Cardiovascular Assessment

Question 1

What technique is most important in the cardiovascular examination?

Answer 1

auscultation

Question 2

What sounds heard best with the bell and diaphragm of a stethoscope?

Answer 2

bell = low pitched sounds
diaphragm = high pitched sounds

Question 3

What changes occur in the first few hours to days of birth?

Answer 3

change in ductal flow, decreasing pulmonary vascular resistance and increasing systemic vascular resistance

Question 4

Cardiovascular assessments should be done when?

Answer 4

at birth, one day of life and pediatric visits

Question 5

What is the first and most important step in cardiovascular assessment?

Answer 5

Maternal history

Question 6

What are the common heart defects of diabetic mothers?

Answer 6

VSD, transposition of the great arteries, hypertrophic cardiomyopathy

Question 7

What common defect is seen in mother’s with lupus?

Answer 7

complete AV block. present with low resting HR, sometimes while in utero

Question 8

What drugs are known to cause heart defects?

Answer 8

amphetamines, alcohol, anticonvulsants (hydantoins, trimethadione, valproic acid, carbamazepine), lithium, retinoic acid, thalidomide and warfarin

Question 9

What does a pink infant at rest but deep red to purplish with crying indicate?

Answer 9

polycythemia (hct >65%) Althought they appear cyanotic they have increased circulating unsaturated hemoglobin.

Question 10

When does central cyanosis become visible?

Answer 10

when at least 5 g of hgb not bound to oxygen/100 mL of blood

Question 11

If given 100% oxygen, how would the cyanosis respond in a cardiac patient

Answer 11

would not increase

Question 12

What is cutis marmorata?

Answer 12

mottling seen in normal infants under certain circumstances such as in the stressed or cold neonate

Question 13

Why would a hypoxic and anemic infant not appear cyanotic?

Answer 13

because there is not enough hemoglobin

Question 14

Because edema is rarely associated with cardiac problems in the neonate, what would peripheral edema indicate?

Answer 14

Turners syndrome

Question 15

A cyanotic infant with non labored respiratory effort may indicate what?

Answer 15

a congenital heart defect that restricts pulmonary blood flow

Question 16

What do palpating the pulses represent?

Answer 16

an approximate determination of cardiac output

Question 17

What pulses are important to palpate and why?

Answer 17

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)

Question 18

What do weak femoral pulses indicate?

Answer 18

decreased aortic blood flow as seen in coarc, aortic stenosis, and HLHS

Question 19

What do bounding pulses represent?

Answer 19

PDA and other aortic run-off lesions i.e. truncus arterioles, aortic regurgitation, systemic arteriovenous fistula

Question 20

What do weak or absent peripheral pulses indicate?

Answer 20

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.

Question 21

A bounding precordium in the term neonate after the first few hours of life may indicate what?

Answer 21

heart defects with increased ventricular volume such as left to right shunts (pda or large VSD) or severe valvular regurgitation (mitral or aortic insufficiency)

Question 22

What is the apical pulse and where is it found?

Answer 22

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

Question 23

What is the PMI

Answer 23

the point of maximum impulse sometimes found in the fifth intercostal space at the lower sternal border. caused by the right ventricular predominance

Question 24

What is a heave?

Answer 24

a point of maximum impulse that is slow rising and diffuse. assoc with volume overload

Question 25

What is a tap?

Answer 25

a sharp, well localized PMI. assoc with pressure overload

Question 26

What is a thrill?

Answer 26

low-frequency palpable murmurs, like purring of a cat. denote a loud murmur (at least grade IV)

Question 27

What are the 4 traditional auscultatory areas and where are they located?

Answer 27

aortic area (2nd intercostal space, right sternal angle)
pulmonic area (2nd intercostal space, left sternal angle)
tricuspid area (4th intercostal space, left sternal angle)
mitral area (4th intercostal space, left midclavicular line)

Question 28

What other areas should be auscultated?

Answer 28

right and left infraclavicular areas, both axillae, anterior fontanel, and liver

Question 29

Why is SVT a medical emergency and what is the treatment?

Answer 29

cardiac output is severely compromised because of short diastolic filing time. treatment includes vagal stimulation (cold washcloth to face), medications or cardioversion

Question 30

What are some common and benign arrhythmias?

Answer 30

sinus arrhythmia, premature atrial beats, premature ventricular beats

Question 31

What are the heart sounds?

Answer 31

S1- closure of the mitral and tricuspid valves, heard most loudly at apex
S2- closure of the aortic and pulmonic valves, heart most loud at the base of the heart

Question 32

What is the term used for mottling of a normal stressed or cold infant

Answer 32

cutis marmorata