Cardio & Vascular Flashcards
What causes S1? S2?
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
What is diastole? Systole?
Diastole: ventricular relaxation and filling, which is helped with atrial contraction
Systole: ventricular contraction, ejecting blood from the heart
Where do we listen to the aortic valve?
Second intercostal space adjacent to the sternum, on the patient’s right side
Where do we listen to the mitral valve?
5th intercostal space on the mid-clavicular line (1/2way between nipple and sternum)
Do we have the patient disrobe for the heart examination
No! We don’t need to do that
Okay so we don’t have the patient disrobe. How do we get the stethoscope to the right place?
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.
What are the patient instructions for finding the aortic valve?
4 fingers down from collar bone very close to breast bone. Make sure not on ribs or breast bone. Patient right.
What are the patient instructions for finding the mitral valve?
Find bottom of breast bone. 4 fingers up and 4 fingers over from it. Make sure not on rib. Patient left.
What do you have to do to confirm a sound is S1 or S2?
Identify by pulse. S1 will coincide with pulse
What is S3? S4?
S3: early diastolic sound, heard right after S2. Aka “Ventricular Gallop”
S4: Late diastolic sound, heard right before S1. Aka “Atrial Gallop”
What is a stenosis?
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
What is a regurgitation?
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
What is the most common cause of vascular disease?
Atherosclerosis
What are the 5 “P” signs of peripheral vascular disease?
Pain Pallor Paresthesia Paralysis Pulselessness
What does auscultation mean?
Listening with the stethoscope (this isn’t exact but effectively the definition for our purposes)
What are we doing when we examine the carotid arteries?
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
How do we palpate the carotid arteries
One at a time after auscultation. Palpate low because of baroreceptors
How do we palpate the temporal pulse?
Palpate in front of, and slightly above the tragus. This is the easiest place to find.
Where do we find the radial pulse?
Forearm, thumb side
Where do we find the brachial pulse?
Below biceps on bony area. Easiest to find with hyperextension
Where do we find the dorsalis pedis pulse?
Slightly lateral to highest cuniform bone. Dorsiflexion helps to feel
Where do we find the posterior tibial pulse?
Posterior and slightly superior to the medial malleolus. Plantar flexion helps to feel
What is the grading system for feeling pulse rate and rhythm?
4 = bounding 3 = full, increased 2 = expected 1 = diminished, barely palpable 0 = absent, not palpable
Make sure to note symmetry!
