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