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Boards Prep- Cardiovascular > Cardiovascular System Physical Examination > Flashcards

Cardiovascular System Physical Examination Flashcards

1
Q

8 aspects of cardiovascular exam

A
  • Skin
  • Pulse
  • Heart Sounds
  • Heart Rhythm
  • Blood Pressure
  • Respiration
  • Oxygen Saturation
  • Pain
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2
Q

Signs of decreased cardiac output

A
  • Cyanosis: bluish color of skin, nail beds, lips, and tongue
  • Pallor: washed out, absence pf pink, rosy color
  • Diaphoresis: excess sweating and cool, clammy skin
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3
Q

What influences pulse?

A

force of contraction, volume and viscosity of blood, diameter and elasticity of vessels, emotions, exercise. blood temperature, and hormones

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4
Q

how long to palpate regular pulse?

A

30 seconds

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5
Q

how long to palpate irregular rhythm?

A

1-2 minutes

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6
Q

Apical Pulse (point of maximal impulse - PMI)

A
  • patient is supine
  • palpate at 5th interspace, midclavicular vertical line (apex of heart)
  • may be displaces upward by pregnancy or high diaphragm
  • may be displaced laterally by congestive heart failure, cardiomyopathy, ischemic heart disease
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7
Q

carotid pulse

A

patient is lying down with head of bed elevated; palpate over carotid artery; on either side of anterior neck between SCM and trachea

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8
Q

what should you do when assessing carotid pulse?

A

assess one side at a time to reduce the risk of bradycardia through stimulation of the carotid sinus baroreceptor, which produces a reflex drop in pulse rate or BP

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9
Q

Grading scale of pulses

A
  • 0: absent
  • 1+ pulse diminished, barely perceptible
  • 2+: easily palpable; normal
  • 3+: full pulse, increased strength
  • 4+ bounding pulse
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10
Q

Normal HR for adults and teens

A
  • 60-100 bpm
  • 40-60 bpm in aerobically trained
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11
Q

Children normal HR

A

60-140 bpm

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12
Q

newborn average HR

A

127 bpm
- range 90-164 bpm

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13
Q

what can cause compensatory tachycardia?

A

volume loss (surgery, dehydration)

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14
Q

Postural Tachycardia Syndrome

A
  • sustained HR increased > 30 bpm within 10 mins of standing (>40 in teens)
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15
Q

Irregular pulse

A

variations in force and frequency may be due to arrhythmias, myocarditis

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16
Q

What can cause weak, thready pulse

A

low stroke volume or cardiogenic shock

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17
Q

what can cause bounding, full pulse

A
  • may be due to shortened ventricular systole and decreased peripheral pressure
  • aortic insufficiency
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18
Q

Aortic valvue auscultation

A

located at second right intercostal space at sternal border

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19
Q

pulmonic valve auscultation

A

located at 2nd left intercostal space at sternal border

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20
Q

tricuspid valve auscultation

A

located at 4th left intercostal space at sternal boarder

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21
Q

mitral valve auscultation

A

located at the 5th left intercostal space at the midclavicular area

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22
Q

S1

A
  • lub
  • normal closure of mitral and tricuspid valves
  • marks beginning of systole
  • decreased in 1st degree heart block
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23
Q

S2

A
  • dub
  • normal closure of aortic and pulmonary valves
  • marks end of systole
  • decreased in aortic stenosis
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24
Q

Systolic murmur

A
  • falls between S1 and S2
  • may indicate valvular (mitral valve prolapse)
  • or may be normal
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25
Q

Diastolic murmur

A
  • Falls between S2 and S1
  • Usually indicates valvular disease
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26
Q

Grades of heart murmurs

A

Grade 1 (softest audible) to grade 6 ( audible w/o stethoscope)

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27
Q

Thrill

A
  • Abnormal tremor accompanying a vascular or cardiac murmur
  • Felt on palpation
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28
Q

Bruit

A
  • An adventitious sound or murmur (blowing sound) of arterial or venous origin
  • Common in carotid or femoral arteries
  • indicative of atherosclerosis
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29
Q

Gallop rhythm

A
  • abnormal heart rhythm with three sounds in each cycle
  • resembles gallop of horse
30
Q

S3

A
  • associated with ventricular filling
  • occurs soon after S2
  • in older individuals, may be indicative of congestive (LV) heart failure
31
Q

S4

A
  • Associated with ventricular filling and arterial contraction
  • occurs just before S1
  • Indicative of pathology including coronary heart disease (CAD), MI, aortic stenosis or chronic hypertension
32
Q

ECG

A

See ECG section

33
Q

Normal BP

A

<120/<80El

34
Q

elevated BP

A

120-129/<80

35
Q

Stage 1 Hypertension

A

130-139 or 80-89

36
Q

Stage 2 Hypertension

A

at least 140 or at least 90

37
Q

Hypertensive crisis

A

> 180/>120

38
Q

When are medications prescribed for stage 1 hypertension

A

when a patient has already had a heart attack or stroke or is at high risk of heart attack or stroke in the presence of diabetes, chronic kidney disease, or atherosclerotic risk

39
Q

Neonate (96hr) BP

A

67-84/35-53

40
Q

Infant (1-12mo) BP

A

72-104/37-56

41
Q

Toddler (1-2 yo) BP

A

86-106/42-63

42
Q

Preschooler (3-5yo) BP

A

89-112/46-72

43
Q

School age (6-9yo) BP

A

97-115/57-76

44
Q

Preadolescent (10-11yo) BP

A

102-120/61-80

45
Q

Adolescent (12-15 yo) BP

A

110-131/64-83

46
Q

Examining orthostatic hypotension

A
  • first BP measured when pt supine for >5 min
  • moves to sitting, immediately take BP, again after 2 mins
  • moves to standing, immediately take BP, again after 2 mins
47
Q

What is considered OH+

A

systolic drop > 20 mmHg or diastolic drop >10 mmHg

48
Q

After what age are high BP levels the same as adults?

49
Q

What is MAP

A

Arterial pressure within large arteries over time; dependent upon mean blood flow and arterial compliance

50
Q

how to calculate MAP

A

take the sum of systolic BP and twice the DBP and divide by 3

51
Q

normal MAP

A

70-110 mmHg

52
Q

normal newborn RR

A

30-40 breaths per min

53
Q

normal child RR

A

20-30 breaths per min

54
Q

tachypnea

A

RR >22 breaths per min

55
Q

bradypnea

A

RR <10 breaths per min

56
Q

hyperpnea

A

an increase in depth and rate of breathing

57
Q

dyspnea on exertion (DOE)

A

brought on by exercise or activity

58
Q

Orthopnea

A

inability to breathe when in a reclining or supine position

59
Q

Paroxysmal nocturnal dyspnea (PND)

A

sudden inability to breathe occurring during sleep

60
Q

Adventitious breath sounds

A
  • crackles (rales): rattling, bubbling sounds, may be due to secretions in the lungs
  • wheezes (rhonchi): whistling sounds
61
Q

Assessing cough

A
  • productive or nonproductive
  • strong or weak
  • coordinated or uncoordinated
  • consistency and color of any secretions
62
Q

What does pulse oximetry provide

A
  • and estimate of PaO2 (partial pressure of oxygen) based on the oxyhemoglobin desaturation curve
  • normal: 98-100%
63
Q

hypoxemia

A

SaO2 less than 90% which corresponds to PaO2 of 60mmHg

64
Q

Anoxia

A

complete lack of oxygen

65
Q

Ischemic cardiac pain (angina or MI)

A
  • diffuse
  • Retrosternal
  • sensation of tightness, achiness in the chest
  • associated with dyspnea, sweating, indigestion, dizziness, syncope, anxiety
66
Q

Symptoms more likely in women

A
  • indigestion or gas like pain
  • dizziness or nausea
  • unexplained weakness or fatigue
  • discomfort or pain between shoulder blades
  • recurring chest discomfort
  • sense of impending doom
67
Q

Referred pain

A
  • cardiac pain can refer to shoulders, backs, arms, neck, or jaw
  • pain referred to back can occur from dissecting aortic aneurism
68
Q

Review dyspnea scale

69
Q

anginal scale

A

1+ light, barely noticeable
2+ moderate, bothersome
3+ severe, very uncomfortable
4+ most severe pain ever experienced

Boards Prep- Cardiovascular (21 decks)

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