Cardiovascular exam Flashcards
Components of the vascular exam are?
- size and symmetry of distal extremities
- color and texture of nail beds
- edema/erythema
- varicose veins/homans sign
- ulcers/brawny discoloration
- clubbing of nails
- cyanosis
What is clubbing?
widened, flattened and scooped
What is brawny?
chronic edema, get hemoglobin deposition into skin, heme that stays there discolors skin
Where do you feel for the posterior tibial pulse?
medial side by malleolus
What does a pulse scale of 3 which equals bounding possibly indicate?
- high blood pressure
- Aortic insufficiency or regurgitation of aortic valve
- aneurysm
Why would regurgitation of aortic valve cause bounding pulse?
blood goes up and rushes back in, so have a high difference between systolic and diastolic
What are you checking with the jugular vein? (generally speaking)
distention, pressure
When auscultating carotid pulse, what should you have patient do?
hold their breath
What is the jugular vein the best estimate of?
right arterial pressure AND right sided function
Internal and External jugular veins
Which is more readily visible?
More reliable?
visible: external
reliable: internal
What are thrills?
palpable vibrations that represent a palpable murmur
What are heaves/lifts?
visible movement of pericardium due to movement of the heart
Feeling PMI can be best done when pt is laying on ?
left side
When is systole heard?
time between S1 and S2 (working time of the heart, when ventricles contract to move blood into lungs and body across pulmonic and aortic valves)
As systole is complete, the —- valves close and create S1? crea
AV valves close
When will you hear systolic murmur?
with first heart sound, S1
What sound do the AV valves closing make?
lubb
S1
What is the sound of S2?
dubb
pulmonic and aortic valves closing
Where is S2 hear the loudest?
aortic area
What is also happening when the pulmonic and aortic valves are closing, and you are hearing S2?
AV valves are opening
What is S2?
actually two sounds that merge during expiration!!!
What sound is louder, s1 or s2?
s2
What is the resting phase of the heart, when the ventricles are refilling with blood from the vena cavas and pulmonary veins?
dyastole
What is the time between S2 and S1?
diastole
What is the time between S1 and S2?
systole
As diastole is completed, the semilunar valves close and create?
s2
What contracts at the end of diastole?
atria
What closes first, the aortic or the pulmonic?
the aortic **can here a split as the pulmonic valve closes, heard best over pulmonic area
What is S3?
a gallop
–quiet, early sound during DIASTOLE that reflects the passive filling stage of the ventricles (second stage is the muscular injection from the atria)
How do you intensify the S3 sound?
have pt raise leg or squeeze hand which increases venous return
When is the S3 sound common?
young children and young athletic adults due to rapid refiling of ventricle
-CHF, mitral/tricuspid incompetence
S4, what can it be confused with because it occurs so late in diastole?
split s1
what is S4 best hear with?
the bell
What cough is associated with being worse in the morning, or only in the am?
chronic bronchitis
What causes a non-productive cough?
viral, interstitial lung disease, tumor, asthma, post nasal drip
What cough is worse in recumbent position?
sinusitis, CHF, reflux
What cough is barking?
croupe, laryngeal
What cough is nocturnal?
asthma, chf
What cough is productive?
infections, bronchiectasis
What cough is bloody?
tumor, CHF
What produces rust sputum?
pneumococcal pneumonia
What produces yellow, green sputum?
pneumonia, bronchiectasis, bronchitis
What produces anchovy paste sputum?
amebiasis
What produces blood streaked sputum?
epistaxis, bronchitis secondary to sever cough, tumor
What produces frothy and or pink sputum?
CHF, PE
What produces bloody sputum? NOT BLOODY STREAKED
Tumor, malignancy, bronchiectasis, PE
What produces foul smelling sputum?
bronchiectasis, anaerobes, lung abscess
difference b/w PND and orthopena?
orthopnea cannot lie down while PND can sleep and then wake up
orthopnea is further advanced CHF
What is platypnea?
SOB sitting up and better breathing lying down
What is kussmaul?
pattern of breathing that is deep and rapid = metabolic acidosis
What is cheyne-stokes?
crescendo/decrescendo interspersed with apnea = brain damage, drugs induced respiratory compromise
What is biot?
irregular patter of breathing = increased intracranial pressure, brain damage, poison
What is ataxic?
irregular breathing, more extreme than biots (usually see in neurology and not common)
