Cardiovascular Physical Exam/ECG Flashcards
Where is the best place to check for a pulse on an infant?
brachial
If a person has a bounding pulse, what would you grade it?
4+
1+ = diminished, barely perceptible 2+ = normal, easily palpable 3+ = more strength
Where would you palpate the pedal pulse?
at dorsalis pedis: dorsal medial aspect of foot
- used to measure LE circulation
What are some modifiable risk factors for heart disease?
tobacco use obesity/physical activity diet diabetes cholesterol
What are the bpm values for bradycardia and tachycardia?
tachy = >100 brady = <60
What could a weak/thready pulse indicate?
low SV, cardiogenic shock
What is postural tachycardia syndrome?
increase in HR that’s >30bpm within 10 minutes of standing
What is the typical HR range for children?
60-140
adults = 60-100
You take the pulse of your patient and it’s bounding. What would you grade this, and what might this indicate?
4+
Could indicate shortened ventricular systole and decreased peripheral pressure
What should target BMI and cholesterol be?
BMI = 18.5 - 24.9
cholesterol = <200
HDL >40, LDL < 100-160
What are the 4 auscultation locations?
ALONG STERNAL BORDER:
1) aortic valve: second R intercostal space
2) pulmonary valve: second L intercostal sp.
3) tricuspid valve: 4th L intercostal space
ALONG MIDCLAVICLE:
4) mitral: 5th L intercostal space
Your patient’s pulse is irregular, what could this indicate?
arrythmias
What are the S1 and S2 sounds?
S1: lub
- closing of mitral/tricuspid valves
- marks beginning of systole
S2: dub
- closing of pulmonary/aortic valves
- marks end of systole
What is a heart murmur?
extra sounds besides just S1/S2
What are S3/4 sounds?
S3 = associated with ventricular filling, may indicate LV heart failure in older adults; occurs right after S2
S4 = associated with ventricular filling and atrial contraction; occurs just before S1
- indicates CAD, MI, aortic stenosis, HTN
What does the P wave demonstrate on an EKG?
atrial depolarization (both atria)
What does the QRS wave demonstrate on an EKG?
ventricular depolarization
What wave represents ventricular repolarization?
t-wave
- relaxation of ventricles here
What does the PR interval indicate?
length of time it takes the impulse to travel from the atria to the purkinje fibers
How long should the PR interval be?
.12-.20s (each box is .04s)
How do you measure the heart rate in an EKG?
count number of Rs in a 6s strip and multiply by 10
Your patient’s PR interval is .30s. What could this indicate?
higher than >.20 could indicate heart block
Your patient’s QRS interval is .25s. What could this indicate?
QRS should be between .06-.12, so it’s larger and that could indicate a PVC
How do you identify the rhythm on an ECG?
measure distance between R’s (peaks), looking for same distance for all
A run of 3 or more PVSCs ina row indicates what arhythmia?
ventricular tachycardia (looks like wide, bizarre QRS waves with no P waves)
What is a PVC?
premature ventricular contraction
What does v-fib look like on ECG?
bizarre, erratic activity with NO qrs complexes
What are the 3 ventricular arrhythmias?
1) PVC
2) ventricular tachy
3) v-fib
What would atrial arrhythmias look like on an ECG?
issues with p-wave
- variable in shape or not there
You examine a depressed ST segment. What does this indicate?
ischemia or injury
What ECG changes might you see in an acute MI?
acute ST elevations
An ECG for a patient exhibits a widened QRS, flattened P wave, and peaked T-wave. What does this indicate?
hyperkalemia
An inverted t-wave can indicate what?
hypokalemia, digitalis use
What are the bipolar/unipolar leads in an ECG?
unipolar: V1-6
bipolar: avR, avL, avF (R/L arm, L foot)
I,II,III are also there, forget if bi or unipolar
What does hypocalcemia do to an ECG?
prolong QRS (less quick systole)
Discuss the varying levels of hypertension.
normal: <120/80
prehypertension: 120-139/80-89
hypertension I: 140-159/90-99
hypertension II: >160/100
What values determine a hypertensive crisis?
> 180 systolic or 110 diastolic
What qualifies a patient as orthostatic?
is systolic drops 20mmHg or diastolic drops 10mmHg
What are normal MAP values?
70-110 mmHg
MAP = mean arterial pressure
What are the values for tachypnea/bradypnea?
tachypnic = >22 brady = <10
What are normal child RRs?
20-30 (while adults are 12-20)
What is it called when a patient has the inability to breathe when in areclining or supine position?
orthopnea
What do rales sound like?
aka crackles: rattling, bubbling sounds
- may be due to secretions in lungs
T/F: pulse ox measures PaO2 of the body.
false, SaO2 (only an estimate of PaO2)
