Cardiovascular- The Exam: Pulse and Heart Rhythm Flashcards
What are some things you are checking when you take the history from the patient?
Reviewing presenting symptoms, note time of onset, progression, natre of symptoms, insight into medical condition, level of activity in increasing or abating symptoms.
Specific areas to check during subjective interview (think cardiac pt.)
- Chest pain, SOB
- Fatigue, weakness
- Palpitations- awareness of pt. of heart rhythm abnormalities
- dizziness, syncope
- edema- especially in dependent body parts, sudden weight gain
- risk factors
- Past medical history- along with medications
- social history- living sitation and support, education level, employment, life style
- quality of life issues- functional mobility, ADLs
- social habits, smoking diet, past/present level of activity
10- observation and inspection of skin color- cyanosis, pallor, diaphoresis
Examine pulse: What should you note?
rate and rhythm
Examine pulse: What factors influence it?
- force of contraction
- volume and viscosity of blood
- diameter and elasticity of vessels
- emotions
- exercise
- blood temperature
- hormones
Examine pulse: how long should you check pulse?
palpate 30 sec for normal pulse
palpate 1-2 min for irregular pulse
Examine pulse: Apical pulse or point of maximal impulse (PMI)
- pt. supine
- palpate 5th interspace, midclavicular vertical line (apex of the heart)
- may displaced upward by pregnancy or high diaphragm
- may be displaced laterally in CHF, cardiomyopathy, ischemic heart disease
Examine pulse: Carotid pulse
- pt. supinehead elevated (that’s what the book says)
- palpate carotid artery between SCM and trachea
- assess one side at a time to reduce risk of brachycardia due to stimulation of carotid sinus baroreceptors> produces a reflex drop in pulse rate or blood pressure
Examine pulse: Brachial pulse
- Palpate over brachial artery. medial aspect of antecubital fossa
- best in infants
Examine Pulse: femoral pulse
palpate over femoral artery in inguinal region
Examine pulse: Popliteal pulse
palpate over popliteal artery, behind the knee with the knee flexed slightly
Examine pulse: Pedial pulse
- palpate over dorsalis pedis artery, dorsal medial aspect of foot
- used to monitor lower extremity circulation
Normal HR
Adults and teenager: 60-100 , 40-60 in aerobically trained
Children: 60-140
Newborn: average 127, range 90-164
Tachycardia
> 100
- exercise commonly results in tachycardia
- compensatory tachycardia can be seen with volume loss (surgery, dehydration)
Brachycardia
<60
What is postural tachycardia syndrome?
sustained HR increase equal to or greater than 30bpm within 10 min of standing (40 in teens)
3 pulse abnormalities
- Irregular pulse- varied force and/or frequency, may be due to arrhythmias or myocarditis
- Weak thready pulse- may be due to low stroke volume, cardiogenic shock
3, Bounding full pulse- may be due to shortened ventricular systole and decreased peripheral pressure, aortic insufficiency
What position should pt. be in when auscultating heart sounds?
supine
Auscultation landmarks
1 Aortic Valve- locate the 2nd R intercostal space at sternal border
2 Pulmonic Valve- locate the 2nd L intercostal space at sternal border
3 Tricuspid Valve- locate 4th L intercostal space at the sternal border
4 Mitral Valve- locate the 5th L intercostal space at the midclavical area
Auscultation: What is the S1 (lub) sound?
normal closure of mitral valve and tricuspid valves; marks beginning of systole. decreased first degree heart block.
Auscultation: What is S2 (dub) sound?
normal closure of aortic and pulmonary valves; marks end of systole. Decreased in aortic stenosis
Auscultation: Murmers (extra sounds)
- Systolic- falls between S1 and S2. May indicate valvular disease (ex:mitral valve prolapse) or could be normal
- Diastolic- falls between S1 and S2. Usually indicates valvular disease
- Grades of heart murmurs- grade 1 (softest) to grade 6 (audible w/ stethoscope off chest)
- Thrill- abnormal tremor accompanying a vascular or cardiac murmur; felt on palpation
Auscultation: What is bruit?
adventitious sound or murmur (blowing sound) of arterial or venous origin; common in carotid or femoral arteries; indicative of atherosclerosis.
Auscultation: explain gallop rhythm
abnormal heart rhythm with 3 sounds in each cycle; resembles the gallop of a horse
- S3: associated with ventricular filling. occurs soon after S2, in older individuals may be indicative of CHF
- S4: associated with ventricular filling and atrial contraction. Occurs before S1, indicative of CAD, MI, aortic stenosis or chronic hypertension
Examine heart rhythm: electrocardiogram (ECG)
12 lead ECG provides info about rate, rhythm, conduction, areas of ischemia and infarct, hypertrophy, electrolyte imbalances, and systemic pathologies (COPD, cerebral T-waves, ect.)
