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What are the Cardiac Landmarks?
Remember by using:
- All = Aortic
- Pigs = Pulmonic
- Eat = Erb's
- Too = Tricuspid
- Much = Mitral (Apical)
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When assessing the Aortic heart beat, what anatomical landmark should you auscultate?
2nd intercostal space, right sternal border
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When assessing the Pulmonic heart beat, what anatomical landmark should you auscultate?
2nd intercostal space, left sternal border
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When assessing the Erb's point, what anatomical landmark should you auscultate?
3rd intercostal space, left sternal border
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When assessing the Tricuspid heart beat, what anatomical landmark should you auscultate?
4th or 5th intercostal space, left sternal border
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When assessing the Apical heart beat, what anatomical landmark should you auscultate?
5th intercostal space, midclavicular line
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Which part of the stethoscope should be used to asses heart sounds?
Both the bell and the diaphragm
Bell for low pitched sounds
Diaphragm for high pitched sounds
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What does Rheumatic Fever cause?
Valvular Insufficiency (by leaving nodules on valves)
May be considered an expected finding in a pt with Hx of Rheumatic Fever
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What are you assessing when auscultating the heart?
- (Closure of the heart valves)
- Rate
- Rhythm
- Abnormal Sounds
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What are normal sounds when auscultating the heart?
- S1 (lub) & S2 (dub)
- S1 loudest at Apex & S2 loudest at Base
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S1
- Mitral and Tricuspid Valve Closure
- Beginning of systole
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S2
- Aortic and Pulmonic Valve Closure
- Beginning of Diastole
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Gallop Rhythms
- Abnormal diastolic filling sounds
- Can occur seperately or together
- Loudest at mitral area/apex
- Best heard with bell
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S3
- Early filling sound
- Often normal <30 years old
- "TENNessee"
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S4
- Late filling sound
- May be "normal" in older adults
- "kenTUCKy"
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Murmurs
- Due to valve defects, high CO2, structural defects or weak contractions.
- Swishing sound
- Audible vibration due to turbulent blood flow
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Rubs
- Due to inflamed pericardial pleura
- Scratchy sound
- Pleura rub together to make grating sound
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Bruits
- Due to turbulent flow (stenosis)
- Swishing sound over carotid
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Normal findings when palpating the heart
Pulsation at Apex (mitral area) which is the PMI
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Abnormal findings when palpating the heart
- Lifts of Heaves: rise along the sternal border with each beat
- Thrills: Fine, palpable vibrations
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What might a patient presenting with peripheral edema be suffering from?
- Right Side Heart Failure
- Fluid collects in the extremities
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What might a patient presenting with CHF (Pulmonary Edema) be suffering from?
- Left Side Heart Failure
- Fluid collects in the lungs
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How much blood does the heart pump every minute?
3-6 liters
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What might a patient with JVD be suffering from?
Right Side Heart Failure
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What are signs and symptoms which would warrant a focused cardiovascular assessment?
- Chest Pain
- Palpitation
- Syncope or dizziness
- Edema
- Fatigue
- Dyspnea, orthopnea or cough
- Extremity changes
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