CV exam 1/18 Flashcards
skin observations linked to
less cardio output and low O2 sat
cyanosis - blue skin, nail beds, lips, tongue
pallor - washed out, absence of pink
diaphoresis - excess sweating, cool, clammy skin
how long to palpate pulse?
- regular rhythm
- irregular rhythm
regular - 30 seconds
irregular - 1 min
what sitations/diagnoses displace apex of heart upward?
pregnancy
high diaphragm
what sitations/diagnoses displace apex of heart laterally?
congestive heart failure
cardiomyopathy
ischemic heart disease
where to palpate carotid pulse?
why only one side at a time?
between SCM and trachea
reduce risk of stimulate carotid sinus baroreceptor > cause decrease in HR and BP
best place to palpate pulse in infants?
brachial
- medial aspect antecubital fossa
pulse palpation sites?
apical radial carotid brachial femoral poplital pedal
where to palpate apical pulse, mitral auscultation?
aka PMI point of maximal impulse
patient supine
palpate 5th interspace, midclavicular vertical line = apex of heart
(location may change based on conditions)
grade for pulse
- normal
- absent
- bounding
normal 2+
absent 0
bounding 4+
normal HR for
- adults
- teens
60-100bpm
normal HR for
- children
60-140bpm
normal HR and average for
- newborn
90-164bpm
average 127bpm
normal HR for
- aerobic athletes
40-60bpm
what is tachycardia?
when would you see compensatory tachycardia?
HR >100bpm
volume loss - surgery, dehydration
postural tachycardia syndrome-
HR increases #? within 10min standing
- adults
- teenagers
adults >=30bpm
teenagers >=40bpm
what is irregular pulse?
possible causes?
varied force and frequency
possibly arrhythmia, myocarditis
possible causes weak pulse?
grading scale?
1+ pulse diminished
low stroke volume, cardiogenic shock
possible cause bounding pulse?
grading scale?
4+ bounding pulse
shortened ventricular systole, decreased peripheral pressure, aortic insufficiency/aortic regurgitation
what is aortic insufficiency, aortic regurgitation
leaking of the aortic valve
- causes blood to flow in the reverse direction during ventricular diastole (aorta > left ventricle)
- cardiac muscle is forced to work harder than normal.
auscultation landmarks
- aortic
- pulmonic
- tricuspid
- mitral
aortic - 2nd R intercostal, sternal
- pulmonic - 2nd L intercostal, sternal
- tricuspid - 4th L intercostal, sternal
- mitral - 5th L intercostal, midclavicular
what auscultation landmark?
2nd R intercostal, sternal
- aortic
what auscultation landmark?
2nd L intercostal, sternal
pulmonic
what auscultation landmark?
4th L intercostal, sternal
tricuspid
what auscultation landmark?
5th L intercostal, midclavicular
mitral
what heart sound?
normal closure mitral and tricuspid valves
beginning of systole
S1 lub
what heart sound?
decreased in 1st degree heart block
S1 lub
what heart sound?
normal closure aortic and pulmonary valves
end of systole
S2 dub
what heart sound?
decreased in aortic stenosis
S2 dub
what heart sound?
extra heart sound, between S1 and S2
may indicate valvular disease (eg. mitral valve prolapse) or normal
systolic murmur
what heart sound?
extra heart sound, between S2 and S1
usually indicates valvular disease
diastolic murmur
how are heart murmurs graded?
- softest audible mumur
- loudest, audible without stethoscope on chest
- softest grade 1
- loudest grade 6
what term?
- abnormal tremor/vibratory sensation felt on the skin overlying an area of turbulence
- accompanies vascular or cardiac murmur
- felt on palpation
- caused by an incompetent heart valve
thrill
what term?
- vascular murmur
- abnormal sound generated by turbulent flow of blood in an artery due to either an area of partial obstruction or a localized high rate of blood flow through an unobstructed artery.
- blowing sound
bruit
where are bruits common?
indicative of what pathology?
femoral arteries, carotid arteries
atherosclerosis
what heart sound?
- abnormal 3 sound in each cycle
- Low frequency sound in early diastole, ventricular filling after S2
- increased atrial pressure leading to increased flow rate
indicative of what pathology?
S3 gallop, “Kentucky” gallop
congestive LV heart failure
athletes
what heart sound?
- abnormal 3 sound in each cycle
- Low frequency sound in presystolic portion of diastole, during ventricular filling and atrial contraction
- just before S1
- left ventricle is noncompliant, atrial contraction forces blood through AV valves, blood strikes the left ventricle
indicative of what pathology?
S4 gallop, “Tennessee”, after load is high blood slams L ventricle
atrial coronary artery disease, MI myocardial infarction, chronic hypertension, aortic stenosis ischemic or hypertrophic cardiomyopathy.
what term?
disease of the heart muscle that makes it harder for your heart to pump blood to the rest of your body.
- can lead to what?
- main types?
Cardiomyopathy
lead to heart failure.
dilated, hypertrophic and
restrictive cardiomyopathy.
