Cardiovascular Exam 3 Flashcards
what is the leading cause of death in the US?
CAD
what is the window to get pts to cardiac cath lab?
90 min
why would you measure JVP?
suspect right atrial pressure increase
what is a symptom of LV heart failure?
SOB, crackles
what is a symptom of RV heart failure?
swelling, pitting edema
why do you have to palpate pulses?
make sure they have peripheral perfussion
what causes a bruit?
trubulence-stenosis or plaque
what is a murmur?
turbulence of blood flow through a valve
where may an aortic valve murmur radiate to?
carotid artery
what is a thrill?
vibration-associated with a murmur (high intensity)
what is a lift or heave?
the heart lifts because it is working so hard to try to get blood out
(mitral prolapse)
if PMI is more lateral or larger in diameter what could that mean?
left ventricular hypertrophy
where is the normal location of the PMI?
4th-5th interspace MCL (midclavicular line)
diameter <2.5 cm (2-3 finger width)
amplitude should be brisk tapping
what causes LVH?
increased total peripheral pressure (HTN)
if PMI is hard to find what would you do?
turn the pt to the left decubitus position to put the heart against the chest wall
if amplitude of PMI is bounding that could mean
it is hypertrophied
what could cause RVH?
pulmonary valvular stenosis
increased pulmonary arterial pressure
describe location and purpose of aortic area
Right 2nd ICS at SB
listen to aortic valve
describe locatino and purpose of pulmonic area
Left 2nd ICS at SB
listen to pulmonic valve
describe location and purpose of tricuspid area
Left lower SB (LLSB) at 3rd, 4th, 5th ICS
listen to tricuspid valve, presence of murmurs and abnormal heart sounds
describe location and purpose of mitral area
MCL at 5th ICS
listen to mitral valve and presence of abnormal sounds
why would you have pt in left lateral decubitus?
accentuate S3, S4 and mitral murmurs
why would you have pt in sitting position?
accentuate aortic murmurs
when might an S3 be normal?
pregnancy, athletes (volume overloaded)
what ocular finding is related to malignant hypertension and end organ damage?
papilledema
when does S2 split without pathology?
during inspiration
what is wide splitting?
secondary to pulmonary stenosis (delayed closure of the P. valve)-blood travels slower through the valve
splitting persists throughout the respiratory cycle
-would also hear a systolic murmur at the pulmonic listening area
what is fixed splitting?
splitting that does not vary with respiration (not as wide as wide splitting)
-right ventricular failure (decrease in pressure)
what is reversed (paradoxical) splitting?
appears on expiration only
-left bundle branch block (diminished contraction = decreased pressure which causes aortic valve to close later)
what is valvular regurg (insufficiency)?
valve does not fully close and allow blood to flow backward
-only happens when valve is supposed to be closed
mitral valve regurg will happen when?
during systole (after S1)
what is a stenotic valve murmur?
narrowed valvulur orifice that obstructs flow
-blood goes forward through a small opening
pulmonic stenotic murmur will happen when?
systole when pulmonic valve is supposed to be open
AV valve stenotic murmur will happen when?
diastole when AV valves are open
what do you document when you identify a murmur?
systolic or diastolic (palpate the radial artery)
what listening area?
qualities-harsh, radiating, etc
when does a midsystolic murmur occur?
begins after S1, but before S2
-usually related to semilunar stenosis
when does pansystolic (holosystolic) occur?
occurs throughout systole
-usually related to AV regurg
when does late systolic murmur occur?
starts in mid-systole to S2
-usually related to mitral valve prolapse
when does early diastolic murmur occur?
starts after S2 and ends before S1
-usually related to semilunar regurg
when does middiastolic murmur occur?
starts after S2 but fades away
-usually related to AV stenosis
when does pandiastolic murmur occur?
occurs throughout diastole
-usually related to semilunar regurg
when does late diastolic murmur occur?
starts in late diastole and ends at S1
what is the location of maximal intensity?
where you hear it best, where it originates
what is radiation?
where else it radiates
- common one is aortic stenosis (radiates to carotid)
- common one is mitral regurg (radiates to axilla)
what is intensity?
graded on 6 pt scale
documented 1/6 (really concentrate)-3/6 (getting close to the chest you can hear it)-4/6 (assoc with a thrill)-6/6 (anyone could hear it even without auscultation)
what is pitch?
high, medium, low
what are quality attributes of a murmur?
blowing, harsh, rumbling, musical
what is an innocent murmur?
no evidence of cardiac disease
- common in newborns
- turbulent flow from LV to aorta
what is a physiologic murmur?
turbulence due to temporary increase in blood flow (pregnancy and anemia)
what is a pathologic murmur?
caused by cardiac disease
