Lecture 11: Cardiovascular Evaluation Flashcards
What is tachycardia considered to be?
Over 100 bpm
What is the normal heart rate range?
60-80 bpm
What is bradycardia considered to be and who can it normally occur in?
Less than 60bpm and it can be a normal occurrence for athletes
How long should you take heart rate for (in determining bpm) for a normal heart? How about in arrhythmias? Exercise?
15 or 30 seconds for a normal heart
60 seconds for a irregular heart
10 seconds during exercise
What are the grading scales for arterial pulses?
0 - absent 1 - trace 2 - normal 3 - greater than normal 4 - bounding
You note that your patient’s pulse is weak. What are the possible reasons for this?
(1) peripheral occlusion
(2) dehydration
(3) low BP
(4) arrhythmia
What different locations can arterial pulses be taken on the body?
- carotid, brachial, radial, femoral, popliteal, posterior tibial, dorsalis pedis , aortic (above umbilicus)
What is JVD a measurement for?
Jugular venous distribution measures right heart failure.
What distance is considered normal when measuring JVD vertically above the sternal angle? Abnormal?
Normal: less than 3-5 cm
Abnormal: greater than 5 cm
How far can one measure JVD?
Up to the angle of the jaw
How is BP indirectly measured?
With a sphygmomanometer at the arm or thigh
What % of the circumference of the arm/thigh is the bladder of the sphygmomanometer at the correct length and width?
Width - 40%
Length - 80%
If you use a BP cuff that is too small, how will this alter the reading?
BP will be too high - inadequate compression of the arm.
What is the technique for taking BP?
-Limb is relaxed and at heart level
-Palpate artery
-Place midpoint of cuff over the brachial artery
-Wrap cuff snugly
-Inflate cuff 20-30 mmHg above point when radial artery disappears
Deflate cuff 2 to 3 mmHg per second
If you miss a reading and or need to retake BP what do you do?
deflate cuff fully and wait 1-2 minutes before next measurement.
If you miss the reading and/or need to retake BP can you take the BP in the other arm?
No, because you want to stay consistent with the limb BP.
When you note a BP measurement in the chart, what must you specify?
Which limb the measurement was taken
Position (ie. sitting/supine/standing)
SBP/DBP
What are the 2 normal heart sounds? Two abnormal?
Normal: S1-S2
adventitious: S3-S4
For listening for normal heart sounds, what part of the stethoscope should you use?
Diaphragm
For listening for adventitious heart sounds, what part of the stethoscope should you use?
The bell
What is the S1 heart sound signify? What does it sound like? Where is it best heard?
- AV valve closure
- lower pitch, softer, longer
- heard best at the apex
What is the S2 heart sound signify? What does it sound like? Where is it best heard?
Pulmonary and aortic valve closure
Higher pitch, louder, shorter
Heard best at base
What is S2 splitting? When can S2 splitting normally occur?
When the pulmonic valve closes a little after aortic
Can occur normally during inspiration as blood flows to right heart increases
What is S3 signify? Who can it occur in normally?
Ventricular gallop, like rumble
Is normal during diastole in children and young adults
What does an S3 heart indicate?
Right heart failure or mitral regurgitation
What does it mean if a S3 heart sound is heard during exercise and not at rest?
The heart isn’t keeping up with activity
Can a S3 heart sound can be induced when doing cardiac auscultation?
Yes. Lay the patient on their left hand side
What is an S4 heart sound? When does it occur?
An atrial gallop
Occurs during diastole; before S1
When is S4 heart sound considered normal?
Never. It’s always abnormal
What does an S4 heart sound indicate?
- stiffness in the left ventricle (hypertrophy)
- cardiomyopathy or chronic hypertension
What sound can be best heard at the base of the heart?
S2
Where is the aortic area during auscultation?
Right 2nd ICS, parasternal
Where is the pulmonic area in auscultation?
Left 2nd ICS parasternal
What sound are you looking for when listening to the pulmonic area?
Physiologic splitting of S2 heart sound
S2 sound is split during inspiration
What sound can be best heard at the apex of the heart?
S1
Where is the tricuspid area?
Right 4th or 5th ICS parasternal
Where is the mitral area?
The apex of the heart. Left 5th intercostal space mid-clavicular line
Where is Erb’s point?
Left 3rd ICS parasternal
What is the significance of Erb’s point?
S1 and S2 can be heard with approximate equal intensity
What is the best way to listen for a murmur?
Listen to Erb’s point and ask the patient to lean forward to maximize the sound of the murmur
When is a systolic murmur heard?
Between S1 and S2
What is a systolic murmur caused by?
Mitral insufficiency (results in regurgitation) Aortic valve stenosis (or even less common- pulmonic valve stenosis)
When is diastolic murmur?
Occurs between S2 and S1 (lub dub sh)
What is cardiac rales?
Crackles that occur because and individual has right heart failure - fluid into the alveoli
How is cardiac rales best heard?
If patient is seated upright or standing, cardiac rales are heard best at the apex is the heart
