspiration visible worse
*Appears when:
- exhaustion;
- asthenic type of constitution;
- relaxed abdominal wall;
- omission of internal organs;
- aneurysm of the abdominal aorta
+explain the Pulsation due to enlarged liver
(hepatic pulsation)
–The true (hepatic venous pulse)
When the hands grasp the protruding edge of the liver with
each pulse stroke, it increases in all directions
Fingers pressed to the liver, with each pulse stroke, not only
rise, but also diverge
–Transmission
When grasping the protruding edge of the liver with each
pulse of the pulse, it does not increase, but only moves in
one direction
Fingers pressed to the liver, with each pulse stroke only
rise, but do not diverge
explain the Arterial pulse
Pulse is the rhythmical vibration of the arterial walls caused by contractions of the heart, blood discharge into the arterial system, and changes in pressure in this system during systole and diastole
what is the Properties of arterial pulse
- Symmetry:
symmetrical/asymmetrical - Rhythm: regular/irregular
- Pulse rate:
- normal (60-90 per min)
- bradicardia (<60 per min)
- tachycardia (>90 per min)
- Pulse pressure:
- pulsus durus (hard or high-tension pulse)
- pulsus mollis (soft)
- normal pulse
- Volume of pulse:
- pulsus plenus (full)
- ulsus vacuus
Assessment of pulse
Pulsus differens
Different volume and force between arms Causes:
- unilateral atherosclerosis of major arteries
- compression of major arteries
(tumors, aortic aneurisms)
Methods of BP measurement and its phases
- Direct (invasive)
- Non-invasive:
- auscultatory (Korotkoff`s method)
- cyclometric
–Office - Ambulatory: HBPM ABPM
- Self-monitoring of BP 24-h monitoring
—phases
1 phase – first quiet tones – Systolic BP
2 phase – short compression murmurs
3 phase – loud systolic murmurs
4 phase – decreasing intensity of tones
5 phase – disappearance of tones – Diastolic BP
Rules of BP measurement
- Rest before the
measurement (5 min. and
more) - No coffee intake or
smoking before the
measurement - Selecting the right cuff
- Supporting of elbow on the table
- Legs shouldn’t be crossed
- Bulb and cuff at heart
level - Keep silence
Classification of BP levels in adults
–Category Systolic BP Diastolic BP
Optimal <120 and <80
Normal 120-129 and/or 80-84
High normal 130-139 and/or 85-89
1st degree AH 140-159 and/or 90-99
2nd degree AH 160-179 and/or 100-109
3rd degree AH ≥180 and/or ≥110
ISH* ≥140 and <90
Percussion of the heart
t
*relative cardiac dullness borders
*absolute cardiac dullness borders
*vascular bundle
*heart configuration
*diameter of the heart
*heart length
Topography of the heart
The axis of the heart is
located:
- top down;
- from right to left;
- from back to front
*From all sides the heart is
partially covered with lungs
*The part that is not obstructed
by the lungs is localized in
the IV intercostal space, is
represented by the right
ventricle
Contours of the heart
*Right:
- up to the 3rd rib the ascending part of the aorta;
- lower - right atrium
*Left:
- descending part of the aorta;
- pulmonary trunk;
- ear of the left atrium;
- left ventricle
Borders of relative cardiac dullness
*Represents the true size of the heart
*Use a quiet percussion
*Define three boundaries:
- the right;
- the left;
- the upper
Causes of an increase in the right atrium
*Diseases of the lungs.
*Stenosis of the right AV-hole.
*Tricuspid regurgitation, or
lack of tricuspid valve.
*Pulmonary embolism.
*Congenital heart diseases.
*Hypertrophy of the right
ventricle.
Causes of an increase in the right ventricle
*Pulmonary hypertension.
*The tetrad of Fallot.
*Stenosis of the pulmonary artery mouth.
*Defect of interventricular septum
