EXAM -2 CV/Peripheral Ass Flashcards
**A heave or lift =
sustained forceful thrusting of ventricle in systole secondary to **↑ **WORKLOAD
Left Vent. Heave seen where?
@ Apex
Right Vent. Heave seen where?
@ Sternal Border
Precordium palpate - If displaced down & to left =
Left Vent. Dilation = volume overload
PRECORDIUm palpate If ↑ force & duration but No change in location =
Left Vent. Hypertrophy = pressure overload
Thrill (palpable vibration), if present =
often accompanied by______
turbulent flow
• Often accompanied by murmur
Percuss -
to detect heart enlargement
Normal
Left border cardiac dullness @ 5 interspace mid-clavicular line
Dullness slopes up medially toward
sternum to **2nd interspace L. sternal border
• Right border matches
R. sternal border
Precordium Enlargement indicates_____ or _______
4 conditions
↑ Vent. volume or wall thickness
• HTN, CAD, HF, Cardiomyopathy
S3 = ____gallop 2 conditions
ventricular gallop• HF & Volume Overload
S4 =________ 1 condition
atrial gallop
Ex: CAD
Negative intra-thoracic pressure =
↑ venous return to Right heart
• A2 closes first,
then P2 – happens on inspiration
increase venous return to right heart
More to the RIGHT, Less to the LEFT (LL)
• MoRe to_____, Less to the______
theRight; Left
Neck Vessels
Reflect efficiency of cardiac function
**Carotids
- Btw. Trachea & sternomastoid m.
* Pressure wave coincides w/ systole
**Jugular veins
Reflects Right side Heart activity
•*** Filling Pressure
• **Volume Changes
Carotid Normal pulse =
• Diminished =______
• Increased = ______states such as
2+ bilaterally
↓ SV
hyperkinetic such as • (exercise, anxiety, fever, etc.)
Auscultate carotid artery for ____
Bruits
3 listening positions: (BAM)
- 1 – angle of jaw
- 2 – mid-cervical area
- 3 – base of neck
Avoid compressing may lead to
false bruits
- Up to 2/3 =______bruit, 2/3+ =
* Total occlusion =
loud ; diminished sound
no sound
Internal Jugular Vein Valve where?
• Only valve btwn. Vena Cava & Brain
JVD indicates ______
Right Sided HF
• Vol. & Pressure increase
• Jugular veins become distended = JVD
Think of Jugular Veins as a
CVP manometer
Allows “reading” of CVP
• Reference point @ Sternal Angle
• Compare w/ highest point of venous pulsation
What is a normal JVP?
Normal = 2cm or less above Sternal angle
Hepatojugular Reflux Test Perform if 2 reasons
- venous pressure elevated
* Suspect CHF
Hepatojugular Reflux Techniques
- Pt. Supine
- Your R. hand @ RUQ over Liver
- Push w/ firm sustained pressure 30 sec.
- Watch jugular veins
***Normal heart hepatojugular Reflux vs CHF
- ***With Normal Heart – veins rise few sec.s, then recede
* *** With CHF – veins stay elevated as long as you push
Clubbing use
Normal clubbing angle is
Profile sign
• Clubbing - use profile sign
• Normal nailbed angle = 160 degrees
Nailbed greater than 180
• 180+ = cyanotic heart ds, cor pulmonale, subacute BE
Normal Capillary fill time is
Normal: 1-2 sec.
• 3+ Capillary refill associated with
vasoconstriction or ↓ C.O.
• (hypovolemia, HF, Shock)
Grade Force w/ 4 point scale
4+______
3+_______
Both indicates ____
bounding
Increased
HYPERKINETIC STATES
Grade Force w/ 4 point scale
1+_______
0______
Both indicates
weak
absent
“Thready” Shock or PAD
Allen Test determines what ?
Determines patency of Radial & Ulnar Arteries
)))Allen test techniques
Compress radial artery with thumb • Ask pt. close fist several times • Continue to compress & ask pt. to open hand • Palm should turn pink ***IMMEDIATELY • If not, ulnar artery occluded • Repeat w/ Ulnar artery
Modified Allen Test – tests what________
• Occlude_________
• Normal color return =
collateral circulation
BOTH arteries
3 – 5 sec.
Leg Inspect
• Measure calf size – s/b equal bilaterally
• Diffuse bilateral edema =________
systemic illness
Leg Unilateral swelling =
acute local problem
• Asymmetry of calves
- **1cm or more refer for poss. DVT
- ***• (+) Homans’ sign (~35%)
- ->Flex knee; anteriorly compress gastroc. M., if pain = (+)
Lymphedema 1-3cm =
mild
Lymphedema 3-5cm
moderate
Lymphedema:5+cm =
severe
Leg • Brown discoloration
Hemosiderin = venous insufficiency/stasis
Venous stasis ulcers
- Above medial malleolus
* Shallow, poorly defined edges
Arterial ulcers
- @ or below lateral malleolus, foot/toes
- Deeper, well defined edge
- “punched out” appearance
Palpate & Inspect Legs
• Use_________
• Assess temperature changes/differences
• Note ___________
• If you suspect arterial deficit, raise legs ~12”, ask pt. to flex feet_______
• Then have pt. sit up, legs over side of bed
• Normal color return =
back of hand
iff gradual or abrupt
• Skin color now reflects only arterial blood contribution
< 10 sec.
Arterial deficit seen with
Unilateral cool leg or foot w/ abrupt temp. drop as you move down
what does Dependent rubor indicates =
severe arterial insufficiency
Palpate popliteal
Popliteal • Difficult to feel • Use both hands Press deep into popliteal fossa • Often felt just lateral to medial tendon
Palpate DP (location)
DP (dorsalis pedis)
• Dorsum, btwn. 1st & 2nd Metatarsal
Palpate PT (posterior tibial)
• Posterior to medial malleolus
Also palpate leg and check for __________
Check for pre-tibial edema
Bilateral dependent pitting edema indicates (2)
HF or Cirrhosis
Manual Compression Test – tests valve competence
What does competent valve prevent?
- Pt. standing
- Compress vericose vein distally
- With other hand 20cm higher, compress vein moving down the leg
- Competent valves prevent wave transmission
___________= normal valves
• No wave felt
During manual compression test if Wave felt =
incompetent valves
What does the vascular doppler check for?
• Tests for diminished peripheral flow
ABI is used for
Ankle-Brachial Index
• Non-invasive test to determine extent of PVD
• Measures pressures @ arm and ankle
In ABI, which pressure is normally higher?
Normal ankle pressure slightly higher
Normal ABI usually =
1.0 to 1.2
ABI that indicates PVD
0.9
ABI that indicates Mild PVD
0.7-0.9
ABI that indicates moderate PVD
0.7 – 0.4
ABI that indicates SEVERE PVD
• 0.4 – 0.3
PVD ABI ______ indicate extreme ischemia impending _________
< 0.3 ; limb loss
