Clinical Skills Flashcards
which pulse is best for assessing volume and character?
carotid
which pulse is best for assessing rhythm and rate?
radial
what is a thrill?
a vibration sensation caused by turbulent blood flow. It’s always accompanied by a cardiac murmur on auscultation. BUT a murmur is not always accompanied by a thrill. When you put your hand on a thrill: it feels like a “purring cat”.
To feel for thrills, how many places do you need to place your hand?
4 (over the 4 auscultatory areas)
What might a displaced apex beat indicate?
LV dilatation (but there are other possible pathologies which could displace apex beat)
Pure LV hypertrophy (with no dilatation) will NOT displace the apex beat. True/ False?
True. Pure LV hypertrophy may, however, result in a change of character of the apex beat from normal to a lifting/ heavy character.
what is a heave?
A feeling of hypertrophied ventricle beating underneath your hand. It feels as if the palm of your hand is being lifted off the surface of the patient each time the heart beats. As the RV makes up a large part of the anterior surface, a heave felt as a result of hypertrophied RV would be felt in the left parasternal area. A similar sensation over the apex beat would indicate LV hypertrophy.
Why are the auscultatory areas positioned as they are?
Because this means that the blood is flowing towards your stethoscope
auscultatory area for mitral valve?
5th left intercostal space, mid-clavicular line
auscultatory area for tricuspid valve?
4th left intercostal space
auscultatory area for pulmonary valve?
2nd left intercostal space, left sternal edge
aucultatory area for aortic valve?
2nd right intercostal space, right sternal edge
what is LUB due to?
closure of mitral and tricuspid valves
What is DUB due to?
closure of aortic and pulmomary valves
in which two locations is the 2nd heart sound louder?
the aortic and pulmonary areas
