Module 4

S4

- TENN e see - a STIFF wall - occurs before S1 - late in diastole - forceful atrial contraction - HTN, pulmonary HTN, elderly

S3

- ken TUCK y - SLOSH ing in - occurs early in diastole - just after S2 - during passive flow from A to V - increased atrial pressure leading to increased flow rates - CHF, dilated cardiomyopathy

S1

"lubb" - closing of T and M - open A and P - ventricular contraction inc. ventricular pressure - loudest - at apex - SYSTOLE - blood pumped out of lungs and body

auscultate

APE to MAN aorta pulmonary erb's point tricuspid mitral/apex

posterior tibialis

Artery posterior of the medial malleous, supplies blood to the foot.

femoral

groin

heart failure

inability of the heart to pump sufficient blood to aorta and pulmonary arteries fluid overload, dyspnea L and R HF

infective endocarditis

infection of endothelial layer (innermost) layer of heart occurs when endocardial surface is damaged as result

AAA abdominal aortic dissection

rupture of aneurysm surgical repair pain of dissection: sudden sharp shifting stabbing

valvular heart disease

stenotic valve (does not open) incompetent valve (does not close)

venous thrombosis

thrombus (clot) develops within vein present with pain, edema, erthema, decrease pulse in leg

S2

"dubb" - diastole - vent relaxation decrease vent pressure - A and P close - T and M open - blood return to atria - 3rd left ICS

grading pulses

4 point scale 4: bouding: anxiety, fever, anemia 3: full increased 2: expected normal 1: diminished barely palpable 0: absent not palpable

questiosn specific to cardiovascular system

ChestPain o ShortnessofBreath o Cough o Nocturia o Fatigue o Fainting o Swellingofextremities o Legcramps/pain

MI

Myocardial ischemia is sustained necrosis

S4 occurs during and associated with

atrial contraction stiff, low compliant vent

pulmonary valve

between right ventricle and pulmonary artery

click/snap and 3 causes

cardiac valve generally open WITHOUT noise unless thickened, roughened, or altered various causes of clicks - valvular stenosis (mitral valve snap) - semilunar valve ( ejection systolic click) - mitral valve prolapse (late non ejection systolic click) often heard with murmur

edema

check lower extremities 0: not pitting edema 1: mild pitting edema; 2 mm 2: moderate pitting edema 4mm 3: moderately severe pitting edema 6mm 4: severe pitting 8 mm last more than 2 min

angina pectoris

chest pain due to ischemia of myocardiu caused by artherosclerosis clinical finding: pain is squeezing duration: 5-15 min unstable is over 30 min

causes of S3 and S4

difficult to hear S3: in children/young adults; disappear when sitting up S4: older adults; after exercise HTN, CAD, anemia, pregnancy

aneurysm

dilation of artery from weakness in arterial wall

S3 occurs during and associated with

early ventricular filling normal in children, adults,

carotid

either side of trachea

how to amplify suspcted S3 and S4

enhance with venous return or arterial pressure passively raise leg (venous return) squeeze your hand (inc. arterial pressure) lie in left lateral recumbent position

pericarditis

inflammation of layer of pericardium and myocardium result of MI cancer trauma infection cardiac surgery pleuritic chest pain

thrombophlebitis

inflammation of vein with or without clot

S1 occurs during and associated with

isovolumetric CONTRACTION close of M and T valve

S2 occurs during and associated with

isovolumetric RELAXATION close of A and P

popliteal

knee

arteries

lead away from the heart when palpating pulse it is the artery

documenting murmurs

location pitch duration quality intensity LPDQI

grades (intensity) of murmurs: grade 4

loud, associated with thrill

grades (intensity) of murmurs: grade 6

loudest, thrill

systolic murmurs

may indicate heart disease, often occur when heart is normal

dorsalis pedis

medial side of dorsal foot

brachial

medial to biceps tendon

grades (intensity) of murmurs: grade 3

moderatly loud

cause of murmurs

no pathologic significance - harmless or still murmurs are common in children, adolescent, young athletes commmon causes - velocity of blood inc (exercise) - viscosity of blood dec (anemia) - structural defect in valve some can indicate serious heart disease

heart murmurs

normal circulation = no noise murmur: gentle, blowing, swooshing sound (KINKED WATER HOSE) - TURBULENT BLOOD FLOW - can be heard during systole or diastole or both - longer in duration than S1 and S2

inspection

patient supine; HOB up 30 degrees, sitting upright inspect - skin color, clubbing, breathing ease, edema, JVD

palpate

point of maximum impulse (PMI) - 5th ICS MCL - contraction L vent lifts or heaves in apical impulse that is more vigorous than expected thrill: fine, palpable, rushing vibration, 2nd ICS

general heart/pvd health history

present health status personal and psychsocial history past med history past diagnostic test

Perfusion

process which blood is forced through a network of vessels all tissues require perfusion of oxygenated blood

grades (intensity) of murmurs: grade 2

quiet but clearly audible, still faint

palpate characteristics in distal extremities

rate rhythm contour amplitude

auscultate carotid pulse

use bell rhythm strength symmetry bruits carotid sinus

diastolic murmurs

usually indicates heart disease

aorta valve

valve between left ventricle and aorta

tricupsid valve

valve between right atrium and right ventricle

mitral valve

valve between the left atrium and the left ventricle; bicuspid valve

veins

veins lead to heart IV = vein

radial

ventral wrist

grades (intensity) of murmurs: grade 1

very faint, heard only after listener has tuned in may not be heard in all positiions; barely audible

grades (intensity) of murmurs: grade5

very loud, thrill present

split

when tricupsid/mitral valve (S1) and pulmonic/aortic valve (S2) do not close SIMULTANEOUSLY S1 not heard tricuspid faint heard easeir in young