Chap. 9 - Cardio techniques Flashcards by Deanna Volking

What should be done to a hypovolemic patient to see neck veins

have them lie flat

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What should you do to a patient that has an increased jugular venous pressure

elevate the patient head to 60 or 90 degrees

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What is increased JVP correlated with

acute and chronic and left side heart failure

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What findings do you see with COPD patients

venous pressure elevate on expiration

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Elevated JVP is specific for

increased left ventricular end diastolic

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What is the usual cause of unilateral distention of the external jugular vein

local kinking or obstruction

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Where does a prominent a wave occur

tricuspid stenosis

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Where does absent a waves occur

Atrial Fibrillation

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Where does large v waves occur

tricuspid regurgitation

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What will a tortuous and kinked carotid artery produce

unilateral pulsatile bulge

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What causes decreased pulsations

decreased stroke volume

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What can pressure on the carotid sinus cause

reflex drop in the pulse rate or blood pressure

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Where does small, thready or weak pulse occur

cardiogenic shock

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Where does a bounding pulse occur

aortic insufficiency

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Where is the carotid upstroke delayed

aortic stenosis

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Which two pulses vary beat to beat

pulsus alternans

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Which pulse varies with respiration

paradoxical pulse

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What are characteristics of Pulsus alternans

alternate loud and soft Korotkoff sounds

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what do you call the difference of more than 10mmHg between the highest and lowest systolic pressure

paradoxical pulse

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What diseases can be associated with paradoxical pulse

pericardial tamponade

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Where can bruits arise from

atherosclerotic narrowing

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What sounds are characteristics of mitral stenosis

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What sounds are characteristic of aortic insufficiency

soft decrescendo higher pitched diastolic murmur

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Where is the S1 sound diminished

1st degree heart block

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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

What impulse is indicated just before the systolic apical beat itself.

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