Cardiovascular Flashcards
Precordium
Area of the chest that overlies heart and adjacent great vessels
Surface landmarks of the heart
Base of heart, Apex (tip) of heart, Erb’s point
Base of heart
Located at the third costal cartilage
Apex (tip) of the heart
-Located at mitral valve area (left ventricle)
-Used to assess point of maximum impulse
Erb’s point
-Halfway point between base and apex
-Location where all 4 valves can be heard
Aortic Valve location
Right 2nd intercostal space next to sternum
Pulmonary Valve location
Left 2nd intercostal space next to sternum
Erb’s point Location
Left 3rd intercostal space
Location of the Tricuspid Valve
Left 4th & 5th intercostal space next to sternum
Location of Mitral Valve
Left 5th intercostal space just medial to midclavicular line
Cardiac Pain
-Most common with activity
-Often a squeeze or pressure
-Like “someone is standing on my chest”
Levine’s Sign
Fist clenched (squeezing) over the precordium
Heart Causes
-Coronary artery disease (CAD)
-Pericardial disorders,
-Valve problems compromising coronary blood flow
Palpitation
-Subjective sensation that the heart has skipped a beat or added an extra bear (pounding, fluttering, racing)
-May be a normal phenomenon or by cardiac issues
(Isolated-common/harmless/After activity-Concerning)
-Pathological issues: Cardiac conditions, non-cardiac conditions, medication, stress, excessive caffeine or alcohol
Anasarca
-Extreme generalized edema
-Due to the heart not pumping effectively (fluid buildup)
-Different from typical edema (affects entire body/severe)
Vasovagal Syncope (Vagal Faint)
-Fainting as an overreaction to certain triggers
-Occurs as a result of sudden drop in heart rate and blood pressure
Hypovolemic Shock
-State of shock resulting from massive blood loss and inadequate tissue perfusion
-Lose more than 20% of body’s blood
-Makes it impossible for heart to pump sufficient blood to rest of organs and body
-Life threatening
Arteriosclerosis
-Hardening and thickening of the arterial walls
-Decreases blood flow
-Atherosclerosis contributes to arteriosclerosis
Artherosclerosis
-Plaques forms with arterial walls
-Causes narrowing of the lumen
-End organs supplied by these vessels receive diminished circulation
Bruit
-Intermittent auscultatory sound (“whooshing”)
-Caused by turbulent flow through an artery due to stenosis (narrowing)
-May also palpate as a thrill
Bruit in the neck vessel can help screen for __________
Artherosclerosis
Ischemia
-Diminished blood supply to an organ or body part
-Main cause: Artherosclerosis
Infarction
-Necrosis (tissue death) due to inadequate blood supply
-Result of prolonged ischemia
Intermittent Claudication
-Localized fatigue of the legs that occur while walking (Can be quickly relieved by rest-2 to 5 minutes)
-Discomfort occurs most often in the calf (also can be foot, thigh, hip or buttock)
Thrombophlebitis/thrombosis
Blood clot (thrombus) formed in the vein
Embolus
-Particle or mass t moves through blood vessels until it reaches a vessel that is too small to let is pass
(Lodges & causes obstruction of blood flow)
-Can cause ischemia and/or infarction
Pulse Pressure
-Represents the force that the heart generates each time it contracts
-Difference between systolic and diastolic pressures
Normal Pulse Pressure
Usually within the range of 30-40mmhg
Abnormal Pulse Pressure Causes
-Benign causes include vigorous exercise
-Pathological causes: atherosclerosis, and aortic regurgitation
Hypertentive Crisis
-Acute, severe rise in blood pressure
-May or may not have organ dysfunction
Urgency Hypertension
> 180/>120 w/o organ damage
-Need evaluation including medication
Emergency hypertension
> 180/>120 mmHg with organ damage
-Immediate emergency
Normal Pulse Pressure Description
-Pressure of the pulse: Normal
-Contour: Smooth and rounded
Small/Weak Pulse
-Pressure of the pulse: Diminished
-Contour: Upstroke slow, peak prolong
Large/Bounding Pulse
-Pressure of the pulse: Increased
-Contour: Rapid rise and fall, peak brief
Bisferiens pulse
Increased rate with double peak
Pulsus Alternans
Regular rhythm but the beats alternate
Paradoxial Pulse
-Opposite of what normally happens
-Inspiration: Amplitude decreases
-Expiration: Increases
Pulsus bigminus
Irregular rhythm with 2 beats close together followed by a pulse
Inspection of hands and nails
Cyanosis, nail clubbing, splinter hemorrhages, palmar erythema, nicotine staining
Cyanosis-Related Disorders
Heart failure, COPD, Pulmonary embolism
Nail clubbing
Associated with cardiopulmonary disease
Splinter hemorrhages
Thin, red to reddish brown lines of blood under the nails that can occur with endocarditis, vasculitis or nail trauma
Endocarditis
Infection of heart valves
Vasculitis
Vessel damage from swelling of blood vessels
Palmar erythema
Portal hypertension
Nicotine Staining
Associated with smoking
Internal jugular vein
Lower neck in triangle formed the two heads of the SCM and clavicle
Jugular venous pressure (JVP) Measurement
-Patient is supine. Elevate trunk to 45 degrees. Tilt chin up &slightly away.
• Use tangential light to find internal jugular vein pulsations. This is the top of the venous column of blood.
• Extend a card/ tongue depressor horizontally from the pulsation while holding a ruler vertically from the sternal angle.
• The card and ruler should intersect. Measure the vertical
distance.
Interpretation of JVP
Normal: less than 2-3cm (<1 inch)
Abnormal: Above 3cm (more than 1 inch), absent
Elevated JVP means
-Classic sign of venous hypertension
-Right sided heart failure
-Tricuspid stenosis
Observe the precordial area for:
-Asymmetry/deformities
-Difficulty breathing
-Heaves (lifting of chest) or pulsations (location, size, contour, & timing)
Apical Pulse (Apex beat)
• Look for Located at Point of Maximum Impulse (PMI) at 5th ICP, midclavicular line
• Ask patient to exhale slowly & hold breath at end of expiration
• If unable to visualize, have patient roll 45° toward left lateral decubitus position
• Exhale completely while shining penlight across region.
• Look for size, intensity, location
Apex Beat
If observed, suggests cardiomegaly, such as left
ventricular hypertrophy
Orthopnea
Difficulty breathing while supine; Consider pulmonary edema due to left ventricular failure
Sternoclavicular pulsation
May suggest dissecting aneurysm of ascending aorta.
Epigastric & subxiphoid pulsations
Usually abnormal; Related to right ventricular hypertrophy or abdominal aortic aneurysm
Palpation: Apical Impulse (apex beat)
• Used fingertips
• Palpate at Point of Maximal Impulse: Location: 5th intercostal space, midclavicular line
• Normal: 2-3 cm diameter
• Abnormal: >3 cm diameter: left ventricular hypertrophy
(Laterally displaced: indicates cardiomegaly)
Palpation: Thrills interpretation
-Normal: No vibration
-Abnormal: Individual locations can indicate different conditions; Aortic valve: ascending aortic aneurysm/Tricuspid valve: Left atrial enlargement
Percussion Interpretations (Heart)
Normal: dullness from sternum to approximately 6cm lateral to the left of the sternum
Abnormal: If large, may suggest hypertrophy
Auscultation of Heart: Principles
-Diaphragm: High pitched sounds
-Bell: Low pitched sounds
Heart Sounds: Types
-Normal: S1 (Lub) and S2 (Dub)
-Extra 3rd sounds: S3 and S4 gallop
-Heart murmur
-Split sounds
-Systolic: Interval between S1 and S2
-Diastolic: Interval between S2 and S1
S1 Lub
-Closure of mitral & tricuspid valves
-Blood flows from atrium to ventricle
-Start of systole
-Best heard with bell
-Ideal to hear sound over mitral
S2 Dub
-Closure of aortic and pulmonary valves
-Blood flows from ventricles to body & lung
-Best heard with diaphragm
-Ideal listen at pulmonic
S2 physiological split
Best heard at pulmonic area with inspiration
Use diaphragm (high pitched sound)
Normal (90% have it)
