Chap. 9 - Cardio techniques Flashcards
What should be done to a hypovolemic patient to see neck veins
have them lie flat
What should you do to a patient that has an increased jugular venous pressure
elevate the patient head to 60 or 90 degrees
What is increased JVP correlated with
acute and chronic and left side heart failure
What findings do you see with COPD patients
venous pressure elevate on expiration
Elevated JVP is specific for
increased left ventricular end diastolic
What is the usual cause of unilateral distention of the external jugular vein
local kinking or obstruction
Where does a prominent a wave occur
tricuspid stenosis
Where does absent a waves occur
Atrial Fibrillation
Where does large v waves occur
tricuspid regurgitation
What will a tortuous and kinked carotid artery produce
unilateral pulsatile bulge
What causes decreased pulsations
decreased stroke volume
What can pressure on the carotid sinus cause
reflex drop in the pulse rate or blood pressure
Where does small, thready or weak pulse occur
cardiogenic shock
Where does a bounding pulse occur
aortic insufficiency
Where is the carotid upstroke delayed
aortic stenosis
Which two pulses vary beat to beat
pulsus alternans
Which pulse varies with respiration
paradoxical pulse
What are characteristics of Pulsus alternans
alternate loud and soft Korotkoff sounds
what do you call the difference of more than 10mmHg between the highest and lowest systolic pressure
paradoxical pulse
What diseases can be associated with paradoxical pulse
pericardial tamponade
Where can bruits arise from
atherosclerotic narrowing
What sounds are characteristics of mitral stenosis
S3
What sounds are characteristic of aortic insufficiency
soft decrescendo higher pitched diastolic murmur
Where is the S1 sound diminished
1st degree heart block
Where is the S2 sound diminished
aortic stenosis
Where would successful palpation less likely to work
thickened chests
What percentage of people have a palpable apex in the supine position
25% to 40%
What percentage of people have a palpable apex in the left lateral decubitus position
50% of people
What are two things that can displace the apical impulse upward and to the left
pregnancy
Where is lateral displacement from the cardiac enlargement seen
heart failure
What does lateral displacement outside the midclavicular line cause
cardiac enlargement 3-4x more likely
What does a diffuse PMI greater than 3cm in the lateral decubitus position represent
left ventricular enlargement
What can an increased amplitude of the pulse reflect
hyperthyroidism
A normally located amplitude that is now a sustained high amplitude impulse is caused by
left ventricular hypertrophy from pressure overload
where is a sustained low amplitude impulse seen
dilated cardiomyopathy
What does a brief middiastolic impulse indicate
S3
What impulse is indicated just before the systolic apical beat itself.
S4
When does a marked increase in amplitude with little or no change in duration occur
volume overload
When does an impulse with increased amplitude and duration occurs
pressure overload of right ventricle
What does a palpable S2 suggest
pulmonary hypertension
What does a marked dilated failing heart have for its impulse
hypokinetic apical that is displaced far to the left
What sounds does the left lateral decubitus accentuate
left sided S3 and S4
The position of sit up, lean forward, exhale completely and stop breathing in expiration will accentuate what sound
aortic murmurs (aortic regurgancy)
What do diastolic murmurs indicate
valvular disease
What do systolic murmurs indicate
valvular disease but can be nothing
What do midsysolic murmurs typically arise from?
bloodflow across the semilunar valves
What do Pansystolic murmurs often occur with?
regurgitant flow across the av nodes
What is a late systolic murmur?
murmur of the mitral valve prolapse
What do early diastolic murmurs typically accompany
regurgitant flow across incompetent semilunar valves
What do middiastolic and presystolic murmurs reflect
turbulent flow across the Av valves
Where does a loud murmur of aortic stenosis often radiate to
neck in the direction of the arterial flow
Where does the murmur of mitral regurgitation often radiate to
axilla suggesting the role of bone conduction
What is Grade 1 of a murmur
very faint
What is Grade 2 of a murmur
Quiet
What is Grade 3 of a murmur
moderately loud
What is Grade 4 of a murmur
loud with palpable thrill
What is Grade 5 of a murmur
very loud with thrill
What is Grade 6 of a murmur
very loud with a thrill
What is the most compelling feature of the murmur from the hypertrophic cardiomyopathy
only systolic murmur that increases during the strain phase
Where are the Korotkoff sounds heard during heart failure
during phase 2 strain phase
