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Health Assessment > Week 5: Cardiovascular Exam > Flashcards

Week 5: Cardiovascular Exam Flashcards

1
Q

What is the flow of the heart from right to left

A

Blood comes through inferior and superior vena cava, right atrium to the right ventricle, then to the pulmonary artery to the lungs (right side of heart goes to lung) pulmonary vein to left atrium to left ventricle to aorta to the heart.

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2
Q

What is S1 and S2

A

S1: closure of tricuspid and mitral valve
S2: close of pulmonic and aortic valve

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3
Q

P wave:

A

atrial depolarization

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4
Q

PR:

A

atrial depolarization complete

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5
Q

QRS:

A

ventricular depolarization begins, atria repolarize

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6
Q

ST segment:

A

ventricular depolarization is complete

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7
Q

T wave:

A

ventricle repolidatszation

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8
Q

Post T wave:

A

ventricular repolarization completes

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9
Q

Apical pulse:

A

5th ICS @ approximately the MCL (mid clavicular line)

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10
Q

Where is the base and apex?

A

Base is top of the heart, apex is at the bottom of heart.

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11
Q

Common/Concerning S/sx

A 
Chest pain
Shortness of breath, dyspnea, orthopnea or paroxysmal nocturnal dyspnea
Dizziness - anemia? 
Palpitations
Racing heart
Exercise/activity intolerance
Fainting/Syncope or Near Syncope
Cyanosis/pallor
Extreme Fatigue
Edema
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12
Q

Questions to ask for cardiac issues

A

Symptoms worse with activity?
Any recent medication changes (new meds, change in dose etc)
Hydration- how much fluid do you drink each day (24 hr fluid recall)
Accompanying symptoms
Has this happened before?
How long has it been going on?
Recent travel or activity changes?
Increased stress?
Caffeine intake?
PMH:Family History, social history (smoking drug use), medication, allergy, decongestion, over the counter meds
Lifestyle, diet exercise habit
Quality of life: how is this affecting the things you like to do, where do you want to be? If they snore?- sleep apnea

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13
Q

Cardiac Assessment Steps

A

Inspect: color, work of breathing/dyspnea (w or w/out exertion), abdominal girth/ascites, edema, clubbing, nutritional status, chest diameter
Palpate: thrill (murmur, may be a incompetent valve), heave (englarge heart, is it working heart? Can you feel it move), PMI (is it displaced - large heart?), chest wall tenderness, edema
Auscultate: all major areas: APETM (aortic, pulmonic, erb’s point, tricuspid, mitral valve), S1, S2, extra heart sounds, murmurs

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14
Q

Orthostatic Vital Signs - what is significant?

A

What is significant?
Pulse ↑by 20 beats per minute
SBP ↓20 mmHg or DBP ↓10 mmHg

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15
Q

Inspection for cardiac

A 
How does the patient appear?
Color, Dyspnea  
Is there a visible heave? 
Thorax shape?
Large abdomen?
Ascites?
Can you see the PMI?
JVD?
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16
Q

PALPATION: Chest Wall

A

Using the finger pads, palpate for heaves or lifts from abnormal ventricular movements
Using the ball of the hand, palpate for thrills, or turbulence transmitted to the chest wall surface by a damaged heart valve
Palpate the chest wall in the:
Aortic
pulmonic,
left sternal border
apical areas

17
Q

Thrill

A

Turbulent vibration

18
Q

Heave:

A

feel apex due to enlarged heart

19
Q

Assessing the Point of Maximal Impulse (PMI) or “Apical Pulsation”

A

Inspect the left anterior chest for a visible PMI
Using your finger pads, palpate at the apex for the PMI . . . Where? Just to the left of the 5th intercostal space; 9cm from midsternal line
Tapping — normal
Sustained — suggests LV hypertrophy from hypertension or aortic stenosis
Diffuse — suggests a dilated ventricle from congestive heart failure or cardiomyopathy
Locate the PMI by interspace and distance in centimeters from the mid-sternal line

20
Q

S1: (lub)

A

Closure of AV valves (Mitral, Tricuspid) Begins systole

Loud at apex

21
Q

S2: (dub)

A

Closure of semilunar valves (Aortic, Pulmonic)
Ends systole
Loud at base

22
Q

Auscultation: APETM

A

aortic area- 2nd right interspace- aortic area

pulmonic area - 2nd left interspace

erb’s point - third intercostal space

tricuspid area - lower left sternal border

mitral area - apex

23
Q

diaphragm is best for detecting ____

A

high-pitched sounds like S1, S2, and also S4 and most murmurs

24
Q

bell is best for detecting ______

A

low-pitched sounds like S3 and the rumble of mitral stenosis

25
Q

Split S2: aortic valve closes before pulmonic valve is heard at?

A

Heard at LSB @ 3rd ICS (Erb’s point)

26
Q

third heart sound (S3):

A

ventricular filling sound, early diastole

Immediately after S2- heard best @ apex or LSB (low pitched, does not change w/ inspiration0

27
Q

Fourth heart sound (S4):

A

ventricular filling sound, late diastole

Immediately before S1

28
Q

Murmurs:

A

turbulent blood flow through a stenotic, or incompetent valve

29
Q

Grade: loudness and thrill

A

I: softer than S1/S2, very faint
II: equal to S1/S2, heard immediately (easy to hear)
III: louder than S1/S2, moderately loud
IV: louder than S1/S2, w/palpable thrill
V: louder than S1/S2, palpable thrill, heard w/part of stethoscope on chest wall
VI: very much louder than S1/S2, palpable thrill, heard w/out the stethoscope
ASD or VSD

30
Q

Describing Murmurs

A

Timing: during systole or diastole, late, early or holo (pan)
Pitch: high, medium, low
Quality (harsh, musical, soft, blowing, or rumbling)
Harsh (AS)
Rumbling (MS)
Location: area heard best
Radiation: neck, back, axillae?

31
Q

Murmurs & Location

A

Leaning left, mitral stenosis
Leaning forward, pericarditis, aortic regurgitation
Valsalva maneuver: squatting - Aortic stenosis
Standing: hypertrophic myopathy - systolic murmur

32
Q

Pericarditis

A

Inflammation of the pericardium

Etiology can be infectious or noninfectious

33
Q

Infective Endocarditis

A

Infection of the endocardial surface of heart; may include one or more heart valves, mural endocardium, or a septal defect
Causes severe valvular insufficiency

34
Q

MVP (Mitral Valve Prolapse)

A

Displacement or prolapse of mitral valve leaflets into the left atrium during systole
Can lead to mitral regurgitation (MR)

35
Q

Considerations for Infants/Children- cardiac

A

Blood oxygenated through placenta until birth, so FO & DA open to feed blood to aorta/systemic circulation
Patent FO- closes @ 1 hour after birth
Patent DA- closes 10-15 hours after birth
Infant heart is more horizontal (apex @ 4th ICS), reaches 5th ICS @ 7yo
Growth, feeding, activity, fam Hx?
Pediatric sized stethoscope
Know normal HR ranges
Innocent/functional murmurs common in 30% of infants/children

36
Q

Considerations for Older Adults - for cardiac

A

Lifestyle greatly affects CV health over time
Increase in systolic hypertension- due to?
Decrease in diastolic pressure» increased pulse pressure
LV wall thickness increases
Decrease in compensation w/activity/exercise
Dysrhythmias, ECG changes
Inc risk of orthostatic hypotension
Inc in systolic murmurs

Health Assessment (9 decks)

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