Cardiology Unit 2, Physical Exam of the Cardio System Flashcards
What are some things to consider with regards to the History of Present illness?
1) Chest Pain
2) Fatigue
3) Cough
4) Difficutly Breathing
5) Loss of Consciousness
6) Leg Pain or Cramps
7) Severe Headaches
8) Swollen Ankles
9) Family History
10) Associated Systoms Related to Complaint of Chest Pain
What questions should be asked regarding chest pain?
Onset, Duration, Characteristics, Location, Severity, Associated Symptoms and Treatment of Pain
What questions should be asked regarding cough as it relates to chest pain?
Onset, Duration, Character of the Cough,
What questions should be asked regarding difficulty breathing as it relates to chest pain?
Dyspnea, Orthopnea, Aggravating Factors, and Paroxysmal Nocturnal Dyspnea
What questions should be asked regarding leg pain or cramps as it relates to chest pain?
Onset, Duration, Relieving Factors, Character, burning in toes, changes in skin color or temperature, dizziness, limping, or discomfort during the night
What questions should be asked about severe headaches as it relates to chest pain?
Onset, Duration, Location, Character and known history of Hypertension
What questions should be asked regarding swollen ankles as it relates to chest pain?
Onset, Duration, location, related circumstances, associated symptoms, rest, massage, heat, elevation and medication
What are some concerns related to family history and chest pain?
Diabetes, Heart Disease, Hyperlipidemia, Hypertension, Obesity, Congenital heart defects, sudden death and other risk factors associated with the Cardio System
What are associated symptoms/complaints with regards to chest pain?
Anxiety, Dyspnea, Diaphoresis (excessive sweating), Dizziness, Nausea and Vomiting
What are some Personal and Social History questions regarding chest pain?
Employment Risks, Tobacco Usage, Nutrional Status, Alcohol usage, Personality Assessment, Usual Exercise activities, relaxation patterns and drug use
What are some age and condition variations in regards to Chest pain?
Pregnant Women and Elderly
What are concerns regarding pregnant women and chest pain?
History of cardiac disease or surgery, dizziness or faintness on standing, indications of heart disease during pregnancy, progressive or severe dyspnea, progressive orthopnea, paroxysmal nocturnal dyspnea, hemoptysis, syncope with exertion, and chest pain related to effort or emotion
What are concerns regarding elderly women and chest pain?
Lower extremity swelling, reproducible lower extremity pain with exertion resolving with rest, venous-stasis ulcers
What are the components of a heart exam?
1) Inspection
2) Palpation
3) Percussion
4) Auscultation
What is involved in the inspection portion of a heart examination?
1) Chest Wall
2) Carotid Arteries and Jugular Veins for pulsations, lifts, heaves and thrusts. Check for symmetry
3) Cyanosis of the skin, nailbeds and capillary refill
4) Apical Impulse (5th Intercostal Space, Midclavicular Line)
What is involved in the Palpation component of a heart exam?
1) Palpate the base, left sternal border, right sternal border, apex, epigastrium and left axillae
2) Apical Impulse (5th intercostal space, Midclavicular Line)
3) Palpating for thrills, rushing vibration, primarily over the base of the heart
What is involved in the Percussion component of a heart exam?
1) Estimate the size of the heart (Better assessed by size of the PMI)
2) Limited Value
3) Left Ventricular Size is better judged by the location of the apical impulse
4) Obesity, Muscular development, or pathologic conditions can distort
5) Chest Radiograph is far more useful
6) Change from a resonant to a dull note marks the cardiac border
What is involved in the ausculation component of a heart exam?
1) Performed with patient sitting and leaning forward or Laying Supine and in the left lateral recumpent position
2) Describe rate, rhythm, duration of cycle, timing, intensity, frequency, splitting or murmurs and quality
3) Isolating each sound
4) Auscultate carotid arteries for bruits or murmurs
5) Pericardial friction rub can be mistaken for cardiac-generated sounds
6) Listen over aortic, pulmonic, second pulmonic, tricuspid and mitral posts
What are the basic heart sounds?
1) S1
2) S2
3) S3
4) S4
What are S1/S2 heart sounds?
S1 and S2 are the most distinct sounds
1) S1: Closure of mitral.tricuspid valves
2) S2: Closure of aortic/pulmonic valves (sometimes split)
What are S3/S4 Heart Sounds?
S3 and S4 are difficult to hear
1) S3: Early Diastole (Passive filling) vibration of ventricular walls
Normal in children/young adults. Pathological in 40 + year olds
2) S4: Ventricular filling from atrial kick (late diastole) loss of compliance or increase stroke volume secondary to higher output
Potential Causes: HTN, CAD, Aortic Stenosis, Cardiomyopathy
What are normal heart sound findings in adults?
1) Resting heart rate is 60-90 BPM and regular
2) No bruits or murmurs are present
What are some typical variations of the heart?`
1) Slender Person: Heart is more vertical and central
2) Stocky Person: Heart lies horizontally and to the left
What are some findings associated with Pathology or Disease?
1) Wide Apical Pulsation may indicate left ventricular hypertrophy. Loss of palpable apical pulsation may indicate fluid, air, or displacement
2) Thrills are associated with failure of the semilunar valve to close, aortic or pulmonary stenosis, or atrial septal defect
3) Loud S1
4) Loud S2
5) Murmurs
What does a loud S1 suggest?
Increased blood velocity, mitral stenosis, heart block, hypertension or calcification of the mitral valve
What does a loud S2 suggest?
Hypertension, Valve Disorder, Stenosis or Fluid
What are some characteristics of Murmurs?
1) Disruption of blood into, through or out of the heart
2) Timing and Duration
3) Pitch
4) Intensity
5) Pattern
6) Quality
7) Location and Radiation
8) Mitral Snaps- MV Stenosis
9) Ejection Clicks-Semilunvar Valves
10) Mid-to Late non-ejection systolic clicks - MV Prolapse
11) Reguritation of any of the valves
12) Aortic/Pulmonary Stenosis
13) Mitral Valve Prolapse
What are the characteristics of Friction Rubs?
1) Pericardial Inflammation
2) Rough parietal, and visceral layers make a sound like grating, machine-like rubbing
3) Unexpected splitting, extra heart sounds, heart murmur should be carefully assessed
What are some normal findings of the heart related to pregnant women?
1) Heart Rate and Position shift during pregnancy
2) Audbile Splitting of S1 and S2
3) Murmurs may be heard
What are the parts of a Blood Vessel Examination?
1) Inspection
2) Palpation
3) Ausculation
4) Blood Pressure
What is inspected during a blood vessel examination?
1) Veins, particularly the Jugular Veins
2) Extremeties for arterial and venous Insufficiencies
What is involved with the palpation component of a blood vessel examination?
1) Observation and Palpating of Pulses, comparing contralateral pulses and upper and lower extremity pulses
2) Pulse Difference between Systolic and Diastolic pressures
What are some variables that contribute to characteristics of the pulse?
1) Volume of blood ejected (Stroke Volume)
2) Distension of the Aorta and Large Arteries
3) Viscosity of the Blood
4) Peripheral Arteriolar Resistance
What is involved with ausculation of the blood vessels?
Listening for abnormal sounds such as potential bruits (turbulent blood flow)
How is amplitude of the pulse described?
On a scale of 0-4
4) Bounding, Aneurysmal
3) Full, Increase
2) Expected
1) Diminished, Barely Palpable
0) Absent, not palpable
What is the sound you are listening for when taking a manual blood pressure?
Korotkoff Sound
1) 1st Korotkoff sound is indicative of Systolic Blood Pressure
2) Last Korotkoff sound is indicative of Diastolic Blood Pressure
How is Pitting Edema described?
1) 1+ Slight Pit, disappears rapidly
2) 2+ Somewhat deep pit, disappears in 10 to 15 seconds
3) 3+ Noticeable deep pit that lasts more than a minute
4) 4+ Very deep pit that lasts 2 to 5 minutes
What is ultrasound?
1) Mechanical wave propagated through a medium at a high frequency to produce images of structures within the human body
2) Sounds waves that travel along longitudinal waves
3) Waves are generated by application of electrical current to piezoelectric crystals in the US transducer (probe)
What is Piezoelectric Effect?
Distortion of a Crystal Causes an electric Change
What are the edges of the probe used for?
Deep Abdominal Imaging
What determines the depth to which the ultrasound will penetrate?
Frequency of the Sound Wave
What are Low and High Frequency Probes used for?
Higher The frequency, the better the resolution but the distance from the skin is reduced
1) Lower Frequency probes are used for deep abdominal imaging
2) Higher Frequency probes are used to give high resolution images of shallow structures
What images are displayed as black in color?
Fluid
What images are displayed as Gray in color?
Tissue
What images are displayed as white in color?
Denser tissue appears bright white
Bone appears brightest white
What is a Color Flow Doppler?
Two-Dimensional image is generated that portrays moving reflectors in color simultaneoulsy with images
What is Gain?
Regulates the amplification (brightness) of returning echoes to compensate for loss of transmitted sound caused by absorption and reflection
What is Hyperechoic?
Echoes returned from a structure
Lesion or Tumor which produces a stronger echo than surrounding structures or tissues
What is resolution?
Ability to distinguish between two adjacent structures
What is a transducer?
1) Electromechanical device that is part of an ultrasound system
2) Device that contacts the patient and converts electrical energy into mechanical energy and vice versa
What is Color Doppler?
1) Assigns to colors to represent flow towards or away from the Probe. 2) Typically blood flow
3) Red indicates flow towards the probe
4) Blue indicates flow going away from the probe
How many types of probes are there?
3
What is a Curvilinear Probe used for?
Abdominal and Obstetric Imaging
What are Linear Probes used for?
Soft Tissue and Small Parts Imaging
What are Phased Array Probes used for?
Uses computer control to “bend” the US beam from flat, small footprint to a wider pie-shaped wedge distally
What is conducting gel?
Required for usage of Ultrasound Probe, eliminates air between the probe and skin
What is a Sub-Xyphoid View?
1) Probe is placed under the Xyphoid Process almost horizontal with the floor and aimed directly udner or slightly left of the sternum
2) Probe marker should face the patient’s right side
3) Pericardium, Right and Left Ventricle are Visualized in the Long Axis
4) Screen shows a portion of the liver at the top, Followed in order the right ventricle, intraventricular septum, and the left ventricle
What is the Left Parasternal View?
1) Probe is placed just to the left of the sternum at about the 5th Intercostal Space with the probe marker to the patients right
2) Probe is rotated Cephalad, aiming toward the right shoulder to obtain the long-axis view
3) Visualizing the Pericardium, Right Ventricle, Interventricular Septum, and Left Ventricle
What is Pericardial Effusion?
Fluid Around the Heart
