Clinical Assessment of CV Patient - Lab Manual Flashcards
explain flow of assessment for CV patient
interview patient
ask about chest pains
review special tests
perform visual inspection
assess blood pressure
determine symptoms
if a patient has excessive nasal secretions what is indicated
Upper respiratory infection
allergies
what is important to understand about one’s cough
its onset
duration and quality
- chronic vs acute
- morning or evening
white sputum indicates
irritation
yellow sputum indicates
infection
green sputum indicates
stagnant pus in dilated bronchi
lung abscess
infected sinus
rusty sputum indicates
pneumonia
currant jelly sputum indicates
pulmonary embolus or neoplasm
pink sputum indicates
pulmonary edema
black sputum indicates
old blood
aspergillosis
soot
when observing sputum what needs to be considered
color
consistency
odor
frothy consistency indicates
common in CHF
gelatinous consistency indicates
neoplasm
what pathology does hemoptysis indicate
pneumococcal pneumonia
- streaky with specks of blood
bright red blood in the spit indicates
rupture of vessels
- could be manifestation of pulmonary TB or cancer
foul smelling sputum may indicate
systemic infection
explain the 4 point scale of dyspnea
1 - mild exertion (short distance on level surface, normal pace)
2 - moderate exertion (running short distance/climbing flight of steps)
3 - minimal exertion (breathlessness while talking, shaving, or washing)
4 - breathlessness at rest
what can be used to assess baseline dyspnea
borg dyspnea scale
what is necessary to palpate? why?
upper and lower chest
lower ribs bilaterally
back bilaterally
– in order to determine breathing pattern
what does S1 sound like? what does it represent?
high pitched and split sound at cardiac apex
mitral and tricuspid valve closure
when will an accentuated S1 be present
mitral or tricuspid valve is widely separated in diastole
or
mitral or tricuspid valves that are hard to open
what would cause S1 to be dampened
when a stenotic valve becomes nearly immobile
what pathologies may cause a soft S1
moderate-severe aortic insufficiency
advanced HF
prolonged P-R interval
mitral valves are incompetent
what does S2 represent?
what physiological action can we assume causes it
closure of semilunar aortic / pulmonary valves
deceleration of blood in the root of pulmonary artery at end-systole
where can S2 be auscultated
second ICS in midclavicular line with diaphragm of stethoscope
what can a soft semilunar aortic valve (A2) closure be indicative of
incompetent aortic valves
severe aortic stenosis
decreased diastolic pressure
air trapping of COPD
an accentuated S2 can be caused by
a loud A2 or P2
P2 = when pulmonary component of S2 is louder than S1
explain timing component of S2
A2 precedes P2
what is wide splitting of S2
when P2 is delayed after A2
- early aortic valve closure or delayed pulmonic valve closure
what is paradoxical splitting of S2? what may cause this?
A2 occurs after P2
early pulmonary valve closure
delayed activation of left ventricle
prolongation of left ventricular contraction
what pathologies may cause wide splitting of S2?
severe mitral regurgitation
RBBB
what pathologies may cause paradoxical S2
early pulmonic valve closure = severe tricuspid insufficiency
delayed activation of left ventricle = LBBB
prolongation of left ventricle contraction = HTN, aortic stenosis, severe systolic dysfunction
what is fixed splitting? what may cause this?
when time interval between A2 and P2 does not increase during inspiration
large atrial septal defect
severe right ventricle failure
when is S3 found
early in diastole
how to auscultate for S3
end expiration with bell near apex
- patient in left lateral decubitus position
explain the occurrence of S3
normal in children and young adults
> 40 y/o = increase in passive diastolic filling in either right or left ventricle
left ventricle S3 is caused by
HR
hypertrophic cardiomyopathy
left ventricular aneurysm
hyperdynamic states
how is right ventricle S3 auscultated
patient supine
3rd intercostal space at left sternal border
what would accentuate RVS3
inspiration
how is S4 auscultated
bell of stethoscope
apex of heart in left lateral decubitus position
when does S4 occur? how to distinguish it?
just before S1
can be extinguished by firm pressure on the bell of stethoscope
what causes S4
vigorous atrial contraction to propel blood into stiffened left ventricle
when will S4 accentuate
inspiration
what is a ventricular gallop associated with
S3
explain ventricular gallop
occurs early in diastole when LV is passively filling
will require a very compliant LV
can be a sign of systolic CHF
what is an atrial gallop associated with
S4
explain atrial gallop
late in diastole during active LV filling
almost always abnormal
noncompliant LV
sign of diastolic CHF
what does a high-pitched diastolic click signify
abnormal semilunar valves
dilation of great vessels
augmented flow states
what does a mid-diastolic opening snap indicate
opening of a stenotic mitral valve
– will disappear when stenotic valve becomes severely calcified because it does not move
what does a dull sound early to mid-diastolic knock indicate
abrupt cessation of ventricular filling
– secondary to a non-compliant and constructive pericardium
if a murmur is present in the right 2nd ICS
what is it called? what is indicated?
aortic area murmur
- systolic murmur
aortic stenosis / aortic valve sclerosis
if a murmur is present in the left 2nd ICS
what is it called? what is indicated?
pulmonic area
– systolic ejection murmur
pulmonic stenosis
atrial septal defect
flow murmur
if a murmur is present in the left 3rd ICS
what is it called? what is indicated?
Erb Point
– diastolic murmur
via aortic or pulmonic regurgitation
– systolic murmur
via hypertrophic cardiomyopathy
if a murmur is present in the left 4th ICS
what is it called? what is indicated?
tricuspid area
– holosystolic murmur
via tricuspid regurgitation or ventricular septal defect
– diastolic murmur
via tricuspid stenosis
if there is a murmur in the 5th ICS at apex of the heart
what is it called? what is indicated?
mitral area
– holosystolic murmur
via mitral regurgitation
– systolic murmur
mitral valve prolapse
– diastolic murmur
via mitral stenosis
location of tricuspid valve in auscultation
just left laterally of sternum
5th ICS
location of pulmonic valve in auscultation
just left laterally of sternum
2nd ICS
location of aortic valve in auscultation
just right laterally of sternum
2nd ICS
explain process of auscultation
begin at apex (midclavicular line 5th ICS)
- listen for S1/S2
move to tricuspid (5th ICS by sternum)
move to pulmonic (2nd ICS left of sternum)
move to aortic (2nd ICS right of sternum)
repeat process with bell looking for murmurs
– have patient lie on their left side to listen to murmurs at apex
when will gallops be heard
S3 = following S2
S4 = just before S1
