Mosbys Flashcards
What is the force exerted against the wall of the artery when ventricles contract?
systolic pressure
The result of cardiac output, blood volume and compliance of the atrial tree is dependent upon (blank)
systolic presure
What is the secondary upstroke in the descending part of the pulse that corresponds to the transient increase in pressure upon closure of the aortic valve.
dicrotic notch
What is the force exerted against the wall of the artery when the heart is in filling or relaxed state and is primarily the function of peripheral vascular resistance
diastolic pressure
What is the difference between systolic and diastolic pressure?
pulse pressure
What is the stroke volume?
volume of blood ejected
What are these:
o Volume of blood ejected – Stroke volume
o Distensibility of the aorta and other large arteries
o Viscosity of the blood
o Peripheral arteriolar resistance
Contributors of arterial pulse and pressure
What are the three types of pressure that gives you an arterial pulse?
systolic, diastolic, pulse
(blank) reflect the activity of the right side of the heart
jugular veins
What is the order of venous pulsation?
A-> c -> x -> v ->y -> a
What are the three peaks of venous pulsation?
A,C,V
What are the 2 descending slopes of venous pulsation?
X and Y
What is happening during the A peak of venous pulsation?
C?
V?
A
• Brief backflow of blood into the vena cava during right atrial contraction
C
• Vigorous backward push from the tricuspid valve when it closes during ventricular systole
V
• Increasing volume and concomitant increase in the right atrium
o Late in ventricular systole
What is happening during the descending slope X and Y?
x
• Passive atrial filling
Y
• Open tricuspid valve and rapid refilling of the ventricles
Infants and children, cutting the umbilical cord requires (blank)
respiration
What happens when you cut the umbilical cord of the child lung and vascular wise?
Expansion of the lungs and air to the aveoli
Pulmonary vascular resistance drops
Systemic vascular resistance increases
Once the pulmonary vascular resistance is lower than systemic vascular resistance, blood flows into the pulmonic arteries instead of across the interatrial foramen ovale
foramen ovale Closes by shifting pressures of the right and left heart
i.e. closes at birth
Blood flows freely to the lungs but not peripherally.
The ductus areteriosus closes within 12-14 hours of life
What happens to systemic vascular resistance in infants right after umbilical cord is cut?
pulmonary vascular resistance?
Why?
increases
decresases
blood flows into the pulmonic arteries instead of across the interatrial foramen ovale
How does the foramen ovale close?
Closes by shifting pressures of the right and left heart
Who does this describe:
o System vascular resistance decreases
o Peripheral vasodilation occurs
Can lead to palmar erythema & spider telangiectasias
o Systolic BP decreases slighty
Greater decrease in diastolic pressure
o Lowest levels seen in the second trimester
o Venous compression of the vena cava and impaired venous return lead to hypotension
o Blood in lower extremities pool in lower limbs
Unless in lateral recumbent position
Due to the enlarged uterus pressing on inferior vena cava and pelvic veins
May cause and increase in dependent edema, varicosities of the legs and vulva and hemorrhoids
pregnant women
WHo does system vascular resistance decrease in?
pregnant women
Peripheral vasodilation occurs where?
in pregnant women
Systolic BP decreases slightly in ( greater decrease in disastolic pressure)
pregnant women
When are lowest level of BP seen in pregnant women?
second trimester
What happens to the blood in lower extremities of pregnant women?
blood in lower extremities pool in lower limbs
Why does blood in lower extremities pool in lower limbs of pregnant women? (unless in recumbent position)
due to enlarged uterus pressing on inferior vena cava and pelvic veins
What cal pooling of blood in lower limbs cause?
May cause and increase in dependent edema, varicosities of the legs and vulva and hemorrhoids
Who does this happen in:
o Calcification damages
o Superficial vessels become more tortuous and prominent
o Arterial walls lose elasticity and vasomotor tone
o Increased peripheral vascular resistance
Elevated BP
older adults
In old people, what loses elasticity and vasomotor tone?
Do old people get increased or decreased vascular resistance?
In old people, which vessels become tortuous and prominent?
arterial walls
increased (i.e. elevated BP)
superficial vessels
During the HPI watch should you look for?
leg pain and cramps? swollen ankles? other symptoms? On a plane or at high elevation? Do any medications help?
During PMH and FH what should you ask about?
Any past cardiac problems?
Any rheumatic fever?
Any hypertension, hyperlipidemia, diabetes, stroke, arrhythmia etc.?
During SH what should you ask about?
Any stress at work?
Any tobacco, alcohol, or illegal drugs? If so, how often?
Diet and exercise? Stay away from McDonald’s!
• Mosby’s says olive oil and red wine (in moderation) = healthy heart
What should you specifically look for in infants and children?
Look for hemophilia, renal disease, and leg pain when exercising
What should you look for in pregnant women?
Look for increases in BP, abnormal bruising or edema, varicosities, pain
Can have preeclampsia -> more common with advanced maternal age (>40), first pregnancy, and previous Hypertension or diabetes
What is preeclampsia?
Hypertension during pregnancy along with protein in urine
In old people, what should you look for?
Look for leg edema and when it occurs Ask if the symptoms hinder daily activity What medications make it better? Varicose veins! • More common in: o Women particularly in pregnancy o Irish and German descent o Sedentary lifestyles o Old age
During the peripheral exam of the arteries, What are you going to palpate?
Which one should you NOT palpate bilaterally at the same time?
• Carotid, brachial, radial, femoral, popliteal, dorsalis pedis, and posterior tibial
Carotid, you might mess up blood flow to the brain
When determining heart rate, how long do you do it for?
15 seconds and times it by four
What is it called if heartbeat is irregular but in a repeated pattern? In this, when is HR higher, lower,
Normal?
sinus arrhythmia
on inspiration, on expiration
on expiration in little kids : )
What is indicitative of a heart rate that is irregular but not in a repeated pattern?
CHF
• Want to compare arteries on each side to look for differences in (blank)
pulse contour, amplitude, and symmetry
When you are checking pulse contour, what are you checking?
for normal pulse
What kind of pulse is Strong, then weak and it repeats -> left ventricle failure
alternating pulse
What kind of pulse has 2 main peaks of pulsation at carotids-> aortic stenosis
pulsus bisferiens
What kind of pulse has a Normal pulse and then premature contraction ->dysrhythmia
bigeminal pulse
What kind of pulse has a Strong pulse (3+) -> exercise, anxiety, fever, hyperthyroidism
Large, bounding pulse
What kind of pulse has ↓ upon inspiration, ↑ upon expiration ->premature contraction, obstruction in trachea or bronchi, asthma, pericarditis
paradoxic pulse
What kid of pulse has High amplitude that is short in duration-> patent ductus arteriosus or aortic regurgitation
Water-hammer (Corrigan) Pulse
When looking at arterial amplitude, what is the scale?
1-4 4 Bounding, aneurysmal 3 Full, Increased 2 Expected 1 Diminished, barely palpable 0 Absent, not palpable
When looking at arterial symmetry, what could lack of symmetry show?
could be an obstruction in circulation
(coarctation of the aorta, atheroscletotic peripheral vascular disease, vasculitis)
What is coarctation of the aorta?
o Aortic arch is narrow in location that ductus arteriosus inserts
(Congenital)
What is vasculitis
inflammation of a blood vessel or blood vessels.
What does the allen test do?
determines sufficiency of ulnar artery
How does the allen test work?
o Kind of random but used when puncturing the radial artery (for blood gas sampling or catheter insertion)
How should the allen test be performed?
1) Compress radial and ulnar artery with palm facing up
2) Have patient close and open fist 5 times
3) release pressure on ONLY ulnar artery
4) if color is regained in less than 5 seconds, your good, if not you have ulnar artery insufficiency THEN DONT PUNCTURE radial artery b/c your arm will then be diminished of a blood supply
You should auscultate or listen over the artery for what?
bruits
what are bruits?
pretty much a murmur sound over an artery use BELL
How do you listen for bruits?
Have patient hold breath so respiratory sounds don’t interfere! It is hard enough to hear as it is : (
What is the most common bruit?
carotid bruit
What sounds just like a carotid bruit?
venous hum
When do you hear venous hum?
anemia and pregnancy
Where can you hear carotid bruit?
subclavian, abdominal aorta, iliac, femoral
When will you hear a carotid bruit?
- Most common cause is aortic stenosis
* Can also occur if there is atherosclerosis in the carotid artery obviously
If you suspect peripheral artery disease/occlusion from this physical exam, how can you be sure?!
look for the P’s
What are the p’s in Peripheral artery disease/occluision?
1) Pallor should be localized, can see cyanosis
o 2) Pain in area distal to stenosis
o 3) Pulselessness
o 4) Parasthesias (only with major arteries)
o 5) Paralysis (RARE)
How can you see how severe the peripheral artery disease/occlusion is?
o Have patient elevate extremity above heart level so it loses color then bring back down and see how long it takes to regain color 2 minutes = SEVERE!
ALSO can do same thing with capillary refill time test with squeezing finger tips, greater than 2 seconds bad. (not diagnosis)
if color doesnt regain for 2 minutes in peripheral artery disease test, what does this indicate?
SEVERE
If a patient has peripheral artery disease/occlusion and has pain in calf which artery is affected?
thigh?
glutes?
Superficial femoral
Common femoral or external iliac
Common iliac or distal aorta
How should you measure blood pressure?
in both arms no clothing Patient must be SITTING USE BELL correct size cuff
When measuring blood pressure where should you put cuff?
2-3 cm superior to crease in arm
While palpating radial pulse, increase pressure to 20-30mmHg above the values at which the radial pulse disappears, then what do you do?
slowly release pressure and wait until you hear pulse=systolic
When reading BP, once the pulse disappears is the (blank) pressure/
diastolic
The sounds you hear while reading BP are called (blank) sounds
Korotkoff sounds
How many phases are there in the korotkoff sounds?
5 phases
•(blank) can be wider in old patients = sounds quiet so be careful b/c you might have inaccurate systole reading
Auscultatory gap
• In general ->taller and bigger = (blank) BP than shorter and leaner!
higher
Normal vs. Pre-HTn vs. HTn
• Normal?
• Pre-HTn? 120-139 or 80-89
• HTn
o Stage 1 ?
o Stage 2 ?120/
120-139 or 80-89
140-159 or 90-99
>160 or >100
In pulse pressure, the difference between systolic and diastolic BP is bad if what?
too narrow or too wide
If diastolic value is above 90 and you expect coarctation of the aorta OR aortic stenosis, measure BP in (blank)
legs at popliteal artery
BP at legs at popliteal artery is (blank) than in arms.
If it isnt, could be coarctation of the aorta or aortic stenosis
higher
What is Orthostatic/postural hypotension?
greater than 15 mmHg drop in systolic BP upon standing (along with drop in diastolic BP).
Increase in heart rate
When should you think about testing for Orthostatic/postural hypotension
o Is on anti-HTn medication
o Has less blood volume
o Has syncope (fainting/lightheadedness)
When might you see Orthostatic/postural hypotension
• Can be seen with mild blood loss (as with a blood donation), drugs, ANS disorder, laying down too long, GI bleeding
What kind of pulse is this: Difference in systolic BP upon expiration and inspiration should be 5 mmHg
paradoxical pulse
WHen do you get an exaggerated paradoxical pulse? When does this happen?
1) Difference in systolic BP upon expiration and inspiration greater than 10 mmHg
2) cardiac tamponade, pericarditis, or COPD
What are some disruptions to a blood pressure test?
cardiac dysrhythmias
aortic regurgiation
venous congestion
valve replacement
