Cardiovascular System Physical Examination Flashcards
8 aspects of cardiovascular exam
- Skin
- Pulse
- Heart Sounds
- Heart Rhythm
- Blood Pressure
- Respiration
- Oxygen Saturation
- Pain
Signs of decreased cardiac output
- 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
What influences pulse?
force of contraction, volume and viscosity of blood, diameter and elasticity of vessels, emotions, exercise. blood temperature, and hormones
how long to palpate regular pulse?
30 seconds
how long to palpate irregular rhythm?
1-2 minutes
Apical Pulse (point of maximal impulse - PMI)
- 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
carotid pulse
patient is lying down with head of bed elevated; palpate over carotid artery; on either side of anterior neck between SCM and trachea
what should you do when assessing carotid pulse?
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
Grading scale of pulses
- 0: absent
- 1+ pulse diminished, barely perceptible
- 2+: easily palpable; normal
- 3+: full pulse, increased strength
- 4+ bounding pulse
Normal HR for adults and teens
- 60-100 bpm
- 40-60 bpm in aerobically trained
Children normal HR
60-140 bpm
newborn average HR
127 bpm
- range 90-164 bpm
what can cause compensatory tachycardia?
volume loss (surgery, dehydration)
Postural Tachycardia Syndrome
- sustained HR increased > 30 bpm within 10 mins of standing (>40 in teens)
Irregular pulse
variations in force and frequency may be due to arrhythmias, myocarditis
What can cause weak, thready pulse
low stroke volume or cardiogenic shock
what can cause bounding, full pulse
- may be due to shortened ventricular systole and decreased peripheral pressure
- aortic insufficiency
Aortic valvue auscultation
located at second right intercostal space at sternal border
pulmonic valve auscultation
located at 2nd left intercostal space at sternal border
tricuspid valve auscultation
located at 4th left intercostal space at sternal boarder
mitral valve auscultation
located at the 5th left intercostal space at the midclavicular area
S1
- lub
- normal closure of mitral and tricuspid valves
- marks beginning of systole
- decreased in 1st degree heart block
S2
- dub
- normal closure of aortic and pulmonary valves
- marks end of systole
- decreased in aortic stenosis
Systolic murmur
- falls between S1 and S2
- may indicate valvular (mitral valve prolapse)
- or may be normal
Diastolic murmur
- Falls between S2 and S1
- Usually indicates valvular disease
Grades of heart murmurs
Grade 1 (softest audible) to grade 6 ( audible w/o stethoscope)
Thrill
- Abnormal tremor accompanying a vascular or cardiac murmur
- Felt on palpation
Bruit
- An adventitious sound or murmur (blowing sound) of arterial or venous origin
- Common in carotid or femoral arteries
- indicative of atherosclerosis