Exam 2: Cardiovascular Assessment Part 2 Flashcards
What does an aortic or pulmonic ejection click sound like and what does it indicate?
- High pitched sound at beginning of systole
- indicated valve disease, dilated aorta or pulmonary artery, or pulmonary hypertension
** Best heard with diaphragm of stethoscope
What is a mitral valve prolapse?
Ballooning of mitral leaflets into the left atrium during systole.
-Mid to late systolic clicks are often present.
What causes venous hum?
- Turbulent blood flow through jugular veins
- both systolic and diastolic sounds
What causes pericardial friction rub and what are the 3 components of it?
- Caused by inflammation of pericardial sac
- 3 components are scratchy, squeaky, and intermittent
What does increased jugular pressure indicate?
- Increased pressure in the right atrium related to intravascular fluid volume
- Mainly reflect right heart function
What is best used to assess jugular venous pressure?
Right internal jugular vein or external jugular vein
How do you perform the specialized exam of measurement of JVP?
Stand on the patients right with the exam table at 30 degrees.
Patients head is turned slightly to the right. Find the highest point of oscillation in the right internal jugular vein.
Measure the vertical distance above the sternal angle.
Add 5 cm and the sum is JVP.
What can cause increased JVP?
Hypervolemia from heart failure, pulmonary HTN, increased venous vascular tone, and pericardial tamponade
What is considered an elevated JVP?
8cm above the RA
What causes decreased JVP?
Hypovolemia due to blood loss or decreased venous vascular tone
How do you perform the specialized exam Hepatojugular reflux?
Patient is supine with the exam table at 30 degrees. Apply firm, sustained pressure to the abdomen in the RUQ over the liver region. Observe the neck for an increase in JVP, followed by a decrease when the hand is released.
JVP will transiently increase in all patients, but is exaggerated in right heart failure.
What is a positive hepatojugular reflex?
Greater than 3cm increase, or is remained elevated.
What is a thrill and what causes it?
Buzzing or vibratory sensation, caused by vigorous blood flow through any narrowed opening.
What is a lift (or heave) and what causes it?
Vigorous cardiac impulse that can be seen/felt through the chest wall, may be caused by ventricular hypertrophy or hyperdynamic ventricular activity.
Where should you palpate when checking for lifts and thrills?
The left sternal border
Where should you palpate for the apical impulse?
The apex
What does the point of maximal impulse represent?
Pulsation of the left ventricle.
Where is the point of maximal impulse for patients with COPD?
Mya be in the xiphoid or epigastric area due to right ventricular hypertrophy
What is cardiac percussion used for?
Estimating cardiac size
What does a cardiac impulse lateral to the mid clavicular line or larger than normal suggest?
Left ventricular enlargement
How do you perform the specialized exam of cardiac percussion?
Begin at the 5th intercostal space in the mid axillary line and percussion medically, listening for onset of dullness.
Ex) Left border of cardiac dullness (LBCD) is 2cm lateral to the midclavicular line in the 5th ICS
What does auscultating the cardiac apex with the bell while the patient is in the left lateral decubitus position help you hear?
-Low pitched filling sounds, such as gallops and murmurs
What does it mean it mean if pulses are 1+?
Pulses are diminished and weaker than expected
What does it mean if pulses are 2+?
Brisk and normal
What does it mean if pulses are 3+?
They are bounding
How would cardiogenic shock affect the carotid arteries?
It could make the carotid pulse small and weak
How does aortic regurgitation affect the carotid pulse?
It makes it bounding
How does aortic stenosis affect the carotid pulse?
It delays the pulse
What is a bruit?
A murmur like sound arising from turbulent arterial blood flow
How do you perform the Allen test and what is a normal result?
Ask the patient to make a tight first. Compress both the radial and ulnar arteries. Ask patient to open hand (it should be pale). Release pressure over ulnar artery.
If normal, the palm flushes within 3-5 seconds
What does the Allen test evaluate?
Patency of the ulnar artery.
Where should you auscultate the abdomen for bruits?
The aorta, renal arteries, iliac arteries, and femoral arteries
How do you perform Homans sign and what does it evaluate for?
- Check for calf pain on passive dorsiflexion of the foot.
- It is an unreliable test for presence of DVT
How do you perform Buerger test?
- Raise both legs to about 90 degrees for up to 2 minutes. Then ask patient to sit up with legs dangling.
- Check for return of color to skin and an abnormal test is when it takes longer than 10 seconds for the color to return.
