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Year 3 - Paramedic Care of Minor Illnesses > Cardiovascular Exam > Flashcards

Cardiovascular Exam Flashcards

1
Q

Which pulses must you first palpate bilaterally in your cardiovascular exam?

A

Radial
Brachial
Pedal
Femoral
Popliteal

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2
Q

Where can you palpate a patients radial pulse?

A

Radial artery

Feel between wrist bone and tendon on the thumb side of the wrist, apply enough pressure to feel a pulse

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3
Q

Where can you palpate a patients brachial pulse?

A

Brachial artery

Feel the bicep area of the antecubital fossa 2cm medial of the tendon and 3cm above the ACF, apply pressure to feel a pulse

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4
Q

Where can you palpate a patients carotid pulse?

A

Carotid artery

Located on both sides of the neck

Feel the front of the neck just below the angle of the jaw, only apply light pressure

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5
Q

Where can you palpate a patients femoral pulse?

A

Femoral artery

Located along the crease midway between the pubic bone and the anterior iliac crest

If there is a lot of fat you may need to press firmly

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6
Q

Where can you palpate a patients popliteal pulse?

A

Popliteal artery

Branch from the femoral arteries in your legs, can be felt behind the patients kneecap

The patient may need to raise their legs for you to be able to palpate effectively

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7
Q

Where can you palpate a patients pedal pulse?

A

Dorsalis pedis artery

Found on the dorsal aspect of the foot, begins on the anterior aspect of the ankle joint and ends just before the proximal aspect of the first intermetatarsal space (between the big toe and second toe)

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8
Q

What would you expect a pulse to be on a healthy adult?

A

60-100bpm

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9
Q

If you observe a pulse of > 100bpm what could this indicate?

A

Tachycardia
Can be a sign of; infection, arrhythmia or anxiety.

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10
Q

If you observe a pulse of < 60bpm what could this indicate?

A

Bradycardia
Could be indicative of a heart block
Could be normal in a fit person

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11
Q

When palpating pulses what are we observing?

A

Rate
Rhythm
Quality
Bilaterally equal

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12
Q

What would an irregularly irregular rhythm indicate?

A

Atrial fibrillation

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13
Q

When describing quality of pulse what are we describing?

A

Strength

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14
Q

What could a pulse of poor/weak strength/quality indicate?

A

Reduced cardiac output
Hypotension

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15
Q

What could a particularly strong pulse indicate?

A

Hypertension

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16
Q

Why must you not palpate the carotid artery bilaterally?

A

Applying pressure to the artery on both sides at the same time can reduce cerebral blood flow and stimulate a vagal response

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17
Q

What can unequal bilateral pulses be a sign of?

A

Cardiovascular problems such as aortic dissection - but you would expect the patient to feel more unwell

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18
Q

Which two pulses do we palpate at the same time and compare?

A

Radial and femoral

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19
Q

Why do we compare the rate of the radial and femoral pulses?

A

A delay in the pulses could indicate aortic coarction, a congenital condition due to the narrowing of the aorta.

Often not picked up until adulthood

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20
Q

If aortic coarction is present, which pulse will be delayed?

A

Femoral pulse will be delayed compared to the radial

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21
Q

When inspecting the jugular vein what angle would you want the patients head to be when laying on the bed?

A

45 degrees

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22
Q

How do you inspect for jugular venous pulsation?

A

Ask the patient to turn their head to the left

This separates the sternocleidomastoid muscles and allows for a better view of the right jugular vein

The jugular vein pulsation is not always visible in a healthy individual but if is visible I am looking to see a double pulsation and it won’t be palpable.

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23
Q

How do you measure jugular vein distension?

A

So, I place my ruler in the angle of louis and take a straight line from the top of the pulsation.

A normal value will be below 4cm.

Anything above 4cm can indicate jugular venous distention, which can indicate right ventricular heart failure.

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24
Q

What is dependent-part oedema?

A

excess fluid builds up in the body causing swelling

oedema that is specific to parts of the body that that are influenced by gravity, such as your legs, feet, or arms

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25
How do you test for pitting oedema?
Press finger on the dial tibia for 10 seconds, after releasing if the skin does not return to normal after 15 seconds
26
Where should you also check for dependent-part oedema in bed bound patients?
Sacral area Due to gravity that is where the fluid is most likely to sit
27
What can pitting oedema be a sign of?
A localised problem with veins in the affected area Or a systemic problem with your heart, kidneys, or liver function causing fluid to be retained Right ventricular heart failure
28
What does DVT stand for?
Deep vein thrombosis
29
Where do DVTs commonly occur?
In the deep leg vein in the calf and thigh Can also occur in pelvis and abdomen in some cases
30
What are the most common signs of a DVT that you should check for?
Redness, swelling, pain and heat in the calf History indicative of risk factors
31
Common risk factors of DVT?
Recent long haul flight Recent surgery Pregnancy Long periods of immobility
32
What are varicose veins?
Enlarged veins near the surface of the skin
33
What are varicose veins a sign of?
A sign of poor circulation cause by weak valves and vein walls
34
If you are unsure on whether you can see varicose veins, how can you make them more visible?
Ask the patient to sit on the edge of the bed as the force of gravity would make them more visible
35
Common risk factors for varicose veins?
Age Family history Obesity Sitting/standing for long periods of time Pregnancy Female
36
Before moving past criteria 5 what should you ask the patient to do?
Remove their top
37
During your cardiovascular exam what should you inspect the anterior chest for?
Deformities Scars Pulsations
38
What deformities are the main deformities you are looking for when performing a cardiovascular exam?
Funnel chest Pigeon chest
39
What is funnel chest?
A deformity where there are depressions on all or part of the sternum
40
What is pigeon chest?
A deformity where the sternum protrudes outwards further than the ribs.
41
Latin name for funnel chest?
pectus excavatum
42
What causes funnel chest?
due to too much growth of the connective tissue that joins the ribs to the breastbone (sternum). This causes the sternum to grow inward. As a result, there is a depression in the chest over the sternum, which may appear quite deep.
43
Why do conditions such as pigeon chest and funnel chest affect the cardiovascular system?
Impacts the cardiovascular system due to displaced organs Severe cases can compress the heart and lungs or push the heart over to one side
44
What main scars should you be observing for during a cardiovascular exam?
Midline scars to indicate sternotomy Left lateral scars observed in mitral valvotomy Left clavicle scars seen in patients with a pacemaker
45
What deformity can be seen here?
Pigeon chest
46
What deformity can be seen here?
Funnel chest
47
Where can you find the apical impulse?
Found in the 5th intercostal space (ICS), 1cm medially from the mid-clavicular line
48
When are you most likely to observe a regular apical impulse?
Children Very thin people
49
What is the apical impulse?
The apical impulse is the apex of the heart hitting the chest wall
50
How do you palpate the apical impulse?
Feeling for the apical impulse again the 5th ICS 1cm medially from the mid-clavicular line, starting with a flat hand to attempt to pinpoint to a specific point.
51
If the apical impulse is displaced towards the left axillar what can this indicate?
Can indicate an enlarged heart such as observed in left ventricular hypertrophy
52
Where are heaves best felt?
In the mitral region
53
What causes heaves?
Heaves are the result of a forceful apical impulse
54
What do heaves often indicate?
Right ventricular hypertrophy Very rarely in severe left atrial enlargement
55
How do you palpate for heaves?
Using the ball of your hand, press firmly on the patents chest in the mitral region
56
Where would you palpate for heaves?
Mitral region
57
How do you palpate thrills?
Place the palm of your hand in each of the four heart zones in the precordium and then on the upper left and right chest wall
58
What are thrills?
palpable heart murmurs
59
What may thrills feel like when palpating if severe enough?
Feel like harsh vibrations if the murmur is severe enough Associated with loud, harsh, or rumbling murmurs. VERY loud when you auscultate.
60
What causes thrills?
aortic stenosis mitral stenosis
61
What is the larger side of the stethoscope called?
Diaphragm
62
What is the smaller side of the stethoscope called?
Bell
63
What cardiac area is 1?
Aortic area
64
What cardiac area is 2?
Pulmonic area
65
What cardiac area is 3?
Tricuspid area
66
What cardiac area is 4?
Mitral area / apical area?
67
What types of sounds is the diaphragm of the stethoscope most useful for picking up?
Diaphragm is most useful for picking up high-pitched sounds
68
Example some sounds that the diaphragm of the stethoscope opposed to the bell is better suited to listening for?
S1, S2, aortic or mitral regurgitation, pericardial friction rubs
69
What types of sounds is the bell of the stethoscope most useful for picking up?
The bell is most useful for picking up low-pitched sounds
70
Example some sounds that the bell of the stethoscope opposed to the diaphragm is better suited to listening for?
S3, S4, mitral stenosis
71
Why must you press the bell lightly on the skin when auscultating?
Applying more pressure stretches the skin taut and results in the bell functioning like the diaphragm
72
Why do we listen for heart sounds in specific spots on the chest?
Not directly over the valve We listen in the best place to hear them
73
Where is the best place to listen to the mitral valve?
Mitral area 5th ICS, 1cm medially from the mid-clavicular line
74
Which side of the stethoscope do you use when listening to the mitral valve?
diaphragm
75
Where is the best place to listen to the tricuspid valve?
Tricuspid area 5th ICS either side of the sternal border
76
Which side of the stethoscope do you use when listening to the tricuspid valve?
diaphragm
77
Where is the best place to listen to the aortic valve?
Aortic area 2nd ICS on the right sternal border
78
Which side of the stethoscope do you use when listening to the aortic valve?
diaphragm
79
Where is the best place to listen to the pulmonary valve?
Pulmonic area 2nd ICS to the left of the sternal border
80
Which side of the stethoscope do you use when listening to the pulmonary valve?
diaphragm
81
Where can you locate Erbs point?
3rd ICS to the left of the sternum
82
What sounds can be heard when auscultating Erbs point?
Best place to hear overall heart sounds
83
What side of the stethoscope do you use when listening to Erbs point?
diaphragm
84
When performing a cardiovascular assessment - when auscultating with the bell of your stethoscope which points would you listen to?
Apical area Bilaterally lower sternal borders Bilaterally 2nd ICS at sternal borders Other areas along sternal borders
85
What sound can be heard when auscultating S1?
LUB
86
What causes the LUB sound heard at S1?
Closure of the AV valves during systole (mitral and tricuspid valves)
87
Where can S1 be best heard?
Mitral Area Tricuspid Area
88
What sound can be heard when auscultating S2?
DUB
89
What causes the DUB sound heard at S2?
Closure of semi lunar valves during start of diastole (aortic and pulmonary valves)
90
Where can S2 be best heard?
Aortic area Pulmonary area
91
What sound may be heard when auscultating S3?
(Low pitched) LUB de DUB
92
What causes the sound heard at S3?
Rapid filling of the ventricles Stretching of the chordae tendonae
93
When can S3 most often be heard?
Pregnancy Children Adults under 40
94
Where can S3 best be heard?
Mitral area
95
What heart sound follows S2?
S3
96
If S3 is present in those over 40 what can this indicate?
Can be pathological Occurs in conditions such as heart failure
97
What heart sound occurs before S1?
S4
98
What sound may be heard when auscultating S4?
(Low pitched) LE Lub Dub
99
What causes the sound heard at S4?
Atria contracting against stiffened ventricles
100
Where can S4 best be heard?
Mitral area
101
If S4 is present, what does this indicate?
ALWAYS pathological Can be a sign of ischaemia, heart failure and left ventricular hypertrophy
102
Why is S2 usually 'split'?
Because the aortic valve closes before the pulmonary valve The closing pressure on the left is 80 mmHg as compared to only 10 mmHg on the right This higher closing pressure leads to earlier closure of the aortic valve
103
Where is splitting of S2 best heard?
Pulmonic area
104
How can splitting of the S2 best be heard?
Using the diaphragm of your stethoscope
105
Splitting of S2 is often normal, but can be heard in what condition?
LBBB
106
What does splitting of the S2 valve sound like?
(High pitched) Split of DUB DE-DUB
107
What causes murmurs to be heard when auscultating?
Turbulent blood flow through the heart
108
Where can murmurs best be heard?
Murmurs can be heard in all areas if present. You should auscultate all cardiac areas when assessing for murmurs
109
What does a murmur sound like?
Whoosing
110
What can causes murmurs?
Increased stroke volume of the heart, for example in; pregnancy, children, fever and athletes Stenosis Regurgitation
111
What is stenosis of the heart valves an issue?
The valves don't fully open
112
What is regurgitation of the heart valves an issue?
The valves collapse back on themselves
113
You ask the patient to lay on their left side, which valves are best appropriate to auscultate in this position?
Mitral and Tricuspid valves
114
Which heart sounds can best be heard with the patient lying on their left side?
S3 and S4
115
You ask the patient to sit up and lean forward, which valves are best appropriate to auscultate in this position?
Aortic and Pulmonic
116
Which heart sounds can be best heard with the patient sat up and leaning forward?
Diastolic murmurs
117
Under which cardiac area does the apex of the heart lie?
Mitral area
118
When palpating the right side carotid pulse which valve should you also listen to?
Mitral valve
119
Why do we palpate the carotid pulse while auscultating at the apex?
Listening to hear that S1 occurs at the same time as the upstroke of the pulse
120
What is bruits?
Bruits are sounds heard associated with turbulent blood flow
121
What does bruits sound like?
Whoosing sound
122
What causes bruits?
Caused by the narrowing of the arteries caused by atherosclerosis
123
When auscultating the carotid artery which side of your stethoscope should you use?
Bell as carotid bruits is often a lower pitched sound
124
How many places along the carotid artery should you listen for carotid bruits?
3
125
How do you auscultate for carotid bruits?
Ask the patient to look the opposite way to where you are standing Ask the patient to hold their breath Listen for any whooshing noises at 3 points along the carotid artery with the bell of your stethoscope
126
Why must the patient hold their breath when assessing for carotid brutis?
Taking a breath can mimic the sound of whooshing
127
What is considered a normal finding when assessing for carotid bruits?
No sound will be heard

Year 3 - Paramedic Care of Minor Illnesses (6 decks)

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