Cardiovascular Flashcards
JVD is a sign of what?
increased right atrial pressure
How do u position the pt for JVD analysis?
Raise the head of the bed or examining table to 30°
Turn the patient’s head gently to the left
Identify the topmost point of the flickering venous pulsations
How do u measure JVD?
Place a centimeter ruler upright on the sternal angle (Angle of Louis)
Place a card or tongue blade horizontally from the top of the JVP to the ruler, making a right angle
Measure the distance above the sternal angle in centimeters, add 5cm (since the Right Atrium is 5cm below sternal angle
A 0 - 8 centimeter elevation is normal
Before you palp the carotids, what should u do?
auscultate for bruits
What should u hear in the carotids normally?
nothing
What will u hear if there is carotid stenosis?
you may hear a Whooshing sound – like the Karotkoff sounds when checking BP
How do u position the pt for a chest palpation?
Stand on the right side of the patient
Drop gown, keep sheet over lower extremities
Palpate shape of chest wall, PMI, Heaves
How do u find the PMI?
Inspect the left anterior chest for a visible PMI
Using your fingerpads, palpate at the apex for the PMI
What are the characteristics of the PMI?
Tapping, or normal
Sustained — suggests LV hypertrophy from hypertension or aortic stenosis, or
Diffuse — suggests a dilated ventricle from congestive heart failure or cardiomyopathy
How do u measure the PMI?
Locate the PMI by interspace and distance in centimeters from the midsternal line
What things are u palpating for in the chest?
heaves or thrills
What is systole?
The right ventricle pumps blood into the pulmonary arteries (pulmonic valve is open)
The left ventricle pumps blood into the aorta(aortic valve is open)
What is diastole?
The ventricles relax
Blood flows from the right atrium → right ventricle (tricuspid valve is open)
Blood flows from the left atrium → left ventricle (mitral valve is open)
What is the diaphragm of the stethoscope best for?
high-pitched sounds like S1, S2, and also S4 and most murmurs
What is the bell of the stethoscope best for?
low-pitched sounds like S3 and rumble of mitral stenosis
What is S1 and S2?
S1 closure of AV valves
S2 closure of Semilunar valves
What is the splitting of S2?
Right sided pressures are lower than the left
Right sided events occur slightly later than left
Example: the aortic valve closes slightly before the pulmonic valve (A2 before P2)
Inspiration causes (accentuates) a split
With expiration the split may disappear
What is an ejection click?
early systole
Sound of diseased aortic valve opening
What is an opening snap?
early diastole
Sound of diseased mitral valve snapping open
What is S3?
Rapid deceleration of blood
Decreased compliance such as heart failure
May be normal in children and young adults
What is S4?
Atrial kick against non-compliant ventricular wall
What are the shapes of murmurs?
Crescendo, decrescendo, or both (sometimes called diamond-shaped)
Give the grades of murmurs from 1-6
Grade 1 – very faint, possibly not heard in all positions
Grade 2 – Easily heard but faint
Grade 3 – Moderately loud
Grade 4 – Loud with palpable thrill
Grade 5 – Heard with stethoscope partially off chest
Grade 6 – Heard with stethoscope off the chest
What do u hear in left lateral decubitis?
Mitral stenosis, S3, S4
What do u hear in Sitting, leaning forward, breath out and hold?
Aortic murmur
What can u hear in Standing, squatting, valsalva?
MVP, aortic stenosis
What do u auscultate in the abdomen?
Aorta
Renal
Iliac
Femoral
What do u palpate in the abdomen?
Using a two sided approach to approximate the diameter of the Aorta
2 cm is “normal”
May not be palpable at all in large patients
What is the 0-4 scale of edema?
1 – ankle
2 – tibia
3 – femur
4 – sacrum
What are varicosities?
Caused by faulty valves in the veins
Can be uncomfortable as well as unsightly
What is stasis dermatitis?
Caused by venous insufficiency
Skin is scaly and discolored by hemoglobin from extravasated RBCs
Can lead to ulcers which are very slow to heal
What are the characteristics of arterial insufficieny?
Smooth, waxy and pale skin
No hair growth
Can lead to eventual ulceration of the skin
NOT to be confused with depilation in a healthy female
What does splinter hemorrhages indicate?
Associated with endocarditis
Caused by tiny clots that damage the capillaries
These are occurring throughout the body but they are only visible under the finger nails.-
What are the 6 arterial palpation points for extremities?
Radial Brachial Femoral Popliteal Dorsalis pedis Posterior tibialis
Describe the allen test
Palm up
Have patient clench fist
Compress both arteries
Have patient open the hand
Observe the palmer pallor
Release the ulnar artery
Finding
Normal – entire hand turns pink in 3-5 seconds
Abnormal – only medial half of hand turns pink
If abnormal repeat and release radial artery
What is the homan sign?
Check for Deep Venous Thrombosis (DVT)
With the knee in flexion, the examiner forcefully dorsiflexes the ankle
Calf or popliteal pain occurs in approximately 35% of the patients with DVT
Homan sign is neither sensitive nor specific for DVT
