Cardiovascular Assessment Flashcards
What technique is most important in the cardiovascular examination?
auscultation
What sounds heard best with the bell and diaphragm of a stethoscope?
bell = low pitched sounds diaphragm = high pitched sounds
What changes occur in the first few hours to days of birth?
change in ductal flow, decreasing pulmonary vascular resistance and increasing systemic vascular resistance
Cardiovascular assessments should be done when?
at birth, one day of life and pediatric visits
What is the first and most important step in cardiovascular assessment?
Maternal history
What are the common heart defects of diabetic mothers?
VSD, transposition of the great arteries, hypertrophic cardiomyopathy
What common defect is seen in mother’s with lupus?
complete AV block. present with low resting HR, sometimes while in utero
What drugs are known to cause heart defects?
amphetamines, alcohol, anticonvulsants (hydantoins, trimethadione, valproic acid, carbamazepine), lithium, retinoic acid, thalidomide and warfarin
What does a pink infant at rest but deep red to purplish with crying indicate?
polycythemia (hct >65%) Althought they appear cyanotic they have increased circulating unsaturated hemoglobin.
When does central cyanosis become visible?
when at least 5 g of hgb not bound to oxygen/100 mL of blood
If given 100% oxygen, how would the cyanosis respond in a cardiac patient
would not increase
What is cutis marmorata?
mottling seen in normal infants under certain circumstances such as in the stressed or cold neonate
Why would a hypoxic and anemic infant not appear cyanotic?
because there is not enough hemoglobin
Because edema is rarely associated with cardiac problems in the neonate, what would peripheral edema indicate?
Turners syndrome
A cyanotic infant with non labored respiratory effort may indicate what?
a congenital heart defect that restricts pulmonary blood flow
What do palpating the pulses represent?
an approximate determination of cardiac output
What pulses are important to palpate and why?
femoral and brachial bilaterally and then one femoral and the right brachial simultaneously. (right brachial is pre ductal bc its from the right subclavian artery)
What do weak femoral pulses indicate?
decreased aortic blood flow as seen in coarc, aortic stenosis, and HLHS
What do bounding pulses represent?
PDA and other aortic run-off lesions i.e. truncus arterioles, aortic regurgitation, systemic arteriovenous fistula
What do weak or absent peripheral pulses indicate?
in the presence of low cardiac output from any cause (shock and cardiac tamponade) but also in lesions with decreased systemic blood flow that rely on the ductus arteriosus for systemic blood flow, such as hypoplastic left ventricle.
A bounding precordium in the term neonate after the first few hours of life may indicate what?
heart defects with increased ventricular volume such as left to right shunts (pda or large VSD) or severe valvular regurgitation (mitral or aortic insufficiency)
What is the apical pulse and where is it found?
the forward thrust of the left ventricle during systole. usually in the fourth intercostal space, either at or to the left of the midclavicular line
What is the PMI
the point of maximum impulse sometimes found in the fifth intercostal space at the lower sternal border. caused by the right ventricular predominance
What is a heave?
a point of maximum impulse that is slow rising and diffuse. assoc with volume overload
