Cardiovascular examination Flashcards
What should you do if abnormal sounds are suspected during lung auscultation
Compare intensity, pitch, quality of sounds bilaterally. ID sounds as vesicular, broncovesicular bronchial or absent
What are normal sounds heard in the trachea
- loud tubular
- tracheal and bronchail sounds
What type of breath sounds should be heard in the distal Airways
- Vesicular breath sounds: high pitched breezy sounds.
- Bronchial sounds heard over distal airways are abnormal and indicate consolidation or compression of lung tissue that facilitate transmission of sound
What breath sounds are considered abnormal?
Adventitious breath sounds. Crackle (formally rails). Plural friction rub Rhonchi Strider Wheeze Decreased or diminished sound Absent breath sound
Adventitious breath sounds.
Abnormal breath sounds heard with inspiration and/or expiration can be continuous or discontinuous
Crackle (formally rails).
Abnormal continuous high-pitched popping sound
- Heard in inspiration.
- Associated with restrictive or obstructive respiratory disorders
- Represent moving of secretions during inspiration (wet crackles).
- Sudden opening of closed Airways (dry crackles)
- If occurring in later half of inspiration indicates atelectasis, fibrosis, pulmonary edema, or plural effusion.
- heard at the bases of the lungs
Plural friction rub
- Dry crackling heard an inspiration and expiration.
- Happens when inflamed visceral and parietal pleura rub together
Rhonchi
Continuous low pitch sounds similar to snoring or gurgling.
- CONTINOUS unlike crakcles that are discontinuous
Occur in inspiration and expiration
-Happens when air passes through obstructed airway of inflammatory secretions, liquid, bronchial spasm or neoplasms
Strider
High pitched wheeze
- indicating upper airway obstruction
- Occurs during inspiration or expiration
Wheeze
- Continuous whistling with a variety of pithces.
- Heard in inspiration and or expiration but variable from minute to minute and area to area.
- Comes from turbulent airflow and vibrations of airway walls.
- due to narrowing caused by: bronchospasm, edema, collapse, secretions, neoplasm or foreign body
Is the duration of inspiration longer or shorter in the trachea? Distal airways?
Trachea- Inspiration is shorter expiration is longer. slight pause in btwn
Distal airways:Inspiratory phase is longer expiratory phase is shorter. No pause
Bronchial breath sounds
Abnormal breath breath sounds heard in locations where vesicular sounds are normally present.
May indicate pneumonia
what do decreased or diminished breath sounds indicate
Congestion
emphysema
hypo ventilation
what do absent breath sounds indicate
Long collapse or pneumothorax
What is broncophony
Increased vocal residence with greater clarity and loudness spoken words.
99
what is egophony
Spoken long :E” sound changes to long nasal sounding “A” sound
Is whispered pectoriloquy
recognition of whispered words 123
What is the anatomic location for electrode limb leads for the right atrium
right arm Infraclavicular fossa medial to the right deltoid muscle
What is the anatomic location for electrode limb leads for the Left atrium
left arm Infraclavicular fossa medial to the left deltoid muscle
What is the anatomic location for electrode limb leads for the right ventricle
Left side of the abdomen below the rib cage left leg
What is the anatomic location for electrode limb leads for the left ventricle
Right side of the abdomen below the rib cage right leg
What is the anatomical location of the chest electrodes for precordial leads V1 and V2
Fourth intercostal space at the right (v1) or left (v2)sternal border
What is the anatomical location of the chest electrodes for precordial leads V3
The way between the one and the V2 and V4
What is the anatomical location of the chest electrodes for precordial leads V4
5th intercostal space at mid left midclavicular line
What is the anatomical location of the chest electrodes for precordial leads V5 V6
v5 Left anterior axillary line at V4 level.
v6 Left mid axillary line at V4 and V5 levels
P wave
Atrial depolarization
PR interval
Time for atrial depolarization and conduction from SA node to AV node.
0.1 - .20 seconds
QRS complex
Interventricular depolarization and atrial repolarization. 0.06 - 0.10 seconds
QT interval
Time for ventricular depolarization and repolarization. 0.20- 0.40 seconds
ST segment
Isoelectric period Following QRS when ventricles are depolarized
T wave
ventricular repoloarization
What is normal sinus rhythm
Atrial depolarization begins at SA node and spreads normally throughout conduction system. Heart rate is between 60 and 100 BPM
Sinus bradycardia/ tachycardia
Less than 60 BPM
over 100 bpm
Sinus arrhythmia
Sinus rhythm but with quickening and slowing of impulse formation in the SA node resulting in beat to beat variation
Sinus arrest
Sinus rhythm with intermittent failure of SA node impulse or AV node conduction that results in complete absence of P or QRS waves
What are premature atrial contractions PAC and what is the clinical significance
Ectopic focus in atrium initiates impulse before SA node.
P-wave is premature with abnormal configuration.
Very common generally benign
May progress to atrial flutter tachycardia or fibrillation.
Can happen from caffeine, stress, smoking, alcohol in any heart dx
What is Atrial flutter and what is the clinical significance
Atrial rate of 250 to 350 BPM
-Sawtooth sheet P waves (flutter waves).
Occurs with valvular disease ishemic disease cardiomyopathy, hypertension, acute myocardial infarction, chronic obstructive lung disease and pulmonary emboli
S/S: Palpitations, lightheadedness, angina due to rapid rate
What is Atrial fibrillation and what is the clinical significance
In an arrhythmia where atria are depolarized between 350 to 600 times a minute.
Irregular in dilation of ECG baseline without discrete P waves
And healthy hearts and patience with CAD, HTN and valvular disease
S/S: Palpitations, fatigue, dyspnea, lightheadedness, syncope and chest pain
What is mobitz 1 and mobitz 2 heart block and what is the clinical significance
Mobitz 1 wenkebach:Progressive prolongation of PR interval until one and pulse is not conducted generally benign
Mobitz 2 : more serious. non conduction of 1 or more impulses after normal PR intervals. May progress to 3rd degree. MAy decrease CO if HR is slow
What is 3rd degree heart block and what is the clinical significance
all impulses are blocked at AV node and none are transmitted to ventricles
atrial rate> ventricle rate
can be caused by digitalis, acute MI, degenerative change to condiction system, heart Sx
What is Premature ventricular contraction PVC and what is the clinical significance
-Premature depolarization of the ventricles due to ectopic focus.
P-wave is absent and QRS is wide and aberrant shape.
Bigeminy- normal sinus followed by QVC.
Trigeminy -PVC occurs after 2 normal sinus impulses
Which atrioventricular block: one, two, three is the most serious
Third-degree atrioventricular block equals complete heart block. MEDICAL EMERGENCY
First-degree atrioventricular block may have no symptoms or change in cardiac function
What is ventricular tachycardia V-tach and what is the clinical significance
3 or more PVCs with ventricular rate >150 bpm
- P waves are absent and QRS is wide
-SeaTac longer than 30 seconds is life-threatening. –Patients are unable to maintain adequate BP and become hypotensive.
-May progress to ventricular fibrillation causing cardiac arrest.
Common causes: MI cardiomyopathy valvular disease
What is ventricular fibrillation V-fib and what is the clinical significance
-Ventricles do not be in coordinated fashion but fibrillate/quiver asynchronously and in effectively. No cardiac output, patient is unconscious.
-Requires immediate defibrillation.
- Afterwords medications to support circulation and intravenous anti-arrhythmic agents.
Cocaine
What is ventricular asystole and what is the clinical significance
Ventrical standstill with no rhythm.
ECG is a straight line.
Requires immediate CPR and medications to stimulate cardiac activity.
What are signs of myocardial ischemia and infarct
ST segment depression
ST segment elevation
Q wave
T-wave inversion
What is a absolute indication for terminating an exercise test ?
drop in SBP >10 mmhg form baseline depite increase in workload + evidence of ishemia
- moderate angina (3 on scale of 4)
- nervous system symptoms(ataxia, dizzy)
- poor profusion; cynosis pallor
- sustained, uncontrolled or at rest ventricular tachycardia
- 1 mm ST elevation without diagnostic Q waves
What is a relative indication for terminating an exercise test ?
- Drop in SBP >10 mm from baseline despite increase in workload without evidence for ischemia
- > 2mm ST segment depression
- PVCs Supraventricular tachycardia , heart block, bradycardia
- fatigue, SOB, wheeze, leg cramp, claudication
- development of bundle branch block or intraventricular delay
- increasing chest pain
- hypertensive response; >250SBP and or 115DBP
what does a negative stress test indicate? a positive test?
Negative stress test. Low probability of coronary artery disease.
Positive test indicates high probability of coronary artery disease
What is the primary energy use during aerobic exercise
ATP
used by long term E system with O2 consumtion
How can you calculate the lower and upper maximum heart rate?
HRmax x 55%.
HR max X 90%
Can you calculate heart rate max.
Graded exercise test or estimated by 220 minus age
How do you calculate heart rate reserve
Lower {(HR max-HR rest)x 40%}+ HR rest
Upper {(HR max-HR rest)x 85%}+ HR rest
How long should aerobic activity be performed (duration)
20-60 mins
- min of 10 min bouts accumulatedd thorughout day
How long should low intensity and high intensity activity be performed for
low intenity >30mins
high intenisty >20 mins
what aerobic exercise duration is recommended for adults Who are not training for athletic competition
Moderate intensity activity for longer duration. Potential hazards and adherence problems associated with high intensity activity
How frequently should aerobic exercise be performed
3-5 days/week
What are the long-term expected outcomes from aerobic exercise .(chrinic adaptations)
- VO2 Max increase at max exercise.
- Decreased heart rate at submaximal exercise. No change at max exercise.
- Increased blood lactate at max exercise decrease at submaximal
- Increase in mitochondrial number and size, capillary density, oxidative enzymes. Increase oxidative capacity of muscle
- Increased maximal voluntary ventilation.
- Increased plasma volume.
- Increased skeletal muscle but blood flow.
- lower BMI
- Improved body heat transfer
- reduced anxeity
What are the Normal cardio respiratory response to acute aerobic exercise
Increased O2 consumption due to increased CO, increased BF, oxygen utilization and exercising skeletal muscle.
Linear increase in SBP with increasing workload. 8 to 12 MMHG per MET
-Change or moderate decrease in DBP.
Increased respiratory rate and tidal value
where Is the designated auscultatory area for the aortic area when listening to the heart
2nd intercostal space at right sternal border
where Is the designated auscultatory area for the pulmonic area when listening to the heart
2nd intercostal space at left sternal border
where Is the designated auscultatory area for the mitral area when listening to the heart
5th intercostal space medial to the left mid clavicular line
where Is the designated auscultatory area for the tricupsid area when listening to the heart
4th intercostal space at left sternal border
S1
lub
First heart sound. Mitral and tricuspid valve close at beginning of ventricular systole.
High frequency sound low pitch and longer duration than S2
S2
dub
2nd heart sound.
Aortic and pulmonary valves close at beginning of ventricular diastole.
High frequency sound with higher pitch and shorter duration then S1
S3
- Third heart sound.
- Vibration of the distended ventricle walls due to passive flow of blood from atria during rapid filling phase of diastole.
- Normal in kids; Physiologic third heart sound.
- Abnormal and adults may be associated with heart failure -called ventricular Gallup
S4
- Pathological sound vibration of ventricular wall filling in atrial contraction.
- May be associated with HTN, stenosis or myocardial infarction
- called atria Gallup
What is the normal red blood cell count for males and females
Male 4.3 - 5.6
Female 4.0 - 5.2
How many leukocytes is the norm
3.54-9.06
Which is available in greater differential blood count neutrophils, lymphocytes, monocytes, eosinophils, basophils
neutrophils, 40%- 70% lymphocytes,20%- 50% monocytes, 4-8% eosinophils, 0–6% basophils 0- 2%
What is the platelet count in the blood
150,000 to 450,000
Thrombocytopenia is a condition characterized by abnormally low levels of platelets
- serrious bleeding can occur at a5,000-20,000
greater than 50k pts are allowed to perform resistive exercise
What is the expected partial thromboplastin time PTT
-Examines clotting factors of all intrinsic pathways except platelets.
-Partial thromboplastin time is more sensitive than prothrombin time detecting minor deficiencies
26.3–39.4 seconds = PPT
11-13.5 =PT
.8-1..1= INR
If clotting time takes too long (high) the blood is taking too long to make a clot. This could be 2\2 liver disease, vitamin K deficiency, or a coagulation factor deficiency (e.g., factor VII deficiency)
- Warfarin coumadin is a blood thinner that will lower PT
- A patient taking warfarin should have INR of 2-3 bc clotting will take longer
What is the normal hemoglobin count for males and females
Males 13.3 - 16.2.
Females 12.0 - 15.8
What is the desirable and high count for total serum cholesterol
Desirable 200.
High 240
What is the desirable and high count for LDL
Desirable 100
High 160-189
What is the low and high count for HDL
Low 40
High 60
What is the desirable and high count for Trilycerides
Desirable 150
High 200-499
What does low hematocrit indicate? High hematocrit ?
Low: anemia, blood loss, vitamin/mineral deficiency,
High: polycythemia vera or dehydration
Precautions to all forms of exercise include the following lab values: hematocrit hemoglobin platelet count white blood cell count
Lab Values:
hematocrit of <27%, (normally in the mid-high 30-40s)
hemoglobin of 8 g/dL or less, (Normally 12/13 + 3 gm/dl for gals and guys)
platelet count of <50,000 mm3, (Normally 165-415 10^3 according to SC )
White cell count of <500 mm3. (Normally 3.5-9.0 10^3)
Patients with a low platelet count should not exercise due to the possibility for excessive bleeding and poor tissue healing.
