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ICM Exam 1 > Week 4 - CV 1 > Flashcards

Week 4 - CV 1 Flashcards

1
Q

Cardiovascular ROS Question?

A

Any chest discomfort or fluttering?

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2
Q

What is the most common way to take a pulse?

A

Palpating radial pulse

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3
Q

2 other less common ways to take pulse

A
  1. Palpate carotids

2. Listen to heart

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4
Q

What must we correlate with BP?

A

Office, home, and ambulatory BP with the “true BP:

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5
Q

What is the “true” BP?

A

Average BP measure over days and weeks

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6
Q

Are routine office BP readings always valid?

A

No

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7
Q

Definition of Hypertension

A

140/90 or higher

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8
Q

3 things that can cause BP error

A
  1. Measurement error
  2. Physiological fluctuations
  3. Anxiety and situational determinants
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9
Q

What are the 2 most accurate and predictive BP measurements?

A
  1. Home

2. Ambulatory

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10
Q

Ambulatory BP monitoring is what?

A

Fully automated and allows recording over an extended period of time

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11
Q

2 types of manual office BP measurements

A
  1. White Coat Hypertension

2. Masked HTN

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12
Q

White Coat HTN

A

Office BP is high, ambulatory is normal

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13
Q

Is cardiovascular risk high or low in White Coat?

A

Low; high in masked HTN

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14
Q

Masked HTN

A

Office BP is normal but ambulatory is high

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15
Q

Width of bladded

A

40% of upper arm circumference (12-14cm avg adult)

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16
Q

Length of bladder

A

80% of upper arm circumference

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17
Q

Cuff is too small

A

BP will read high

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18
Q

Cuff too large

A

BP will read low on small arm, high on large arm

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19
Q

How long should pt avoid smoking or drinking caffeine before taking BP?

A

30 minutes

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20
Q

Patient requirements for BP

A

Sit quietly for at least 5 minutes in chair and feet on floor

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21
Q

Should arm be free of clothing?

A

Yes

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22
Q

What should there NOT be for BP?

A
  1. Scarring
  2. Arteriovenous fistulas
  3. Lymphedema
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23
Q

How should the arm be positioned?

A

Brachial artery is at heart level (4th interspace)

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24
Q

How do we estimate systolic pressure?

A

Palpation - radial artery

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25
Q

How much do we add after radial artery disappears for systolic?

A

30mmHg

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26
Q

Define Auscultatory Gap (potential problem)

A

Silent interval that may be present between S and D

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27
Q

What can the AG do?

A

Underestimate S and overestimate D

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28
Q

Which side of bell goes over brachial artery?

A

Bell (low pitch sounds)

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29
Q

What are the flow sounds called?

A

Korotkoff sounds

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30
Q

What should our rate of deflation be?

A

2-3mmHg per second

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31
Q

What is systolic?

A

When we hear sounds of at least 2 consective beats with cuff on

32
Q

What is D with the cuff?

A

Whenever the turbulent flow sounds disappear

33
Q

Should BP be taken in both arms at least once?

A

Yes

34
Q

Is there normally a 5-10mmHg pressure difference in the arms?

A

yes

35
Q

What is a pressure difference of 10-15mmHg in each arm occur in?

A
  1. Subclavian Steal Syndrome

2. Aortic Dissection

36
Q

Do we assign worst possible classification?

A

Yes

37
Q

Is a single elevate BP reading sufficient to establish diagnosis of HTN?

A

No

38
Q

Normal BP

A

<120 and <80

39
Q

Pre HTN

A

120-139 or 80-89

40
Q

HTN Stage 1

A

140-159 or 90-99

41
Q

HTN Stage 2

A

> 160 or >100 (or =)

42
Q

Do we need to take into account history of BP’s regardless of our findings?

A

Yes (someone might live normally with HTN, if they come back w/ a normal BP, that would be considered abnormal)

43
Q

Define Orthostatic Hypotension

A

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

44
Q

2 positions we measure BP and HR in OH?

A
  1. Resting from 3-10 minutes

2. Within 3 minutes after pt stands up

45
Q

What is normal when a pt stands up?

A

SBO drops slightly or remains unchanged, while DBP rises slightly

46
Q

What else is signficant for OH?

A

Accompanied symptoms of tachycardia

47
Q

JVP

A

Jugular Venous Pressure and Pulsations

48
Q

What does JVD reflect?

A

Pressure in R atrium OR central venous pressure

49
Q

Where is JVD best assessed?

A

R internal jugular vein

50
Q

What has a recent study said about JVD?

A

R external jugular is better than R internal for measuring

51
Q

What does JVD fall with? Rise?

A

Loss of blood; R or L HF, pulmonary HTN, tricuspid stenosis, and pericardial compression or tamponade

52
Q

How do we estimate level of JVP (2 ways)

A
  1. Find highest point of oscillation in internal jugular vein
  2. Point above which external jugular vein appears collapsed
53
Q

How is JVP measured?

A

Vertical distance above sternal angle

54
Q

Whatever you measure

A

5cm

55
Q

Higher the JVP measurement, what?

A

Higher the PP

56
Q

Why do we ausciltate the carotid artery?

A

For bruits or thrills

57
Q

Do we want high pressure on the carotid sinus?

A

NO

58
Q

Do we press on both carotids at the same time?

A

NO; reduces blood flow to brain and could induce syncope

59
Q

What is the amplitude of the carotid pulse correlate well with?

A

Pulse pressure

60
Q

What do we look for in the contoud of the pulser wave?

A
  1. Speed of upstroke
  2. Duration of its summit
  3. Speed of downstroke
61
Q

How is the normal upstroke?

A

Brisk

62
Q

Is the downstroke less abrupt than upstroke?

A

No

63
Q

Specific formula to Small, Weak Pulses

A

Decreased CO = SV x HR

64
Q

Pulsus Alternans specific symtpom

A

L ventricular HF

65
Q

Bigeminal Pulse specific symtpom

A

Premature contraction

66
Q

Parasoxical Pulse

A

Palpable decrease in pulse amplitude on quiet inspiration

67
Q

Do we need BP cuff is paradoxical sign is less pronounced?

A

Yes

68
Q

How much do SBP drop in parasoxical?

A

> 10mmHg in inspiration

69
Q

Where do we find paradoxical pulse?

A

Percardial tamponade and frequently in exacernations of asthma and COPD

70
Q

Where is paradoxical sometimes noted?

A

Constrictive pericarditis

71
Q

Where is the Point of Maximal Impulse? (PMI)

A

Anterior chest

72
Q

Where is the Point of Maximal Impulse? (PMI)

A

Anterior chest

73
Q

Apex beat is how palpable?

A

25%-40% of healthy adults in supine position

50% of healthy adults in L lateral decubitus position

74
Q

How do we palpate for heaves, lifts, or thrills?

A

Palm or fingerpads

75
Q

What are lifts and heaves?

A

Sustained impulses

76
Q

How are lifts and heaves produced?

A

Enlarged R or L ventricle or atrium and occaionally by ventricular aneurysms

77
Q

How do we check thrills?

A

Press with the ball of your hand to check for a buzzing or vibratory sensation from underlying vascular turbulence from heart murmurs

ICM Exam 1 (7 decks)

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