Cardiovascular System Flashcards
What position are patients examined when doing a cardiovascular examination?
45 degrees and exposed from the waist upwards
Where can the radial artery be palpated?
Between the tendon of the flexor carpi radialis and the tendon of the brachiradialis
What does the radial pulse suggest?
Rate and Rhythm
What pulse rate indicates bradycardia?
<60bpm
What pulse rate indicates tachycardia?
> 100bpm
How is the radial pulse palpated?
Count the pulses within the 30 seconds and multiply by a factor of 2.
Where is the ulnar artery palpated?
Lies between the flexor digitorum superficialis and the flexor carpi ulnaris
Which two positions can the brachial artery be palpated?
1) Brachial artery medial the bicep’s tendon (medial to the antecubital fossa)
2) middle third of the humerus in the medial bicipital groove.
- Ensure that the elbow joint is fully extended
What position is the elbow in when palpating the brachial artery?
Fully extended.
Where is the common carotid artery palpated?
1) Medial border of the sternocleidomastoid muscle
2) Lateral border of the thyroid cartilage
What does the carotid pulse give?
Character and volume can only be detected from the central arteries.
Where is the apex beat palpated?
5th intercostal space at the mid-clavicular line.
How is the apex beat palpated?
Start palpating from the lateral side (near the mid axillary line) - anterior towards the mid-clavicular line
A patient with cardiomegaly will exhibit what type of apex beat when palpated?
Displaced apex beat
What is the range of a normal pulse rate?
60-100bpm
What are the units for a pulse rate?
Beats per minute
Give 4 pathological causes of an absent apex beat in the 5th intercostal space MCL?
Pericardial effusion
Pleura effusion
Obesity
Emphysema
Demonstrate how you will palpate a heave
Place the heel of your hand parallel to the left sternal edge of palpate for heaves.
How is a heave detected/felt, once palpated?
The heel of your hand is lifted with each systole
Parasternal heaves are associated with what type of pathology?
Right ventricular hypertrophy
Demonstrate how you will palpate a thrill
Assess the thrill across each of the heart valves
Place hand horizontally across the chest wall, with the flats of your fingers and palm over the valve to be assessed.
What is a thrill?
A thrill is a palpable vibration caused by turbulent flow through a heart valve
What is a heave?
A parasternal heave is a precordial impulse that can be palpated
Name all four heart valves
Pulmonary
Tricuspid
Mitral
Aortic
Where is the aortic valve auscultated?
Right sternal border in the 2nd intercostal space
Where is the pulmonary valve auscultated?
Left sternal border in the 2nd intercostal space
Where is the tricuspid valve auscultated?
Left 5th costo-sternal border
Where is the mitral valve auscultated?
Left 5th intercostal space at the apex beat
-Use the Bell of the stethoscope
What are the 5 pathological causes of an ejection systolic murmur?
Aortic stenosis Pulmonary stenosis Aortic sclerosis Atrial septal defect Hypertrophic obstructive cardiomyopathy (HOCM)
How can aortic stenosis be detected on auscultation?
Auscultate the carotid arteries using the diaphragm whilst the patient holds their breath
Where is aortic stenosis accentuated?
Carotid arteries
How can aortic regurgitation be accentuated?
Inform the patient to lean forwards, and auscultate of the aortic area with the diaphragm during expiration
What type of murmur is associated with aortic stenosis?
Ejection systolic murmur
In what position should patients be in when assessing for mitral valve pathologies (stenosis/regurgitation)?
Left lateral decubitus position
What should the patient be doing when accentuating the auscultation for aortic stenosis?
Holding their breath
What type of murmur is associated with aortic regurgitation?
Early diastolic murmur
What type of murmur is associated with mitral valve regurgitation?
Pan-systolic murmur during expiration
Where is mitral valve regurgitation detected?
Left lateral decubitus position, mitral area
When palpating for mitral valve regurgitation, where does the murmur radiate to?
Radiates into the axilla
Which type of valvular defect is associated with murmur radiation into axilla?
Mitral valve regurgitation
A pan-systolic murmur is associated with which type of valvular defect?
Mitral valve regurgitation
In what position should the patient be in when detecting for aortic regurgitation?
The patient should lean forwards
What part of the stethoscope should be used when palpating for mitral stenosis?
The bell
What type of murmur is associated with mitral valve stenosis?
Mid-diastolic murmur
A mid-diastolic murmur is associated with which type of valvular defect?
Mitral valve stenosis
When is the pan-systolic murmur heard in mitral valve regurgitation?
Expiration
What are the four areas of pulse palpation in the lower limb?
1) Femoral artery
2) Popliteal artery
3) Dorsalis pedis artery
4) Posterior tibial artery
At which point should the femoral pulse be palpated?
The mid-inguinal point
Where is the mid-inguinal point?
The midpoint between the anterior superior iliac spine and the pubic symphysis
Where can the popliteal pulse be palpated?
Inferior region of the popliteal fossa
How is the popliteal pulse palpated?
Place thumbs on the tibial tuberosity
Passively flex the knee to 30 degrees
Curl fingers into the popliteal fossa - compress the popliteal artery against the tibia
Where can the posterior tibial pulse be palpated?
Posterior to the medial malleolus of the tibia
Where can the dorsalis pedis pulse be palpated?
Located on the dorsum of the foot, lateral to the extensor hallucis longus tendon, over the second and third cuneiform bones
Describe the right upper border of the heart
3rd Costal cartilage, 1cm from the sternal angle
Describe the right lower border of the heart
6th costal cartilage 1cm from the sternal border
Describe the right border of the heart
3rd to 6th costal cartilage 1cm from the sternal border
Describe the left upper border of the heart
2nd ICS, 2.5cm from the sternal angle
Describe the left lower border of the heart
5th ICS, mid-clavicular space
What are the three pulses palpated in the head and neck?
1) Carotid artery
2) Superficial temporal artery
3) Subclavian artery
Where is the carotid artery palpated?
Palpated in the neck between the lateral side of the thyroid cartilage, and medial border of the sternocleidomastoid muscle
Which is the strongest pulse used to assess character and volume?
Carotid pulse
Where is the superficial temporal artery pulse palpated?
Palpated in front of the tragus of the ear
Which pulse can be felt, anterior to the tragus of the ear?
Superficial temporal artery pulse
Where is the subclavian artery palpated?
Can be palpated in the supraclavicular fossa region, the angle between the clavicle and sternocleidomastoid
Which dissection is associated with severe chest pain, anterior and posterior?
Type A aortic dissection
A type B aortic dissection is associated with what type of pain radiation?
Back pain, followed by chest and abdominal pain
Describe the surface markings for the arch of the aorta
· Beginning of the arch (from ascending aorta) at the level of right 2nd CC · End of the arch (becomes thoracic aorta) at the level of left 2nd CC.
Top of the arch in between the sternal angle and jugular notch
Sternal angle (T4/T5)
What are the major branches from the aortic arch?
Brachiocephalic artery
Left common carotid
Left subclavian artery
Describe and demonstrate the surface markings for the right common carotid artery
Right sternoclavicular joint to the lobe of the right ear
Inform the patient to turn their head to the left side.
