Cardiovascular assessment

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  1. what are important landmarks in the Heart?
    • PMI: point of maximal impulse - apical impulse - apex of the heart. It is located in the 5th intercostal space, lateral to the midclavicular line.
    • BASE: Near the right ventricle and the edge of the sturnum. At the top near the pulmonary artery and aorta.
    • Midclavicular line: middle of the clavile.
    • Anterior axillary line: Almost at the end of the clavicle.
  2. What is preload? When do ventricules contract? what is afterload? What is CO? what is BP?
    • Preload: Stretch of the muscle before contraction - Volume overload.
    • Ventricles contract in systole.
    • Afterload: Degree of vascular resistance to ventricle contraction - pressure overload.
    • CO: The amt ejected to maintain tissue perfusion. Can be calculated: stroke volume x HR.
    • BP: CO x Systemic vascular resistance
  3. What is systolic BP? What is Dyastolic BP? What is pulse pressure?
    • SBP: Pressure generated by the LV during sytole, when the ventricle ejects blood into the aorta.
    • DBP: Pressure generated by blood remaining in the arterial tree during dystole, when the ventricles are relaxed.
    • Pulse pressure: Systole - dystole.
  4. What are the sounds of the heart? Which one are pathologic? Describe each sound?
    • Common sound in the heart are S1 (lop) S2 (dub).
    • Pathologic are S3 in adults, and S4 in everyone.
    • S1: produce when the mitral valve closes and corresponds to the carotid artery pulsation.
    • S2: produced by the aortic valve. Marks the end of systole.
    • S3: It is caused by rapid deceleration of the blood agains the ventricular wall as the blood moves from atrium to ventricle.
    • Pathologic in older adults, no children and younger adults.
    • S4: Always pathologic. Marks atrial contraction.  it immediately precedes the S1 sound. It symbolizes decrease ventricular compliance.
  5. What is a murmur?
    • A longer in duration heart sound (lob shish dub).
    • They can be benign, or pathologic (valvular disease)
    • The most common murmur is the Mitral valve regurgutation, due to the high pressure in the Lt ventricle.
  6. Murmur grades?
    • I: barely audible if listen carefully.
    • II: faint
    • III: loud with no palpable thrill.
    • IV: Loud murmur with palpable thrill.
    • V: Loud with palpable thrill and barely need the stethoscope on the chest.
    • VI: Loud with palpable thrill, stethoscope not on chest.
  7. What is the normal impulse conduction in the heart? What does the p wave stand for? QRS? T?
    • AS node --> through atrium --> AV node --> blundle of his --> perkenji fibers.
    • P-wave: atrial depolarization/spreading of the impulse through the atria.
    • QRS: ventricular depolarization/ impulse through the ventricles.
    • T-wave: Ventricular re-polarization.
  8. What are common changes in finding in older adults?
    • Extra sound may develop: S3 linked with CHF, S4 decreased ventricle compliance.
    • Murmurs: Mitral regurgatition common bc of the high pressure in the Lf ventricule.
    • HTN: Stiffnen of the arteries bc of increase in systolic BP, orthostatic hypotension.
    • Rythm distrubances: Atrial and ventriculas ectopy.
  9. what are common changes in findings in childbearing women?
    • PMI could moved to the 4th IC space.
    • Venous hum. (vein walls vibrating)
    • increase in blood volume.
    • Vasodilation resulting decreased BP.
  10. What is JVP? How do u know where the venous pulsation is?
    • Index the Rt heart pressure and CO.
    • JVP low: loss of blood
    • JVP high: Rt or Lt Heart failure, pulmonary HTN, Tricuspid stenosis, and tamponade.
    • This is not used in children <12.
    • Venous pulsation can be seen, but if palpable, they get obliterated (disappear)
  11. Carotid pulse? how to describe it?
    • The carotid pulse is the best way to identify the S1 sound.
    • Brisk: normal.
    • Delayed: suggests aortic stenosis.
    • Bounding: Suggests aortic insufficiency.
  12. Areas of the heart? What sound sound more in each area? Do u use the bell or diaphram?
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    • Base: S2
    • Apex: S1
    • Use the diaphram.
    • Use bell for murmurs, so come back to the last 3 spots and re-listen.
  13. Where should u use the diaphram? and where the bell?
    • Diaphram: high-pitches sound, press firmly ( S1,S2, aortic and mitral murmurs).
    • Bell: Use for low-pitched sounds, press lightly (S3, S4, mitral stenosis) although murmurs are heard better w the bell most of the time.
  14. when do systolic murmurs occur? diastolic? How are they described?
    • systolic murmurs: B/t the S1 and S2, they usually coincide with the carotid pulse.
    • Diastolic: B/t S2 and S1. It is a red flag!
    • Description: Crescendor, decrescendo, plateu, or both.
  15. what are some techniques to heard the heart better?
    • supine to sitting.
    • Valsalva maneuver (bear down):  systolic murmur of hypertrophic cardiomyopathy increases.
    • Pulsus alterans: Alternating loud and soft korotkoff sounds, force of arterail pulse alternates strong and weak, usually it means Lt sided heart failure.
    • Paradoxical pulse: Greater than normal drop in systolic pressure during inspiration as you decrease the cuff. It indicates tamponade or pericardial restriction.
  16. 1)
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    1) normal sinus rythm

    2) Sinus arrhythmia.

    3) Sinus tachycardia.

    4) Sinus Bradycardia.

    • 5) atrial fibrilation (cannot see the real p, irregular)
    • 6) Atrial flutter

    7) ventricular fibrulation

    8) Vetricular Tachycardia.
Card Set
Cardiovascular assessment
Cardiovascular assessment
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