Cardiovascular ROS

Question 1

What are some Symptoms-

Answer 1

chest pain, or discomfort, 
palpitations
Heart failure, high blood pressure (HBP)
Heart murmurs, Rheumatic fever
Dyspnea, orthopnea, Paroxysmal Nocturnal dyspnea (PND)
edema 
Past test- ECG or other tests

Question 2

common complaints

chest pain

Answer 2

differentiate btw cardiac vs. pulmonary, Musculoskeletal
GI
- does is radiate, when,
what, and how it started

Question 3

palpitations

Answer 3

racing
fluttering
pounding,
stopping of heart beat
how, what, SOB 
what makes it worse, better?

Question 4

Shortness of Breath

Answer 4

Orthopnea- worse in supine; better upright?
how many pillows
Paroxysmal Nocturnal Dyspnea (PND)- does it awakens pt from sleep
Paroxysmal== episode that come and go

Question 5

Edema

Answer 5

local vs systemic
Periorbital/face, Ue’s abdomen
Pitting edema? (>/ 10%)
location- feet/ankles/ tight fitting rings/ jewelry/ clothes tight around abdomen
Dependent edema- LE’s- post standing upright for a period of time

Question 6

CVS Exams steps- 1- Examine

                                Inspect

                                Palpate

                              Auscultate

Answer 6

Vitals- BP, HR, RR

Jugular venous pulsations and carotids pulses

Carotids with fingers individually

Carotids with Bell/ w patient holding breath

Question 7

2- Inspect

                            Auscultate-5 cardinals areas 
                            with diaphragm/ bell 

                             bell

                            Diaphragm

Answer 7

Anterior Chest wall at apical impulse with light for point of maximal impulse (PMI)

Aortic valve -2nd ICS R sternal border
Pulmonic valve- 2nd ICS L sternal border
Erb’s point- S2 is loudest heard at 3rd ICS L sternal border
Tricuspid valve- 4th ICS Left sternal border
Mitral valve- 5ith ICS L Mid-clavicular line

Mitral Valve murmurs- left lateral decubitus-

Aortic valve murmurs- sitting up and leaning fwd- (exhale and hold breath).

Question 8

Apical Impulse

Answer 8

heard at apex of the hear-

palpated- at 5th Interspace/ medial to the mid-sternal line

Question 9

Interspaces

Answer 9

Mid-sternal line
Mid-clavicular line
Anterior Axillary line
Mid-axillary line

Question 10

Carotid pulses

Upstroke

Answer 10

Listen for any Bruits

Brisk= normal

Delayed= suggests Aortic stenosis or atherosclerosis

Bounding= suggests Aortic Insufficiency

Question 11

Pulses Alternans

Answer 11

the force will alternate btw strong and weak;

from strong and weak ventricular contractions

Question 12

Paradoxical pulse

Answer 12

Greater than normal drop in systolic pressure during inspiration

Question 13

Pericardial Tamponade

Answer 13

or pulse varies with respiration
-increased JVP 
rapid or diminished pulse 
dyspnea
check BP

Question 14

Point of Maximal Impulse (PMI) apical

Answer 14

Tapping= Normal

Sustained=suggests LVH from HTN or aortic stenosis

Diffuse=suggests dilated ventricle from CHF or cardiomegaly.

Location- Amplitude (tapping)

duration( during systole)

diameter (2.5 cm)

Question 15

Heart sounds
S1

                         S2

Answer 15

Both close due to pressure differentials:
Mitral and tricuspid valves close - short and softer

Aortic and Pulmonic valves close- louder, longer
- Erb’s point heard best

Question 16

Heart Murmurs
Timing

                   Palpate

                    Duration

                  Stenosis

                  Intensity

                  Quality

                  Pitch

Answer 16

= systolic or diastolic

for carotid upstroke

systolic murmur = murmur coincides with the carotid upstroke
Early, mid or late systolic

Crescendo= grows louder ie: mitral stenosis

Decrescendo= grows softer ie: aortic regurgitation\

Plateau= “Machinery” same intensity throughout ie: mitral regurgitation or holosystolic.

Crescendo-decrescendo= rises intensity, then falls ie: aortic stenosis

Grade I to VI
IV,V, and VI- must have Thrill
ie: Harsh II/VI- pitched holosystolic murmur at apex= mitral regurgitation

Soft/blowing= Decrescendo diastolic at L sternal border- Aortic regurgitation

Harsh, musical, soft , blowing, or rumbling

High, medium, low