Weekend 2 lecture 1 Flashcards
things to remember in a chart review
Hospital course Chief complaint Procedures during this hospitalization Results from any special tests Labs
What to gather from patient interview
Cardiac risk factors PMH/PSH: for all body systems Level of Mentation Recognize early signs of hypoperfusion Anginal equivalent Specify any recurrent pain patterns Baseline level of dyspnea Use of 15 second count or borg scale of perceived dyspnea
Borg Scale of Perceived Dyspnea
its a scale on 1-10 tell marks at 2, 5. 7, 10
No shortness of breath .5 Slight SOB 1 2 Mild SOB 3 Moderate SOB 4 5 Strong or hard breathing 6 7 Severe SOB 8 9 10 SOB so severe you need to stop and rest
Evaluation of venous pressure
what veins to check
Jugular venous distention of the external jugular vein
Jugular venous distention of the internal jugular vein
Estimation of central venous pressure
Examination of veins in the dorsum of the hand
What things do we observe very generally think like ROM, Edema etc.
Edema Skin Respiration EKG Urine output
What is Pluse alternans
what are some factors that influence the arterial pluse
Several factors influence the arterial pulse: stroke volume, ejection velocity and systemic vascular resistance
Note pulse rate and rhythm
Compare HR counted at the apex and the peripheral pulse rate
Pulsus alternans: a regular alternation in the force of beats, so that a weak pulse regularly follows a strong pulse. The alternating pulse volume is produced when the stroke volume increase and then decreases from beat to beat.
Whats a minmal pressure for the radial artery and or femoral or cartoid artery
Whats Pulsus parodoxus
Pulsus parodoxus: an exaggerated decrease in pulse volume during inspiration and increase in pulse volume during exhalation.
Typically if a pulse can be felt in the following areas there is a minimal systolic pressure as noted:
Radial artery 80mm Hg
Femoral artery 70mm Hg
Carotid artery 60mm Hg
where is the point of maximal heart sound and what is it a good indicator of?
Chest wall excursion
Point of maximal impulse: the point where the cardiac impulse on the chest wall is felt the strongest
Apex beat or apical impulse: the most lateral and inferior point at which an examiner can see or feel the cardiac impulse
Good indicator of heart size
Thrills: palpable murmurs
What are bruits:
Bruits: arise from turbulence in the arteries at their branching points or in areas where a blood vessel is narrowed
Supraclavicular arterial bruit: a low to medium pitched short, systolic crescendo-decrescendo murmur which is unaffected by respirations
Describe the S1 sound
The first heart sound
Marks mitral (M1) and tricuspid (T1) closure. It is heard loudest at the mitral area. This sound defines the onset of sytole
How can I recognize the first heart sound when the heart rate is fast?
Palpate the carotid artery. S1 precedes the palpable arterial upstroke, whereas S2 immediately follows this pulse
Also, the apical impulse is coincidental with the onset of S2, whereas S2 follows the apical lift
Describe the S2 sound
S2: The second heart sound
The second heart sound signals the end of ventricular systole. It is comprised of two components A2 and P2 which relate to aortic and pulmonic valve closure
Physiological splitting of S2
During expiration, A2 and P2 are heard as one because the interval between them is small. During quiet respiration, at the height of inspiration, the splitting of the two sounds is evident
Describe the S3 sound
S3: ventricular gallop may originate from one or both ventricles
Related to a sudden deceleration of early diastolic ventricular inflow caused bya sudden limitation of expansion along the longitudinal axis of the ventricular wall
Right ventricular S3 becomes louder during inspiation due to the increased venous return to the right ventricle a a larger stroke volume
Left ventricular S3 remains unchanged or decreases in loudness during inspiration
Describe the atrial gallop whatever the fuck that is aka
S4: atrial gallop, caused by vibrations created in the ventricles as they expand in the second phase of rapid diastolic filling when the atria contract. The S4 occurs after atrial contraction and before the S1.
A left-sided S4 is louder on expiration
A right-sided S4 is louder on inhalation
Describe a summation gallop and a pericardial friction rub
Summation Gallop: occurs when the S3 and S4 sounds fuse. It is heard when heart the heart rate is >120, due to the fact that diastole shortens and results in the S3 and S4 being superimposed.
Pericardial Friction Rub: heard in patients with inflammation of the pericardial membrane or the pleural sac. This sounds like sandpaper being used, a match being struck, or leather squeaking.
Best auscultated over the third or fourth ICS at the left sternal border
reasons for murmurs
Result from turbulent blood flow, which produces a series of vibrations in cardiac structures
Four main factors in the production of murmurs
High rates of flow through normal or abnormal valves
Backward flow through an incompetent valve, septal defect, or patent ducturs arteriosus
Decreased viscosity, which cauForward flow through a constricted or irregular valve, or into a thin or dialated vesselses increased turbulence and contributes to the production and intensity of murmurs
