Pulses

Question 1

what is the radio-radial delay

Answer 1

palpate both radial pulses simultaneously. healthy = occur at the time. delay is associated with subclavian artery stenosis or aortic dissection

Question 2

what is the collapsing pulse associated with

Answer 2

aortic regurgitation

Question 3

how to assess if there is collapsing pulse

Answer 3

1. ensure patient has no shoulder pain.
2. palpate radial pulse with hand wrapped around wrist
3. quickly raise arm above head
4. feel for tapping impulse in muscle bulk of arm as blood empties from arm quickly in diastole –> palpable sensation (water hammer pulse)

Question 4

when can the water hammer pulse occur

Answer 4

fever, pregnancy, cardiac lesions (ar/pda), anaemia, av fistula

Question 5

what is narrow pulse pressure associated with

Answer 5

aortic stenosis

Question 6

what is wide pulse pressure associated with

Answer 6

aortic regurgitation

Question 7

why should you auscultate the carotid artery for a bruit before palpting

Answer 7

palpation may dislodge a plaque leading to a stroke

Question 8

what does a raised jugular venous pressure indicate

Answer 8

fluid overload, right ventricular failure, tricuspid regurgitation

Question 9

how do you perform the hepatojugular reflex

Answer 9

apply pressure to the liver. observe jvp for a rise. in healthy people it should fall after 1-2 cardiac cycles. if the rise is sustained and =>4cm it is a positive result

Question 10

what does a positive hepatojugular reflux sign suggest

Answer 10

right sided heart failure or tricuspid regurgitation