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Physical Diagnostics > Cardiovascular System > Flashcards

Cardiovascular System Flashcards

1
Q

Define cardiovascular

A

the heart and blood vessels

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2
Q

List the general assessment tools used for the cardiovascular system

A

inspection, palpation, auscultation, and in some rare cases percussion

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3
Q

What is an important exam that is directly related to the cardiovascular system when a pt is experiencing abnormalities?

A

ophthalmoscopic exam of the eyes allows for the only direct visualization of the arteriovenous system

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4
Q

What is hypercholesterolemia?

A

high cholesterol

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5
Q

Hypercholesterolemia may cause….

A

xanthelasma and arcus senilis

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6
Q

What is xanthelasma?

A

yellowish plaques on eyelids

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7
Q

What is this?

A

xanthelasma

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8
Q

What is arcus senilis?

A

extreme whitish ring around the iris

common in people 40 years old and younger

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9
Q

What is this?

A

arcus senilis

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10
Q

Doing an opthalmoscopic exam when assessing the cardiovascular system may help diagnose….

A

hypertension or diabetic retinopathy (proliferative and nonproliferative)

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11
Q

What is this?

A

copper wiring, indicitive of hypertension

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12
Q

What is this?

A

nonproliferative diabetic retinopathy, visible with the “tortorous” blood vessels

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13
Q

Doing an oral exam when assessing the cardiovascular system may help diagnose…

A

petechiae on the palate, often seen with infective endocarditis (this infection begins in the oral cavity)

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14
Q

What is JVD? What is it indicitive of?

A

bulging/distention of the jugular vein

indicitive of CVP, which is in the right atrium of the heart

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15
Q

The angle of Louis is important for calcuating _____

A

JVD

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16
Q

What is another name for the angle of Louis?

A

sternal angle or manubrium sternal angle

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17
Q

Is the jugular notch easily palpable on all patients?

A

yes

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18
Q

Where can you find the angle of Louis?

A

2nd rib is in line with it

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19
Q

How far is the heart from the angle of Louis?

A

5cm inferior to the angle of Louis is the base of the heart

base of heart = superior portion of heart

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20
Q

What is the “point” of the heart called?

A

the apex

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21
Q

If you detect JVD through observation, it is time to measure for _____ next

A

JVP

If you detect JVD through observation, it is time to measure for JVP next

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22
Q

How do you measure JVP?

A

bed at 30-45 degree angle

find the angle of Louis and position a ruler on the angle

use anything else vertical, like a tongue depresser and line that up with the highest point that you see the jugular vein bulging

you’re essentially making a right angle, take the height and add 5cm to the height

JVP= anything larger than 8cm is too high and deemed abnormal

6-8cm is WNL and CVP is okay

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23
Q

Which patients should you be measuring JVP?

A

senior patients (60+ years old)

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24
Q

What is a normal JVP?

A

6-8cm

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25
Q

What is an abnormal JVP?

A

8cm water or higher

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26
Q

When measuring JVP, what else should you be doing in this area?

A

auscultate and palpate the carotid pulse

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27
Q

What does COPD stand for?

A

chronic obstructive pulmonary disease

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28
Q

What does COPD include?

A

usually includes emphysema and chronic bronchitis

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29
Q

What is emphysema?

A

air sacs of lungs are damaged and enlarged, causing breathlessness

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30
Q

How does COPD affect PMI?

A

PMI will be shifted because the heart gets displaced from the enlarged lungs (over inflated)

PMI is usually lower in cases of COPD and more to the right

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31
Q

the apex of the heart hits the ________ chest wall every time it beats. This is called the ____

A

the apex of the heart hits the anterior chest wall every time it beats. This is called the PMI

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32
Q

Describe where you are palpating when assessing PMI

A

palpate till the 5th intercostal space and then feel for the mid-clavicular area on the left side

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33
Q

What does PMI stand for?

A

Point of Maximal Impulse

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34
Q

What is normal PMI?

A

width of impulse should be 2-3cm

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35
Q

What is an abnormal PMI?

A

larger than 3cm, this is indicitive of cardiomegly

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36
Q

What is cardiomegaly?

A

enlarged heart

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37
Q

How many fingers should you palpate with when assessing PMI?

A

4 fingers, feel for the apex

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38
Q

What does SV stand for?

A

stroke volume

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39
Q

What does a vigourous stroke volume mean? Example of cause?

A

increased stroke volume

blood volume is being ejected with each beat

vigorous exercise would appear as a bounding pulse

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40
Q

How do you confirm heaves or thrills after palpation?

A

with a stethoscope

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41
Q

How do you assess for thrills? What do thrills indicate?

A

palpate with metacarpals to feel for vibrations, called thrills

this is indicitive of turbulent blood flow

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42
Q

How do you assess for heaves? What are heaves/what does this mean?

A

palpate with your hand to the heart for heaves

heaves are sustained impulses

this usually means that ventricles are enlarged

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43
Q

What are the 4 positions for ausculatation of the heart?

A

1) supine
2) left lateral decubitus
3) upright
4) upright leaning forward

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44
Q

List the pt postion(s) for a normal heart auscultation

A

supine and upright

both of these positions you should be able to hear all areas of the heart

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45
Q

List the pt position(s) for abnormal heart auscultation (or was unheard in other positions)?

A

left lateral decubitus and upright leaning forward

only use these positions if:

  • you cannot hear the mitral valve area or base of heart
  • if it sounds abnormal
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46
Q

the b of “lub” is _________ than p in “dup”

A

the b of “lub” is harsher than p in “dup”

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47
Q

What is the first sound of the heart?

A

S1= closure of the AV valves “lub”

AV= atrioventricular valve

mitral valve + tricuspid valve.

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48
Q

What is the second sound of the heart?

A

S2= closure of the semilunar valves “dup”

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49
Q

What are the 4 valve areas of the heart?

A

aortic, pulmonic, tricuspid, and mitral valve areas

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50
Q

T/F

The mitral closes slightly before the tricuspid, and aortic slightly before the pulmonic, so there are 4 sounds, but indistinct

A

true

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51
Q

Which heart valve area is the loudest?

A

mitral

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52
Q

What position should the stethoscope be held when auscultating the heart?

A

angled slightly anteirorly

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53
Q

Which valvular area should you start with when auscultating the heart?

A

aortic

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54
Q

List the order of valvular areas you should auscultate

A

1) aortic
2) pulmonic
3) tricuspid
4) mitral

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55
Q

Where is the aortic valve?

A

count to the 2nd intercostal space on the right side

56
Q

Where is the pulmonic valve?

A

straight across from the aortic valve, on the left side

57
Q

Where is the tricuspid valve?

A

move down 2 more intercostal spaces from the pulmonic valve

58
Q

Where is the mitral valve?

A

over the mid-clavicular line, in line with the nipple

with women, push in and up because you need to move through the breast tissue

59
Q

Are S3 and S4 sounds commonly heard?

A

No, it is often only heard on patients with heart or vascular problems

60
Q

When is the S3 sound heard?

A

S3 is heard if the left ventricle of the heart is non-compliant as blood rushes in after opening the mitral valve

the heart is usually non-compliant because of scar tissue (ex: scar tissue from a heart attack)

61
Q

When is the S4 sound heard?

A

S4 is heard at the end of atrial contraction with the final release of blood

audible if the ventricle is non-compliant

it is normal to hear this in children or in slim adults

62
Q

Which heart sounds are considered extra sounds, or subtle sounds?

A

S3 and S4

63
Q

What are the 2 types of murmurs?

A

1) regurgitation of insufficeny (often mitral regurgitation)
2) stenotic murmurs (often aortic stenosis)

64
Q

What is aortic stenosis?

A

a murmur caused by the narrowing/stiffening of the aorta

65
Q

What is mitral regurgitation?

A

murmur caused by mitral valve not closing all the way

blood flows backwards

makes a swooshing sound

66
Q

When listening to the heart its important to note what?

A

volume

radiating anywhere?

rhythm

67
Q

What is considered a severe heart murmur?

A

if the murmur is radiating somehwere

68
Q

Where does an aortic stenosis usually radiate to?

A

towards the neck

69
Q

Where does a mitral regurgitation usually radiate to?

A

the axilla (armpit)

70
Q

What is the grading scale for a heart murmur?

A

rated on a scale of 1-6 from faint to loud /6

71
Q

What does a 1/6 on the heart murmur grading scale mean?

A

faint murmur

72
Q

What does a 2/6 on the heart murmur grading scale mean?

A

easily heard murmur

73
Q

What does a 3/6 on the heart murmur grading scale mean?

A

moderately loud murmur

74
Q

Which murmur ratings are the most common?

A

1/6, 2/6, and 3/6

75
Q

What does a 4/6 on the heart murmur grading scale mean?

A

loud murmur, thrill palpable

76
Q

What does a 5/6 on the heart murmur grading scale mean?

A

thill present, can hear with edge of stethoscope its so loud

77
Q

What does a 6/6 on the heart murmur grading scale mean?

A

thill present, can hear with your ear, no stethoscope needed because its so loud

78
Q

What are the gallop sounds?

A

S3 and/or S4

79
Q

When assessing the abdomen, what general assessment tools may you use?

A

inspection, palpation, and auscultation

80
Q

Where is the abdominal aorta located?

A

lies left of the midline

81
Q

When assessing the cardiovascular system where may you find a bruit sound?

Hint: there are 2 bruits in the neck chapter (carotid artery + thyroid gland). What is another bruit location we learned?

A

aortic abdomen

bruit may indicate turbulent blood flow usually due to atherosclerosis

82
Q

What is lymphedema?

A

tissue swelling caused by an accumulation of fluid that’s usually drained through the body’s lymphatic system

ex: a complication from a mastectomy may cause this

83
Q

What are the 2 types of blood insufficiencies?

A

venous and arterial insufficiency

84
Q

What is venous insufficiency?

Describe the color, where it is commonly found, and whether it blanches or not

A

blood is unable to flow back to the heart properly

purplish-blue, black color

causes hemosiderin

lack of hair in areas of insufficiency

common in the LE

if you palpate it, it will blanch

85
Q

What causes hemosiderin?

A

hemosiderin staining usually happens on the lower legs, near the ankles, or on your feet

caused by blood leaking out of capillaries

the blood pools under the skin and leaves a residue of hemoglobin that settles in the tissue there, causing skin discoloration

86
Q

What is arterial insufficiency?

Describe the color and location

A

pale skin in LE, no blood flow to this area

87
Q

What is this?

A

venous insufficiency

88
Q

What is this?

A

arterial insufficiency

89
Q

What is this?

A

gangrene

90
Q

What is this?

A

cellulitis

91
Q

What is gangrene?

A

no blood flow (ischemia), causes tissue to die

92
Q

What is ischemia?

A

blood flow (and oxygen) is restricted or reduced somewhere in the body

93
Q

What is cellulitis?

A

infection of the skin, very painful

red, swollen skin, common in LE

if you palpate it, it will blanch

94
Q

What are the 2 types of edema?

A

diffuse edema (symmetical), and asymmetical edema

95
Q

What is pitting edema?

A

if you palpate the skin, it will cause pits

takes a while for the skin to return back to “normal” after palpation

96
Q

What is this

A

varicose veins

97
Q

For patients with PVD, what should you be checking for? What is wrong with the blood?

A

check for spider veins and varicose veins

blood is not flowing the way it should, there is a blockage

98
Q

What should you be noting for patients with vascular disease?

A

note dusky color, waxy appearance, and lack of hair

may cause “peau d’orange”

99
Q

What is peau d’orange?

A

Peau d’orange is French for orange peel

characterized by edema and pitting and results from blockage of lymphatic drainage

symptom in which the skin becomes thick and pitted, with a texture and appearance similar to that of orange peel

100
Q

What causes the thickening of nails?

A

bad blood flow results in thick nails

thick nails are subjected to get infected

101
Q

What is an extreme ulcer we learned in class?

A

pedal ulcer

102
Q

When examinig the LE, what should you be taking note of?

A

symmetry

color

temp. (use back of your hand)

texture, etc.

103
Q

Venous and arterial insufficenies may feel ____ to the touch

A

cool

Venous and arterial insufficenies may feel cool to the touch

temp. of skin is colder than rest of body

104
Q

cellulitis may feel ______ because of the increased blood flow to that area

Hint: think of a genetic temp word

A

warm

cellulitis may feel warm because of the increased blood flow to that area

105
Q

What is PAD?

A

peripheral artieral disease

most common in LE, results in intermittent claudication (on/off)

106
Q

What is intermittent claudication?

A

pain affecting the calf, and less commonly the thigh and buttock, that is induced by exercise and relieved by rest

also common in elderly with walking

107
Q

Which pulses can you palpate?

A

brachial

radial

femoral

popliteal

dosalis pedis (DP)

posterior tibial (PT), etc.

108
Q

Which pulse is the most difficult to find/palpate? What makes it so difficult?

A

popliteal

the biceps femoris muscle is in the way

109
Q

Where is the dorsalis pedis (DP) pulse located?

A

lateral to the tendon of the extensor hallucis muscle

110
Q

Where is the posterior tibial (PT) pulse?

A

posterior to the medial malleolus bone

111
Q

Describe the capillary refill time test

A

push on the distal part of the hallux muscle, or on a nail

if it takes more than 3 seconds, then it is abnormal cap. refill

112
Q

Describe the Allen test

A

have pt close their fist tightly

you will push/palpate on radial and ulner arteries and have pt open hand slowly

open palm should appear pale and color should return when you let go of arteries

should be within 5 seconds, anything longer is deemed abnormal

IF pt has abnormal result try again doing one artery at a time and one hand at a time to compare results

113
Q

brady-

A

pertaining to: slow

ex: bradycardia
def: slow heart rate

114
Q

-cardio-

A

pertaining to: heart

ex: cardiomegaly
def: enlargement of the heart

115
Q

sphygmo-

A

pertaining to: pulse

ex: sphygmomanometer
def: instrument for measuring BP

116
Q

supra-

A

pertaining to: above

ex: supraventricular
def: above the level of the ventricles

117
Q

tachy-

A

pertaining to: fast

ex: tachycardia
def: rapid heart rate

118
Q

angi(o)-

A

pertaining to: blood vessel

ex: angiography
def: radiographic visualization of blood vessels

119
Q

embol(o)-

A

pertaining to: wedge, stopper

ex: embolism
def: sudden blocking of a vessel by a clot

120
Q

phleb(o)-

A

pertaining to: veins

ex: phlebotomy
def: incision into a vein for blood removal

121
Q

thrombo-

A

pertaining to: clot

ex: thromboembolism
def: obstruction of a blood vessel by a clot that has broken loose from its site of formation

122
Q

varico-

A

pertaining to: twisted, swollen

ex: varicose
def: unnaturally swollen and twisted

123
Q

If a pulse is described as absent or nonpalpable, what does this mean in terms of scale? Examples that may cause this?

A

0 or 0/4

Ex: asystole, thrombosis, or occlusion

124
Q

If a pulse is described as weak, diminished amplitude, or may have difficulty locating, what does this mean in terms of scale? Examples that may cause this?

A

1, 1/4, 1+/4

Ex: stenosis, left ventricular failure, hypovolemia, anemia, dehydration

125
Q

If a pulse is described as normal or readily palpable, what does this mean in terms of scale? Examples that may cause this?

A

2, 2/4, 2+/4

Ex: hemodynamic stability

126
Q

If a pulse is described as strong, increased amplitude, or quickly palpable, what does this mean in terms of scale? Examples that may cause this?

A

3, 3/4, 3+/4

Ex: anxiety, mild exertion, caffeine

127
Q

If a pulse is described as bounding, what does this mean in terms of scale? Examples that may cause this?

A

4 or 4/4

Ex: fever, strenuous exercise, fear, cocaine

128
Q

Define bradycardia

A

slower than expected heart rate, generally beating fewer than 60 bpm

129
Q

Define tachycardia

A

very fast, rapid heart rate

130
Q

What is the normal heart rate range?

A

60-90 bpm

131
Q

What is normal BP?

A

120/80 or less

132
Q

What is the prehypertension range?

A

120-139/ 80-89

133
Q

If a pitting edema is rated +1, what does this mean?

A

roughly 2mm in depth, disappears rapidly

134
Q

If a pitting edema is rated +2, what does this mean?

A

roughly 4mm in depth, disappears in 10-15 sec.

135
Q

If a pitting edema is rated +3, what does this mean?

A

roughly 6mm in depth, may last more than 1min

dependent extremity swollen

136
Q

If a pitting edema is rated +4, what does this mean?

A

roughly 8mm pit or deeper, may last 2-5min

dependent extremity grossly disoriented

137
Q

What can indicate JVD (besides the jugular venous bulge)

A

varicose veins and spider veins

Physical Diagnostics (13 decks)

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