ECR Cardiovascular 12.5.12 Flashcards
Where is the PMI (Point of maximum impulse)
5th intercostal space
Left Ventricle
What are common comlaints that would warrant a CV pathology?
Chest pain
Fatigue
Cough
Difficultly breathing (Dyspnea, Orthopenia, Paroxysal noctural dyspnea)
Loss of consiousness
What is orhopnea
lie down, positional breathing
What is Paroxysmal nocturnal dyspnea
lying down, aweaken by cough in the middle of night
4 steps of cardiac exam
Insection
Percussion
Palpation
Auscultation
Steps for vascular Exam
Pulses
Signs of arterior or venous insufficiency
What to look for in General Appearance
Level of concsiousness (aweake, alert, responsive to the environemnet
Signs of distress, labored breating, sweating, in pain, anxiety, cyanotic
Height and weight
What are four Vital Signs
BP
PUlse
RR
Temp
Cardiac Exam Components (3)
Inspect
Palpate
Ausculate
Pericardium
fibroserous sac surrounding heart and roots of great vessels (pericarditis if there is sac)
Myocardium
Chambers- Atria and Ventricles- supplies pumping energy
Endocardium
LINING OF HEART CHAMBERS and valves prevents thrombosis
What are the three chambers of the heart
- Right/Left Atria- Reservoirs
- Right/Left Ventricle- Pumps
- Interatriala nd Interventricular septa- divide right/left heart chambers
What are the 4 valves of the heart
- Tricuspid- separates Rt Atrium and Rt ventricle
- Mitral valve- left atrium and left ventricle
- Pulmonic valve- rt ventricle and pulmonary artery
- Aortic-Valve- left ventricle and aorta
Where is the PMI
Point of Maximal impulse
5th intercostal space (midclavicular line (apex)
Precordum, wehre you hear heart beat, medial clavicule–> Left ventricle, Mitral region
Palpation: Heaves and Thrills
Palpate with side of hand of MCP joints for thrilsl (grade 4 or greater murmur) and heaves
WHen are heaves visible or palpable?
when chamber enlargemetn or hypertrophy is present and impacts the chest wall with cardiac motion
What are normal heart sounds?
S1/S2- most distinct, splitting
What are extra heart sounds?
Gallops S3/S4- more difficult to hear
Murmurs (Grade I-VI)
Friction rubs
Bell vs Diaphragm
Bell - smaller (low pitched sounds)
Diaphragm- sensitive to high pitched sounds
What happens during Systole
period of ventricular contraction to eject blood
Aortic and pulmonic valvaes open.
Mitral and Tricuspid valves close
What happens during Diastole
Period of Ventricular relaxation/ atria move blood to ventricle
Aortic and Pulmonic valves Closed.
Mitral and Tricuspid Valves Open
S1- 1st heart sound
Ass. with closure of mitral and tricuspid leaflets
(aortic and pulmonary open)
M1 an T1
which is louder during S1, M1 or T1?
M1 is louder and best heart at apex
T1 is best heard at lower LSB (lowe sternal border)
S2
Componnent of S2 include (arotic valve closure) and P3 (pulmonic alve closure)
Which is louder duing S2 (A2 or P2)?
A2 is louder than P2
A2 is heradn thorught the precordium
2 is heard best in 2nd and 3rd ICS on left close to sternum
What are the pulses tha tyou have to ausculate and palpate (5)
- Carotid
- Femoral
- Popliteal
- Posterior Tibila
- Dorsalis Pedis
What are pulses and what do they mesure?
Measure of PERFUSION (blood flow oxygen) to a region
Arteries carry blood form heart/
Pulses measure arterial Pressure
How can perfusion be impaired
cardiac problem/heart failture
Arterial disease/ Atheriosclerosis
Traumatic Injury
Which pulses are central pulses. When are they lost?
Carotid
Femoral
Loss at SBP (systolic baseal pressure?_ <50
Which pulses are peripheral?
Brachial, radial
popliteal
posterior tibial
Dorsalis Pedis
What are the gradign for periphearl arteries?
3_= boudnign
2+ risk, expected (normal)
1+- diminished, weaker than expected
0- absent, unable to palpate
indicate whether it is equal bilaterally
Where do you ausculate for Bruits?
Temporal
Carotid
Abdominal aorta
Renal/iliac/femoral arteries
Indicated Turbulent Flow-
Transmitted murmurs
Obstructed arterial disease
Remember to HOLD BREATH
Other findings ass. with arterial insufficiency
Palor/cyanosis
Poor hair growth/skin atrophy
Impaired wound healting
Regional uscle pain with exertion (claudification) - insufficiency
Check the tem
venous insufficiency/edema
when examing lower extremeity, look for signs of venous insufficiency (problem returign BF to heart)
Inspect for varicose veins and skin findings ass with poor blood return (statis dermatitis, swelling)
Edema
Note for pitting
1( slight) - 4 (marked)
may indicate regional pathology (unilateral) or more significant cardiac patholgoy/heart failure (bilateral)
S3
heard after S2
Originates as blood hits the ventricular walls during ventricular filling (diastole)
When is S3 heard best?
What is cause for it
when listening over mitral area
Overload ofa non-compliant left ventricle
LV hypertrophy
what is S4
heard after S3, prior to S1
Originates as blood hits ventricualr walls during late ventricular filling (atrial kick)
when is S4 best heard
low pitch (bell) best heard when listenign over mitral area
Overlaod of a non-compliant left ventricule (LV hypertoprhy)
Which heart sounds are like Kentucky
S1, S2, S3
Which heart sounds are like Tennessee
S4 S1 S2 S3
How are murmurs different form S3 and S4
Cardiac murmurs are differentiated form ehart soudns by their longer duration
S3/S4- blood hitting ventricualr walls
Murmur- narrow valve orifice (stenosis)
What causes murmucs
forward flow thorugha narrowed valve orifice (stenosis)
High flow rate through normal or abnormal orifices
Backward flow through a valve that doesn’t fully close (regurgitation or insufficiency)
When do you hear systolic murmuc?
between S1 and S2
When do you hear diastolic murmur
between S2 and S1
What is the gradign scale for murmurs
I-VI
Grade I1
faint, heard only by cardiologist
Grade II
quiet but heard immediately
III
moderately loud, no thrill
IV
loud, thrill present
V
very oud, heard with scope off of chest
VI
very oud, heard with /without scope
