Cardiovascular Exam Flashcards
What is the only vein that carries O2 rich blood?
The Pulmonary veins
The Normal Lateral Chest X-ray allows you to look at what part of the heart?
Allows you to look behind the heart
What is the most common chief complaint for cardiac events?
Chest pain
What is Angina?
The consequence of hypoxia of the myocardium resulting from an imbalance of coronary blood supply and myocardial demand
What is the Levine’s sign?
A classic sign seen from people who are experiencing sharp CV pain caused by angina or MI. The Patient places a tight closed fist in front of his chest.
Other causes of chest pain other than problems of the heart?
Pulmonary, intestinal, gallbladder and musculoskeletal problems.
Questions to ask for those with chest pain
1) Location
2) Duration
3) Ever happen before
4) How often
5) Anything make it better?
6) Does anything make it worse
Common symptoms of CV disorders
1) Confusion/syncope/dizziness
2) Palpations
3) Cough/wheezing
4) Hemoptysis
5) SOB
6) Chest pain/tightness
7) Incontinence/impotence/heat intolerance
8) Fatigue
9) Leg Edema
What questions would you ask in the Family History in a CV exam
1) Diabetes
2) Heart disease
3) Hyperlipidemia
4) HTN
5) Congenital heart defects, VSD
6) Sudden death
Define systole
The action of the ventricles contractions
What are the 2 systolic events of the heart?
1) The right ventricle pumps blood into the pulmonary arteries (thru the pulmonic valve)
2) The left ventricle pumps blood into the aorta (thru the aortic valve
Define diastole
When the ventricles are relaxed
What are the 2 diastolic events of the heart?
1) Blood flows from the right atrium into the right ventricle (via the tricuspid valve)
2) Blood flows from the left atrium into the left ventricle (via the mitral valve)
What the equation for Cardiac Output?
CO = SV x HR
What is stroke volume?
The volume of blood pumped from one ventricle of the heart with each beat.
What is preload?
The end diastolic volume at the beginning of systole directly related to the stretch .
Preload is associated with what law?
Starling’s
What is contractility?
The ability for the ventricles to contract during systole. (ejection fraction)
What is afterload?
The amount of resistance that the left side of the heart has to overcome to eject blood. (squeeze)
What is the equation for blood pressure?
BP = CO x systemic vascular resistance (SVR)
What are the relations between HR and temperature?
Fever may increase HR and respirations
Hypothermia may decrease HR and respirations
What are the accepted regular pulse ranges and irregular definitions?
Normal for adults - 60 - 100 bpm
Bradycardia - under 60 bpm
Tachycardia - over 100 bpm
With children there is a range based on age.
What are the accepted regular respiration ranges and irregular definitions
Normal for adults - 12 - 20 breaths/m
Tachypnea - More than 20 breaths/min
Agonal - Irregular breathing (can be slow or fast)
What are the accepted regular ranges of blood pressure?
Systolic - btwn 100-140
Diastolic - btwn 60-80
Blood pressure more concerns which side of the heart?
the left
What are three methods of taking a blood pressure
1) Direct measurement - Involves the insertion of an intra-arterial catheter (arterial line or A-line)
2) Indirect measurement - Involves a blood pressure cuff and stethoscope
3) Measurement by palpation - Hold arm at the level of the heart and palpate brachial or radial artery
What happens in the blood pressure cuff is the wrong fit?
Too small - artificially elevated BP
Too large - artificially lowered BP
What is a problem with the measurement by palpation method of taking a blood pressure
It only identifies the systolic BP
How do you test someone for orthostatic hypotension?
Have the patient lie down flat for 5 min., then take a BP. Sit them up and repeat. Also repeat in a standing position if no symptoms occur with sitting them up
How do you determine if someone has orthostatic hypotension?
If there is more than a 20 mmHg systolic or 10 mmHg diastolic drop in BP from lying down to sitting/standing or if patient becomes dizzy
How would you define Supravalvular Aortic stenosis in a physical exam
If there is a difference in BP of more than 20 mmHg between arms
How might you be able to define a Coarctation of the aorta in a physical exam?
If the BP is elevated in both arms and you take the BP of the legs and if the legs are lower it may be an indication
How might you be able to define a pulses paradoxus in a physical exam?
Deflate the BP cuff until pulses are heard in expiration only, then until heard during inspiration. There is a pulses paradoxus if the difference is more than 10 mmHg.
What might a pulses paradoxus be a sign of?
You should consider a cardiac tamponade, pericardial effusion, constrictive pericarditis, asthma or emphysema.
How/where do you feel the pulse on the radial artery?
You palpate on the volar surface radial aspect of the wrist with the 2nd, 3rd and 4th fingers
What will you will be measuring for with the radial pulse
The rate, rhythm, contour & amplitude of the pulse.
How do you measure the rate of the pulse
Count for 30 seconds and multiply by 2 (most accurate for regular rhythms)
What would you be checking for on the skin for the CV exam…
1) Temperature
2) Central & peripheral cyanosis
3) Pallor
4) xanthomata (hypercholesterol)
5) Erythema marginatum (acute rheumatic fever)
What would you be checking for on the nails for the CV exam…
Splinter hemorrhages (non-specific finding in ineffective endocarditis.
What would you be checking for on the face for the CV exam…
1) Wide set eyes, strabismus, low set ears, upturned nose, hypoplasia of the mandible (supravalvular aortic stenosis)
2) Moon face and wide set eyes (pulm stenosis)
3) Expressionless face & puffy eyes (hypothyroid/cardiomyopathy)
What would you be checking for on the eyes for the CV exam…
1) Xanthelasma - (hypercholesterol)
2) Arcus senilus (hypercholesterol if under 40 y/o)
3) Opacities in cornea (cor pulmonale, or myocardial involvement
4) Displacement of lens (Marfan’s/aortic regurgitation
5) Conjunctival hemorrhages (ineffective endocarditis)
6) Sausage link vessels ( HTN, eclampsia)
What would you be checking for on the neck for the CV exam…
Webbing ( Turner’s syndrome, Coarctation of aorta, pulmonic stenosis.
What would you be checking for on the mouth for the CV exam…
High arched palate (Congenital heart prob/MVP) Palate petachiae (ineffective endocarditis
What would you be checking for on the chest for the CV exam…
Pectus excavatum or caranutum (Marfan’s/MVP)
What would you be checking for on the extremities for the CV exam…
Extra phalanx (finger or toe) - (ASD) Long slender fingers - (Marfan's)
What does the Jugular Venous Pulse reflect?
Right atrial pressure
How should the patient be to measure the Jugular Venous Pressure?
Lying with the head up at a 30 or 45 degree angle with the patient’s head turned gently to the left
Which vein should you measure to get the Jugular Venous Pressure?
Internal or external Jugular Vein (internal preferred)
Where should the Ruler be placed to get the Jugular Venous Pressure?
On the sterno-menubrial angle
What is a normal reading when measuring the Jugular Venous Pressure?
Upper limit of normal is 4-5 cm at 45 degrees, 6 cm at 30 degrees
What is the a wave in a Jugular Venous Pulsation?
(Atrial contraction) It reflects the sight rise in atrial pressure that accompanies atrial contraction.
When does the A wave occur?
Before the S1 and the carotid pulse
What is the X decent in a Jugular Venous Pulsation?
(atrial relax) When the atrial relaxation occurs and the ventricles contract
What is the V wave in a Jugular Venous Pulsation?
(venous filling) When the atria begin to fill
What is the Y descent in a Jugular Venous Pulsation?
(Atrial emptying) When blood flows into the right ventricle
Why does the Hepatojugular Reflex occur?
Due to the inability of the right side of the heart to accommodate the increased venous return