Evaluating the Heart Flashcards
What happens during diastole? Do you feel a pulse?
Ventricles relax and fill
No pulse felt
AP closes
What happens during systole? Do you feel a pulse?
Ventricles contract
Pulse felt
MT closes
What’s the S1 sound and what causes it?
S1 = “lub”
Sound of MT closing
Where would you hear the S1 sound loudest?
Lower toward the apex of the heart
How can you determine whether sound is S1 or S2?
Feeling pulse
Pulse coincides with S1
What symptoms would you note that would get you to check the heart sounds?
SOB, fatigue, Orthopnea
Edema, nocturia
Ischemic chest pain, irregular rhythm or rate
How would you palpate to feel for S1?
At site of strongest pulse - typically radial
Palpate 30-60 seconds
Where would you auscultate the heart?
Mitral = Apex of heart
5th intercostal space on left( 1/2 way btw nipple and sternum)
Aortic = Base of heart
2nd intercostal space on right
How could you make it easier to hear heart sounds?
Have patient lean forward
Is the mitral sound related to inflow or outflow?
Inflow into left ventricle
Is the Aortic sound related to inflow or outflow?
Outflow
How would you go about auscultating the heart?
Snake stethoscope down pt’s shirt
Have them position stethoscope head
Have them put fingers on either side of head
Grab stethoscope head and listen
How would you direct the pt to the mitral heart sound?
Base of sternum, 4 fingers over, 4 fingers up
How would you direct the pt to the aortic heart sound?
4 fingers under clavicle right near the sternum
What is an S2 split and when would you hear it?
When aortic and pulmonic don’t close at same time
Happens during inhale in young pts
Nbd
When would you hear an S3 sound? What does it sound like?
Ventricular
Lub Duba
When would you hear an S4 sound? What does it sound like?
Late diastolic/atrial
t’lub dub
When causes a heart murmur?
Disrupted flow of blood from valves
Stenosis: Valve can’t open as much as it should
Regurgitation: Valve doesn’t close quite right
What causes stenosis heart murmur?
Aortic (systolic) or triscupid (diastolic) stenosis
What causes regurgitation heart murmur?
Mitral (systolic) or pulmonic (diastolic) regurgitation
How would you tell which valve was causing the murmur?
Do EKG
What are signs and symptoms that would lead you to do a vascular eval?
Ischemic diseases
TIA
Angina
Peripheral vascular disease
What are the 5 p’s to watch out for that would lead to a vascular eval?
Pain, pallor, paresthesia, paralysis, pulselessness
What do you look for when inspecting pt for vascular dz
Extremities for pallor, cyanonsis or loss of hair on toes
Where would you listen when you auscultate the carotids and what are you listening for?
Listening at base of neck, in the middle where it bifurcates and at the angle of the jaw
Do bifurcation if only can do one
What can you specifically hear at the bifurcation of the carotid?
Bruit if the carotid >50% stenosed but
What’s the general rule for auscultating and palpating the carotid?
Auscultate high, palpate low
Where would you palpate the patient for a vascular eval?
Carotids (ONE AT A TIME) at base of neck
Temporal artery (in front of tragus)
Radial pulse + brachial pulse
Dorsalis pedis + posterior tibial
Where is the dorsalis pedis and posterior tibial pulse? What can you do to make them easier to feel?
Dorsalis pedis: Lateral to highest cuneiform on foot
Dorsiflexion
Posterior tibial pulse: Posterior and slightly superior to medial malleolus
Plantar flexion
Where’s the brachial pulse and what could you do to make it easier to feel?
Below biceps on bony area
Hyperextend it.
