Cardiovascular and Peripheral Vascular Assessment Flashcards
precordium
area of the chest overlying the heart
inspect, palpate, and ausculate
no percussing, chest x-ray is more reliable to identify the borders of the heart
Angle of Louis
sternal angle, used to identify 2nd intercostal space
Aortic area
2nd intercostal space, right sternal boarder
pulmonic area
2nd intercostal space on the left sternal border
Erb’s point
3rd intercostal space on the left sternal border
Tricuspid area (right ventricular area)
4th or 5th intercostal space to the left sternal border
Mitral area (apical area)
5th intercostal space, medial to the midclavicular live
epigastric area
area overlying the xiphoid process
lift
a slight movement
heave
more vigorous movement; may see at the sternal border and a left ventricular heave at the apex
apical pulse
a normal pulsation located over the apex of the heart, at the 5th intercostal space medial to the midclavicular line
dependent edema
found in dependent areas such as feet and sacrum
peripheral edema
feet and hands
generalized edema (anasarca)
all over the body; massive edema
pulmonary edema
fluid accumulation in the lungs due to imbalanced capillary dynamics
cerebral edema
fluid in the brain
pitting edema
press your finger into edematous area for 2-3 seconds and note the depth of indentation
grades of pitting edema
1+: slight pit, normal contour
2+: deeper pit, fairly normal contour
3+: puffy, appearance of deeper pit
4+: extremely deep pit, definitely swollen
thrills
palpable cardiac murmur; feels like the throat of the purring cat and is considered abnormal. signifies turbulent blood flow and accompanies loud murmurs
pulses
palpate all pulses bilaterally temporal arteries carotide arteries radial, ulnar, brachial arteries apical impulse femoral, popliteal, posterior tibialis, dorsalis pedis arteries
skin temp
use dorsum or back of hand
normal=warm
skin turgor
indicates hydration status
assessed by pitching the skin and releasing it
best tested on the sternum or forehead
skin goes back within 3 seconds
capillary refill
normal should be 2 seconds or less
3-4 seconds= sluggish
>4= abnormal
auscultation of heart
auscultate all pericardial areas first with diaphragm and then bell
diaphragm for loud/high pitched sounds
bell for low pitched sounds
breath through nose
rate and rhythm
First heart sound (S1)
closure of mitral and tricuspid valves
apex of the heart
using diaphragm of the stethoscope
Second heart sound (S2)
closure of aortic and pulmonic valves
base of the heart
using diaphragm of the stethoscope
Extra heart sounds (S3)
Also known as ventricular gallop Heard in the mitral/apical area with the bell of the stethoscope Immediately after S2 (diastole) Normal in children and young adults Never normal in people over 30 Left lateral (side lying) position Kentucky sound
Extra Heart sound (S4)
Also known as atrial gallop
Heard in the mitral area using the bell of the stethoscope
Abnormal in most adults
happens before S1
Due to increased resistance to ventricular filling
Tennessee
ischemia, coronary artery disease, aortic stenosis
Split S1
mitral and tricuspid heart valves not closing together
high pitched sound heard best in the tricuspid area using the diaphragm
assoc with right bundle branch block
Split S2
aortic and pulmonic valve not closing together
more common in children
heard best in the pulmonic area with the diaphragm
ejection click
click sound produced by movement of stiffly deformed valve
best heard with diaphragm
Midsystolic
indicates mitral valve prolapse. Part of the mitral valve balloons into left atrium
Murmurs
harsh, rumbling, blowing sound caused by blood flow across a defective valve, or the shunting of blood through an abnormal passage
assessed for timing, location, radiation, pitch, quality, intensity
intensity of heart murmur grade
grade i: very faint
grade ii: quiet but audible
grade iii: moderately loud
grade iv: loud, associated with a palpable thrill
grade v: very loud
grade vi: loudest. may be audible with the stethoscope lifted off the chest wall
Bruits
blowing or “purring” sound that indicates a distortion of a blood vessel that could interfere with blood flow
auscultated with the bell
carotid arteries bruits
begin at base towards chin. ask patient to hold breath
thyroid gland bruits
if gland feels enlarged. occurs because of accelerated blood flow through gland
assess the non cardiac parameter of cardiac function
clouded sensorium suddenly decreased visual acuity suddenly decreasing hearing sudden and progressive difficulty in locomotion diminished reflexes
signs and symptoms of poor perfusion
oliguria: scanty urine production
anorexia/constipation: results from marginal perfusion of the GI tract
hepatic engorgement: produced by weakened hearts inability to receive and pump venous blood
air hunger: from impaired perfusion of oxygenated blood to the lungs
