Examination of Cardiac Patient

Question 1

4 important aspects of chart review

Answer 1

1. hospital course
2. chief complaint
3. procedures during hospitalization (resutls from tests)
4. Labs

Question 2

4 things to look for when looking at a patients medications

Answer 2

1. current meds
2. meds with impact on hemodynamic responses
3. intravenous meds (w/ a short half life)
4. timing of meds

Question 3

3 things to look out for during patient interview

Answer 3

1. level of mentation (hypoperfusion)
2. anginal equivalent (recurrent pain patterns)
3. baseline lvl of dyspenia

Question 4

borg scale of percieved dyspenia

levels 0, 2, 5, 10 are what?

Answer 4

0 - no shortness of breath
2 - mild SOB
5 - strong or hard breathing
10 - SOB so bad you need to stop and rest

Question 5

during the observation/evaluation of venous pressure what 4 areas should you observe?

Answer 5

1,2 Jugular venous distension of external and internal jugular vein

3. central venous pressure
4. veins of dorsum hand

Question 6

what 3 factors influence arterial pulse?

Answer 6

1. stroke volume
2. ejection velocity
3. systemic vascular resistance.

Question 7

what is pulsus alternans?

Answer 7

regular alternation in force of beats - weak pulse follows a strong pulse.
produced when stroke volume increases then decreases from beat to beat

Question 8

what is pulsus parodoxus?

what is the minimal systolic pressure in the radial, femoral, and carotid artery?

Answer 8

pulse volume decreases during inspiration and increases in exhalation
80, 70, 60 mmHg

Question 9

where is the apex beat/apical impulse on the body?

what is a thrill?

Answer 9

most lateral and inferior point cardiac impulse can be felt on a patient (indicator of heart size)
palpable murmur

Question 10

what do you do differently when auscultating the lungs versus auscultating the heart?

Answer 10

with the lungs you want to auscultate both anteriorly and posteriorly going side to side, while with the heart you want to use the inching method via moving from apex > sternal border > aortic area (or vice versa)

Question 11

how hard do you press down on the patients skin with the diaphragm? with the bell?

Answer 11

diaphragm - leave slight depression in their skin

bell - gently to barely make air seal

Question 12

what is a bruit?

what does a supraclavicular arterial bruit sound like?

Answer 12

abnormal sound in an artery where blood rushes past an obstruction.
low to medium pitch crescendo-decrescendo

Question 13

what does S1 mark the sound of?

where is it heard the loudest?

Answer 13

Mitral M1 and triscupid T1 closure

mitral area

Question 14

what does S2 mark the sound of?

how is it possible to hear A2 and P2 as separate sounds?

Answer 14

signals the end of ventricular systole, A2 and P2

have the patient quitely breathe

Question 15

What does S3 mark the sound of? (Abnormal)
when is right ventricular S3 loudest?
How is the sound different during left ventricular S3?

Answer 15

ventricular gallop (rushing in)
inspiration
remains unchanged or decreases in loudness

Question 16

what does S4 mark the sound of? (Abnormal)

when is left sided and right sided S4 loudest?

Answer 16

atrial gallop (stiff wall)
Left sided - louder on expiration
right sided - louder on inhalation

Question 17

when does a summation gallop occur? (2) Abnormal sound

Answer 17

when S3 and S4 sound fuse

heart rate > 120

Question 18

which patients present with a pericardial friction rub?

where is it best to auscultate to detect this condition?

Answer 18

patients with inflammation of the pericardial membrane or pleural sac
over the 3rd or 4th ICS at left sternal border

Question 19

4 main factors in the production of heart murmers

Answer 19

1. high rate of flow through valves
2. forward flow through constricted valve
3. backward flow through incompetent valve
4. decreased viscosity of blood

Question 20

classifications of murmurs for systolic/diastolic

Answer 20

early, mid, late, holosystolic (systolic only)

continuous

Question 21

6 grading intensities of heart murmurs

Answer 21

I: audible only with concentration
II: faint, but heard immediately
III: not loud, but somwhat louder than grade II
IV: loud, but still of intermediate intensity. Associated with a palpable thrill
V: very loud, and heard with only one edge of the stethoscope against the chest wall. Palpable thrill.
VI: so loud that it can be heard with the stethoscope off the chest wall. A palpable thrill is present

Question 22

which korokoff sounds are typically used to measure BP?
which in pregnant women and children
exercising patients?

Answer 22

1st and 5th
1st and 4th
1st, 4th, and 5th or just 1st and 4th