Cardiovascular assessment - important concepts Flashcards
Try to name at least 4 different risk factors for cardiovascular disease.
Previous family history Increased age Elevated serum cholesterol High BP Diabetes mellitus Ethnicity obesity smoking sedentary lifestyle post-menopausal women
What is atherosclerosis?
Accumulation of lipids in the arteries
What are modifiable risk factors for cardiovascular disease?
Serum cholesterol BP diabetes obesity smoking sedentary/lack of exercise
What is one of the major risks for congestive heart failure?
alcohol
In the DASH guideline (Dietary approach to stopping hypertension), what substance is recommended to be limited?
salt
What are the steps for performing the physical assessment of the cardiovascular system? (general)
History –> inspection –> palpation (pulses for example) –> auscultation (HR and sounds)
If there is chest pain in a CV assessment, what do we use?
OLDCARTS
How can we differentiate MSK pain from angina or MI pain?
Palpating MSK pain will make it worse.
If the pain radiates down the left arm or on a dermatome, this is common of angina/MI
- classic sign is that pain leaves after stopping exertion for the latter
Occurs when the peripheral arteries don’t get enough oxygen when exerted - ex: calf muscles start to cramp and become painful due to lack of oxygenation.
Intermittent clautication
What are some associated symptoms with CV issues?
Nausea, vomitting, diaphoresis, SOB, syncope (etc.)
What is syncope?
fainting
Describe the causal arrow between respiratory and cardiovascular.
Cardiovascular tends to influence respiratory, but respiratory does not really influence CV
What is nocturia?
excessive urination at night
Pain for CV issues tends to be described as what?
Crushing
What do we look for in the general survey for assessment of the CV system?
Skin colour Respirations Speech pattern Size and shape of thorax Finger - nailbeds, clubbing
What do we look for during inspection of the peripheral vascular system?
colour of lower extremities
body hair distribution
lesions, scars
edema
Where is the best place to start for a CV assessment?
Vital signs
When checking the carotid pulse, what should you ask the patient to do?
Hold their breath to prevent hearing bronchial sounds (hold your breath so you are cognizant of how long you are making them do it too!)
When listening to the carotid pulse in a CV assessment, what part of the stethoscope is used?
the bell
Where is the PMI?
4-5th ICS, midclavicular line
What are the five different areas to listen for heart sounds?
How do we listen to them?
Aortic, pulmonic, Erb’s point, tricuspid, mitral
(all people enjoy time magazine)
use diaphragm first, then bell
Where do we place the stethoscope for the aortic heart sounds?
Right side of chest near the sternum, 2nd ICS
Where do we place the stethoscope to hear the pulmonic heart sounds?
left sternal border, 2nd ICS
Where do we place the stethoscope for the Erb’s point heart sounds?
left sternal border, 3rd ICS
Where do we place the stethoscope for the tricuspid heart sounds?
lower left sternal border, 3-4th ICS
Where do we place the stethoscope for the mitral heart sounds?
where we find the PMI
Where is S2 best heard?
Pulmonic area
Where is S1 best heard?
Mitral area
What is S1
Signals the beginning of systole and is the sound heard when the AV (tricuspid/mitral) valves close.
Heard best at the mitral area
What is S2?
Signals the beginning of diastole.
Sound heard when the semi-lunar valves close (aortic and pulmonary).
Best heard at pulmonic area.
turbulence causing swooshing or blowing sound, mostly due to cardiac abnormalities
murmurs
turbulent blood flow, usually by partial obstruction
bruits
Systolic murmurs are heard when?
between S1 and S2
When are diastolic murmurs heard?
After S2
When does S3 happen?
S4?
S3 after S2
S4 right before S1
Where would a diastolic murmur be heard best?
aortic area (or pulmonic)
Where would a systolic murmur be heard best?
tricuspid area (or mitral)
What are some effects of aging on the heart?
which is most important?
*increased BP is the most important
Increased collagen and decreased elastin
decreased contractility and HR
cardiac valve stiffening due to lipid accumulation or stenosis
Decrease in pacemaker cell numbers in the SA node
decreased sympathetic control of the CV system
arterial blood vessels thicken and become less elastic
