cardiovascular exam Flashcards
where are the 4 places used on the cardiovascular exam
atrial
pulmonary
tricuspid
mitral
always pay tra…velers money
where can you examine the aortic valve from
the upper right sternal border of the right intercostal space
where can you examine the pulmonary valve
upper left sternal border at the level of the 2nd left intercostal space
where can you examine the tricuspid valve
lower left sternal angle of the left 4th intercostal space
where can you examine the mitral valve
over the apex beat point - 5th left intercostal space along the mid-clavicular line
where do you find the carotid pulse
in the neck, medial to the sternocleidomastoid muscle
where do you find the brachial pulse
2cm above the elbow joint - medially, beside/ underneath biceps tendon
where do you find the radial pulse
proximal to the wrist joint, on the radial side
where do you find the femoral pulse
half way between the hip and mid way in the crease in the leg and push in (and a bit up)
where do you find the popliteal pulse
behind knee join, halve them bend knee, once in position ask to take their legs weight
where do you find the posterior tibial pulse
inside of the leg, behind the ankle joint
where do you find the dorsalis pedis pulse
on the bone 3cm (ish) up between the big and 2nd toe
how is rate calculated
15 seconds multiply
how can be rhythm described
regular, regularly-irregular, irregularly-irregular
what can the volume of the radial pulse be described as
normal, bounding, full, thread, low volume
what are you looking for on the hands and arms of a patient in the cardiovascular exam
tar staining warm and sweaty hands peripheral cyanosis clubbing splinter haemorrhages capillary refill fine tremor iv tract marks
what should you be looking for when examining the head in the cardiovascular exam
malar flush
anaemia - lower eyelids
look for sings of xanthelasmata
corneal arcus
look for central syanosis
iron deficiency - angular sotmatits
what should you look for on the lower leg examination of the cardiovascular exam
pitting odema
atrial disease
varicose veind
what should you be looking for when examining the head in the cardiovascular exam
malar flush
anaemia - lower eyelids
look for sings of xanthelasmata
corneal arcus
look for central cyanosis
iron deficiency - angular stomatitis
what is xanthelasmata
sharply demarcated yellowish deposit of cholesterol underneath the skin - linked to atherosclerosis
what is corneal arcus
where white arcs appear on the cornea (coloured part of eye) makes the bored look fuzzy
what is angular stomatitis
erythema and maceration (redness and broken skin) of the skin adjacent to the angle of the mouth.
what should you look for on the lower leg examination of the cardiovascular exam
pitting oedema
atrial disease
varicose veins
how do you examine for pitting oedema
inside of the leg - couple of inches above the ankle
firm pressure with thumb - for 15 seconds
should leave indentation
what are you looking for to suggest atrial disease
cold, smooth, hairless skin
with increased capillary refill time in the toe, and arterial leg ulcers
how do you examine for varicose veins in the legs
ask the patient to stand and look on both the front and back of legs
what is the normal range for JVP
under 4cm
what does JVP stand for
jugular venous pulse
how is JVP measured
vertical height of the flickering column from the sternal angle
what must be done when looking for the JVP
the patient must be at 45 degrees
when palpated you should not feel a pulse (making sure its not the carotid)
relaxes their head and leans it to their left
where is the JVP located
it lies between the sternal and clavicular heads of the sternocleidomastoid muscle
what is the best way to see the JVP
from a lateral angle - even from a bit behind the patient
what are you doing in the inspection of the precordium (front of chest) in the cardiovascular exam)
inspectiong palpating and ascultating
what are you looking for on inspection of the precordium
any chest deformities - kyphoscoliosis or pectus excavatum
any scars
any pace maker - left infra-clavicular area
visible pulsation
what are you examining on palpation
trackeal position
cardiac pacemaker
apex beat
heaves
thrills
what are you examining on palpation
tracheal position
cardiac pacemaker
apex beat
heaves
thrills
what is the apex beat
the most lateral and inferior palpable pulsation
what are heaves
when the hand is easily lifted with the chest
what are thrills
a palpable buzz - usually a systolic murmur
how do you examine for heaves
press flat hand firmly on to the left side of the sternum
how do you examine for thrills
place hand on apex beat and both sides of the sternum
what are the 3 parts to auscultation during the cardiovascular exam
listen to all 4 valve areas (diaphragm and bell0
listen for left side systolic murmurs
listen for left side diastolic murmurs
what is the S1 sounds
mitral and tricuspid valve closure (onset of systole)
what are the S2 sounds
aortic and pulmonary valve closes (onset of diastole)
when are 3rd heart sounds heard
heard in diastole
when are 4th heart sounds heard
less common and occurs just before S1
when should you listen for murmurs
listen between S1 and S2 (systolic)
listen between S2 and S1 (diastolic)
what are the 4 valve areas
atrial
pulmonary
tricuspid
mitral
what should you do when auscultating the 4 valve areas
palpate the carotid pulse - pulses at the same time as S1
what to things are you listening for when looking for left side systolic murmurs
aortic stenosis
mitral regurgitation
how do you examine for aortic stenosis
DIAPHRAGM
listen over aortic valve again, then over both carotid arteries
for murmur and high pitched injection (systolic between S1 and S2)
how do you examine for mitral regurgitation
DIAPHRGM
listen again over the apex beat and then the left axilla for pansystolic murmur
when/ how do you auscultate for bruits
when preforming the pheriferal pulsese
asculcultate with diaphragm over femoral and carotid
what are bruits
the wooshing sound that is made whn blood rushes past a obstruction
how do you measure radial femoral delay
take both the femoral and radial pulse and feel for delay - there shouldn’t be one
how do you check for a collapsing pulse
find radial pulse
ask patient if they have any pain in their arm or shoulder
raise arm above head while taking pulse
what is a pansystolic murmur
a murmur that last through both systole and diastole
what are the two things examined when listening for left side diastolic murmurs
mitral stenosis
aortic regurgitation
how do you examine for mitral stenosis
USING THE BELL
place stethoscope on apex beat - get patient to roll onto left side
and listen while the patient is holding their breath on expiration
what would mitral stenosis sound like
a low pitched ‘‘rumbling’’ mid-diastolic murmur
how would you examine for atrial regurgitation
USING THE DIAPHRAGM
ask the patient to sit up, and listen to the lower left sternal edge
while the patient holds their breath on expiration
