Cardio & Vascular

Question 1

What causes S1? S2?

Answer 1

S1: ventricular contraction causes increased pressure, closing the mitral and tricuspid valves

S2: at the end of systole, the low ventricular pressure allows the aortic and pulmonic valves close

Question 2

What is diastole? Systole?

Answer 2

Diastole: ventricular relaxation and filling, which is helped with atrial contraction

Systole: ventricular contraction, ejecting blood from the heart

Question 3

Where do we listen to the aortic valve?

Answer 3

Second intercostal space adjacent to the sternum, on the patient’s right side

Question 4

Where do we listen to the mitral valve?

Answer 4

5th intercostal space on the mid-clavicular line (1/2way between nipple and sternum)

Question 5

Do we have the patient disrobe for the heart examination

Answer 5

No! We don’t need to do that

Question 6

Okay so we don’t have the patient disrobe. How do we get the stethoscope to the right place?

Answer 6

Have the patient slide the steth under their clothes, and have them place the bell on their skin. Tell patient which side (bell vs diaphragm) to use. Have patient put hand over steth head borders on ouside of clothes, and you place your hand over theirs. Turn your eyes away.

Question 7

What are the patient instructions for finding the aortic valve?

Answer 7

4 fingers down from collar bone very close to breast bone. Make sure not on ribs or breast bone. Patient right.

Question 8

What are the patient instructions for finding the mitral valve?

Answer 8

Find bottom of breast bone. 4 fingers up and 4 fingers over from it. Make sure not on rib. Patient left.

Question 9

What do you have to do to confirm a sound is S1 or S2?

Answer 9

Identify by pulse. S1 will coincide with pulse

Question 10

What is S3? S4?

Answer 10

S3: early diastolic sound, heard right after S2. Aka “Ventricular Gallop”

S4: Late diastolic sound, heard right before S1. Aka “Atrial Gallop”

Question 11

What is a stenosis?

Answer 11

Passage through valve narrowed. Murmurs heard as blood rushes through open valve.

Aortic stenosis is associated with a systolic murmur

Tricuspid stenosis is associated with a diastolic murmur

Question 12

What is a regurgitation?

Answer 12

Incompetent valves allow blood to flow backward. Murmurs heard as blood flows backward through a poorly closed valve

Mitral regurgitation is associated with systolic murmur

Pulmonic regurgitation is associated with diastolic murmur

Question 13

What is the most common cause of vascular disease?

Answer 13

Atherosclerosis

Question 14

What are the 5 “P” signs of peripheral vascular disease?

Answer 14

Pain
Pallor
Paresthesia
Paralysis
Pulselessness

Question 15

What does auscultation mean?

Answer 15

Listening with the stethoscope (this isn’t exact but effectively the definition for our purposes)

Question 16

What are we doing when we examine the carotid arteries?

Answer 16

Auscultate for bruit at 1st bifurcation of common carotid (high on neck). Bruit is due to stenosis of the vessel.

Rarely heard if 90% block

Have patient hold breath.

In normal, may hear nothing, may hear heart beat

Question 17

How do we palpate the carotid arteries

Answer 17

One at a time after auscultation. Palpate low because of baroreceptors

Question 18

How do we palpate the temporal pulse?

Answer 18

Palpate in front of, and slightly above the tragus. This is the easiest place to find.

Question 19

Where do we find the radial pulse?

Answer 19

Forearm, thumb side

Question 20

Where do we find the brachial pulse?

Answer 20

Below biceps on bony area. Easiest to find with hyperextension

Question 21

Where do we find the dorsalis pedis pulse?

Answer 21

Slightly lateral to highest cuniform bone. Dorsiflexion helps to feel

Question 22

Where do we find the posterior tibial pulse?

Answer 22

Posterior and slightly superior to the medial malleolus. Plantar flexion helps to feel

Question 23

What is the grading system for feeling pulse rate and rhythm?

Answer 23

4 = bounding
3 = full, increased
2 = expected
1 = diminished, barely palpable
0 = absent, not palpable

Make sure to note symmetry!