Week 4 - CV 1 Flashcards
Cardiovascular ROS Question?
Any chest discomfort or fluttering?
What is the most common way to take a pulse?
Palpating radial pulse
2 other less common ways to take pulse
- Palpate carotids
2. Listen to heart
What must we correlate with BP?
Office, home, and ambulatory BP with the “true BP:
What is the “true” BP?
Average BP measure over days and weeks
Are routine office BP readings always valid?
No
Definition of Hypertension
140/90 or higher
3 things that can cause BP error
- Measurement error
- Physiological fluctuations
- Anxiety and situational determinants
What are the 2 most accurate and predictive BP measurements?
- Home
2. Ambulatory
Ambulatory BP monitoring is what?
Fully automated and allows recording over an extended period of time
2 types of manual office BP measurements
- White Coat Hypertension
2. Masked HTN
White Coat HTN
Office BP is high, ambulatory is normal
Is cardiovascular risk high or low in White Coat?
Low; high in masked HTN
Masked HTN
Office BP is normal but ambulatory is high
Width of bladded
40% of upper arm circumference (12-14cm avg adult)
Length of bladder
80% of upper arm circumference
Cuff is too small
BP will read high
Cuff too large
BP will read low on small arm, high on large arm
How long should pt avoid smoking or drinking caffeine before taking BP?
30 minutes
Patient requirements for BP
Sit quietly for at least 5 minutes in chair and feet on floor
Should arm be free of clothing?
Yes
What should there NOT be for BP?
- Scarring
- Arteriovenous fistulas
- Lymphedema
How should the arm be positioned?
Brachial artery is at heart level (4th interspace)
How do we estimate systolic pressure?
Palpation - radial artery
How much do we add after radial artery disappears for systolic?
30mmHg
Define Auscultatory Gap (potential problem)
Silent interval that may be present between S and D
What can the AG do?
Underestimate S and overestimate D
Which side of bell goes over brachial artery?
Bell (low pitch sounds)
What are the flow sounds called?
Korotkoff sounds
What should our rate of deflation be?
2-3mmHg per second
What is systolic?
When we hear sounds of at least 2 consective beats with cuff on
What is D with the cuff?
Whenever the turbulent flow sounds disappear
Should BP be taken in both arms at least once?
Yes
Is there normally a 5-10mmHg pressure difference in the arms?
yes
What is a pressure difference of 10-15mmHg in each arm occur in?
- Subclavian Steal Syndrome
2. Aortic Dissection
Do we assign worst possible classification?
Yes
Is a single elevate BP reading sufficient to establish diagnosis of HTN?
No
Normal BP
<120 and <80
Pre HTN
120-139 or 80-89
HTN Stage 1
140-159 or 90-99
HTN Stage 2
> 160 or >100 (or =)
Do we need to take into account history of BP’s regardless of our findings?
Yes (someone might live normally with HTN, if they come back w/ a normal BP, that would be considered abnormal)
Define Orthostatic Hypotension
Decrease in systolic blood pressure of 20 mm Hg or a decrease in diastolic blood pressure of 10 mm Hg within three minutes of standing when compared with blood pressure from the sitting or supine position
2 positions we measure BP and HR in OH?
- Resting from 3-10 minutes
2. Within 3 minutes after pt stands up
What is normal when a pt stands up?
SBO drops slightly or remains unchanged, while DBP rises slightly
What else is signficant for OH?
Accompanied symptoms of tachycardia
JVP
Jugular Venous Pressure and Pulsations
What does JVD reflect?
Pressure in R atrium OR central venous pressure
Where is JVD best assessed?
R internal jugular vein
What has a recent study said about JVD?
R external jugular is better than R internal for measuring
What does JVD fall with? Rise?
Loss of blood; R or L HF, pulmonary HTN, tricuspid stenosis, and pericardial compression or tamponade
How do we estimate level of JVP (2 ways)
- Find highest point of oscillation in internal jugular vein
- Point above which external jugular vein appears collapsed
How is JVP measured?
Vertical distance above sternal angle
Whatever you measure
5cm
Higher the JVP measurement, what?
Higher the PP
Why do we ausciltate the carotid artery?
For bruits or thrills
Do we want high pressure on the carotid sinus?
NO
Do we press on both carotids at the same time?
NO; reduces blood flow to brain and could induce syncope
What is the amplitude of the carotid pulse correlate well with?
Pulse pressure
What do we look for in the contoud of the pulser wave?
- Speed of upstroke
- Duration of its summit
- Speed of downstroke
How is the normal upstroke?
Brisk
Is the downstroke less abrupt than upstroke?
No
Specific formula to Small, Weak Pulses
Decreased CO = SV x HR
Pulsus Alternans specific symtpom
L ventricular HF
Bigeminal Pulse specific symtpom
Premature contraction
Parasoxical Pulse
Palpable decrease in pulse amplitude on quiet inspiration
Do we need BP cuff is paradoxical sign is less pronounced?
Yes
How much do SBP drop in parasoxical?
> 10mmHg in inspiration
Where do we find paradoxical pulse?
Percardial tamponade and frequently in exacernations of asthma and COPD
Where is paradoxical sometimes noted?
Constrictive pericarditis
Where is the Point of Maximal Impulse? (PMI)
Anterior chest
Where is the Point of Maximal Impulse? (PMI)
Anterior chest
Apex beat is how palpable?
25%-40% of healthy adults in supine position
50% of healthy adults in L lateral decubitus position
How do we palpate for heaves, lifts, or thrills?
Palm or fingerpads
What are lifts and heaves?
Sustained impulses
How are lifts and heaves produced?
Enlarged R or L ventricle or atrium and occaionally by ventricular aneurysms
How do we check thrills?
Press with the ball of your hand to check for a buzzing or vibratory sensation from underlying vascular turbulence from heart murmurs
