CVS PVS Flashcards
Chapter 9, pp 333-385; 391-403 Chapter 12, pp 489-519
When inspecting, palpating and some of the auscultation of the precordium, what position should the patient be in?
Supine with 30 degree elevation at the head.
Area over the heart and lower chest
Precordium
PMI
Point of Maximal Impulse
Where is the PMI?
4th and 5th intercostal space near the midclavicular line.
When palpating the precordium, what would you methodologically be doing?
Use fingerpads first followed by the ball of the hand.
Important areas to palpate
- Aortic (2nd intercostal space on R)
- Pulmonic (2nd intercostal space on L)
- 3rd, 4th, 5th intercostal spaces along the left sternal border (Tricuspid Valve area)
- Mitral Valve/Apical Area (More towards midclavicular on L)
When palpating the extremities, you notice lymphadenopathy near the elbow. Tell me the name of these lymph nodes and where they are in relation to the general “elbow.” And what might this indicate?
Epitrochlear Lymph Nodes;
Located superior to the medial epicondyle.
Skin infection, Lymphoma, other skin malignancy
What vessels drain into the epitrochlear lymph nodes?
Ulnar, Forearm, Hand
Lymph nodes near those V-cuts cuz I’m so swole/built. (Near the groin)
Inguinal Lymph Nodes
How do you auscultate the carotid arteries?
Have patient hold breath and auscultate over each carotid artery in the neck using the diaphragm of your steth.
When palpating peripheral pulses, what is important to note about the carotid pulse?
YOU NEVER PALPATE BOTH AT THE SAME TIME
What are the 7 peripheral pulses to palpate for?
- Carotid
- Radial
- Brachial
- Femoral
- Popliteal
- Dorsalis pedis
- Posterior Tibial
When auscultating the precordium, what is important to know about your steth?
USE DIAPHRAGM, SHEESH!
Exceptions to the diaphragm usage in auscultating…of course there are exceptions…“Hhhii”
Use Bell for:
- Tricuspid Area
- Mitral Area
(Only after auscultating with Diaphragm, though)
This is the sound heard when the mitral and tricuspid valves close. What stage of the Cardiac Cycle are we in?
S1
Systole
“Lub”
It occurs just after atrial contraction and immediately before the systolic S1 and is caused by the atria contracting forcefully in an effort to overcome an abnormally stiff or hypertrophic ventricle.
S4 (Very Rare)
It occurs at the beginning of diastole after S2 and is lower in pitch than S1 or S2 as it is not of valvular origin. The third heart sound is benign in youth, some trained athletes, and sometimes in pregnancy but if it re-emerges later in life it may signal cardiac problems (Heart Failure. Beta Blocker anyone?).
S3
This is the sound heard when the aortic and pulmonic valves are closed. What stage of the Cardiac Cycle are we in?
S2
Diastole
“Dub”
Vibratory sensation cause by the heart felt on the body surface.
Thrill
After completing the first part of auscultation (with patient in a certain position), what do you do?
Ask patient to sit up and auscultate again while patient holds his breath.
Assessing the patency of the ulnar and radial blood supply. What is the name of this test?
Allen Test
Suspected Right Heart Failure would cause us to look for??
Jugular Venous Pressure
How to perform the Allen Test?
- Have the patient make a fist
- Compress both the ulnar and radial arteries with your thumbs and fingers
- Ask the patient to open the hand (note that the palm is pale)
- Release the pressure that you are holding over the ulnar artery.
If the ulnar artery is patent, the palm flushes within 3-5 minutes.
***You may also assess the patency of the radial artery by releasing the pressure on the radial artery rather than the ulnar artery.
Measurement of Jugular Vein greater than ______ cm above the sternal angle is considered elevated JVP.
3-4 cm
How to measure JVP?
- Identify the right internal jugular vein
- Identify the highest point of pulsation in the right IJ vein.
- Extend a long rectangular object or card horizontally from this point to a centimeter ruler held vertically from the sternal angle making a 90° angle.
The distance measured in cm above the sternal angle is the JVP. A measurement greater than 3-4cm above the sternal angle is considered elevated.
Anterior chest pain is often described
Ripping or Tearing
Factors that contribute to Arterial Pressure
- SV
- PR
- Blood volume
- Aorta/Large artery distensibility
Which chamber of the heart takes up the majority of the space of the anterior cardiac surface?
Right Ventricle
Any clinical symptom caused by myocardial ischemia
Acute Coronary Syndrome
Where is dependent edema located?
Lower extremities
Risk Assessment for CAD begins at what age?
20 years old
During systole, the aortic and pulmonic valves are _______ and the mitral and tricuspid valves are _______.
Open; Closed (S1 Sound!)
During diastole, the aortic and pulmonic valves are _______ and the mitral and tricuspid valves are _______.
Closed; Open (S2 Sound!)
How do you subjectively check for orthopnea?
How many pillows does the patient sleep with?
If the PMI is more than ______ deviated laterally to the midsternal line, it’s a sign of hypertrophy.
10 cm
T/F
JVP can be associated with pulmonary hypertension.
TRUE, or Right Heart Failure (Same thing kinda)
Diameter of PMI in supine patients
1-2.5 cm
