CV Assessment Flashcards
CV Fetal Changes
- Lungs are bypassed and blood is pumped through patent ductus arteriosus
- Both L and R ventricles pump into systemic circulation
CV Newborn Changes
- Closure of ductus arteriosus w/in 24-48 hours
- Closure of foramen ovale from increased L vent pressure, causes L vent to increase in size
- Murmurs are common in 1st 48 hours
CV Infant/Child Changes
- year 1 = L:R ventricle ratio = 2:1
- by age 7, the heart has reached its adult position
- S3/S4 common
CV Pregnancy Changes
- increased blood volume by 40-50% (70% with twins) (mostly plasma)
- Left ventricle increases in thickness and mass
- Increased CO by 30-40%
- Heart is shifted horizontal with slight axis rotation
- SVR is decreased
- BP may be slightly decreased in 2nd tri
CV Older Adult Changes
- heart decreases with age unless HTN/heart disease causes enlargement
- Valves fibrose and calcify
- Decreased SV and CO during exercise
- Delayed contractility
- Longer returns to normal HR; tachycardia not tolerated well
- SA node fibrosed –> ECG changes
- Apical impulse hard to find
- S4 common
Cardiac Origin of Chest Pain Symptoms
- substernal
- specific and abrupt onset
- provoked by activity/emotion/eating
- relieved by rest/nitro
- disappears if cause is eliminated
- accompanied y diaphoresis
- may awaken from sleep
- forces patient to stop effort
- Pain often early in AM
- Greater liklihood in cold weather
Signs of Pericardial Fluid
- decreased heart sounds
- non-visual of apical impulse
PMI
- L 5th intercoastal, MCL (adults)
- L 4th intercoastal medial to nipple (children)
- point at which apical impulse is most readily felt or seen
Heave or Lift
- if apical impulse is more vigorous than expected
- may indicate hypertrophy, increased CO
Thrill
- fine, palpable, rushing vibration; palbaple murmur
- typically found in L or R intercostal
Carotid Pulse
Synchronous with S1
-located medial to and below angle of jaw
Aortic Valve area
2nd R intercoastal at sternal border
Pulmonic Valve area
2nd L intercoastal at sternal border
Tricuspid area
4th L intercoastal at sternal border
Mitral
Apex, 5th L intercoastal at MCL
S1
- closure of mitral and tricuspid valves (AV)
- coincides with beginning of systole
- longer duration
S2
- closure of aortic and pulmonic valves (semilunar)
- coincides with beginning of diastole
S3
- passive flow of blood from atria
- when easy to hear = S3 gallop or early diastolic gallop
- Heard during diastole
- ken-TUCK-y
- MR
S4
- vigorous atrial ejection
- vibration in valves
- Often confused with S1 split
- presystolic gallop
- commonly heard in elderly pts
- due to increased resistance to vent filling
- TEN-nes-see
- AS & late MR
Mitral Regurgitation
- Holosystolic
- Plateau shaped intensity
- high pitched
- harsh blowing
- may obliterate S2
- radiates from apex to base or L axilla
- thrill may be palpable
- S1 diminished
- S2 more intense with P2 accented
- S3 present
- S3-S4 gallop common in late dz
- “Hand grip technique”
Aortic Stenosis
- Midsystolic Murmur
- Coarse
- Diamond shape
- crescendo-decrescendo
- L sternal border - apex
- S1 may disappear
- S2 soft or absent
- S4 palpable (L vent hypertrophy)
Murmur Grading
I barely audible II quiet, but clearly audible III moderate IV loud, associated with thrill V loud, thrill easily palpable VI very loud, without stethoscope, thrill palpable and visible
PR interval
0.12-0.2
QRS
< 0.12
QT
< 0.48 ish
U wave
- small deflection after T wave (r/t purkinje fibers)
- Common in bradycardia
- Can be seen with electrolyte issues, hypothermia, hypothyroidism
Expected Pulse Grade
+2 in brachial pulses bilaterally
Normal JVP
3-4cm above sternal angle with HOB at 30 degrees
6-9 per presentation
1+ edema
2mm, disappears rapidly
2+ edema
4mm, disappears 10-15 secs
3+ edema
6mm; >1 minute
4+ edema
8 mm; lasts 2-5 minutes
