Term
| Murmurs, How they are Produced |
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Definition
Increased flow across normal valve
Partially Obstructed Forward flow: stenosis
Backflow: incompetent valve (regurgitant)
Flow Into dilated chamber
Shunting through abnormal passage |
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Term
| Grade? Thrill?: May be heard without a stethoscope |
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Definition
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Term
| Grade? Thrill?: Very loud, may be heard with the stethoscope partially off the chest |
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Definition
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Term
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Definition
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Term
| Grade? Thrill?: Moderately loud |
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Definition
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Term
| Grade? Thrill?: Clearly audible, but quiet |
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Definition
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Term
| Grade? Thrill?: Very faint, barely audible |
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Definition
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Term
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Definition
insufficient AV valves
stenotic aortic or pulmonic valve
“innocent” or functional - thin chest wall - fever - anemia
VSD
other |
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Term
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Definition
Ejection: aortic pulmonic stenosis
Holosystolic : mitral tricuspid regurgitation
Late systolic: +/- click/snap MVP |
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Term
| Diastolic Murmurs: causes |
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Definition
Usually pathologic
Insufficient aortic or pulmonic
Stenotic AV valves
Other |
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Term
| Diastolic Murmurs: causes |
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Definition
Early (Aortic regurg)
Mid (mitral/tricuspid stenosis)
Late (+/- opening snap mitral stenosis) |
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Term
| Continuous Murmurs: cause |
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Definition
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Term
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Definition
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Term
| Blood Pressure – JNC VII: Normal |
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Definition
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Term
| Blood Pressure – JNC VII: Pre-Hypertension |
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Definition
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Term
| Blood Pressure – JNC VII: stage i htn |
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Definition
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Term
| Blood Pressure – JNC VII: Stage ii htn |
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Definition
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Term
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Definition
Symmetry - compare side to side
Rate - normal adult 70-100 - tachycardia >100 - bradycardia <60
Rhythm - regular - regularly irregular - irregularly irregular
Amplitude/Force |
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Term
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Definition
4+ = bounding, very increased
3+ = full, increased
2+ = expected/normal
1+ = diminished
0 = absent, not palpable |
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Term
| Angle of Louis or sternal angle |
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Definition
| - sterno- manubrial junction - point where 2nd rib attaches to sternum |
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Term
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Definition
Inspection
Palpation
Percussion - rarely performed
Auscultation |
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Term
| Inspection: why use tangential lighting |
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Definition
| Tangential Lighting - to assess carotid pulsation - JVD - apical pulsation - heaves/lifts |
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Term
| Inspection: Jugular Vein - how does distension increase or decrease |
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Definition
| Jugular Vein - distension decreases as head and torso are elevated |
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Term
| Anatomic location of internal jugular |
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Definition
| Anatomic location of internal jugular - between 2 heads of sternocleidomastoid |
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Term
| Inspection: Jugular Veins (estimating CVP) |
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Definition
pt. reclining @ 300
tangential lighting
check symmetry
measure (> 4cm is above sternal angle is abnormal)
hepatojugular reflux |
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Term
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Definition
Fingers
Toes
Skin
Eyes
Circumoral |
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Term
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Definition
Temp Changes - use backs of hands to compare side to side - upper and lower extremities
Capillary Refill - check upper and lower extremities - < 2 seconds considered normal
Peripheral edema - graded
Thrill - palpable vibration at site of partial obstruction of valve or artery |
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Term
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Definition
Compress nail to blanch nailbed
Release
Observe time it takes for pink nailbed to recover
< 2 sec is norm |
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Term
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Definition
1+: slight, disappears rapidly (2mm)
2+: deeper than 1+, disappears in 10-15 sec. (4mm)
3+: noticeably deep, >1 min., ext. swollen (6mm)
4+: deep pit, lasts 2-5 min., gross swelling (8mm) |
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Term
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Definition
Use Palmar aspect of MCPJ’s
Palpable vibration may indicate partial vascular obstruction or abnormal flow across heart valve
Grade 4 or higher murmur |
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Term
| palpation of pulses which pulses |
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Definition
Carotid
Apical
Brachial
Radial
Femoral
Popliteal
Dorsalis Pedis
Posterior Tibial |
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Term
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Definition
Fingertips
Compare side to side
Never both at once |
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Term
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Definition
PMI (point of maximal intensity) i.e. 5ICS LMCL
Heaves
Lifts
Thrills
MCPJ’s to feel
Fingertips to localize |
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Term
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Definition
| brachial medial side of elbow, radial, radial side of wrist |
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Term
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Definition
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Term
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Definition
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Term
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Definition
Audible vibrations caused by partial obstruction of blood flow
Sometimes palpable
Timing with pulse
Ask pt to hold breath to eliminate tracheal sounds
Bell of stethoscope |
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Term
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Definition
Audible vibrations = bruit
Palpable vibrations = thrill |
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Term
| Most Common Sites for ausculation of arteries |
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Definition
Temporals
Carotids
Renal arteries
Abdominal aorta
Iliacs
Femorals
Use Bell to localize |
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Term
| Cardiac Auscultation: listen for |
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Definition
Rate
Rhythm
S1 & S2
Systole & diastole
Murmurs
Extra sounds |
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Term
| s1 vs s2- what is closing |
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Definition
S1 - closure of mitral and tricuspid
S2 - closure of aortic & pulmonic |
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Term
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Definition
Systole - contraction of ventricles - timing with pulse
Diastole - relaxation of ventricles - longer than systole |
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Term
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Definition
Mitral and Tricuspid valve closure (AV valves)
Best heard at apex
Usually heard as one sound
Louder than S2
Same time or slightly before carotid pulse is palpated (way of identifying systole) |
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Term
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Definition
Closure of aortic and pulmonic valves (semilunar)
Heard best at base
Two components:
A2: aortic, loudest
P2: pulmonic |
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Term
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Definition
Early diastolic sound
Low frequency
Best heard: at apex, w/bell, left lateral decubitus
Cause: rapid ventricular filling
Normal: in children & young adults
Older patient: may indicate heart failure |
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Term
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Definition
Late diastole
Use bell at apex
Physiologic in young pt. w/ thin chest wall
Confused with split S1
Cause: increased resistance to ventricular filling (decreased LV compliance or increased volume) |
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Term
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Definition
Over 6 areas with diaphragm and bell
Valve sounds are transmitted to these areas |
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Term
| tricuspid valve heard best |
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Definition
| Tricuspid valve usually heard at left lower sternal border (RSB shown) |
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Term
| cardiac auscultation- positions |
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Definition
Aortic 2ICS RSB
Pulmonic 2ICS LSB
2nd Pulmonic 3ICS LSB
Tricuspid 5ICS LSB
Mitral 5ICS LMCL |
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Term
| how should pt hold breath for cardiac auscultation |
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Definition
| Exhaling and holding breath decreases interfering breath sounds and decreases lung pressure on heart. |
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Term
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Definition
| Venous Hum: Continuous, low pitch, Neck and supraclavicular areas (Rt. side) More common in children, Caused by internal jugular turbulence |
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Term
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Definition
| Chest radiograph demonstrates rib notching (ribs 3-8 bilaterally). There is a figure-three sign in the left upper mediastinum secondary to hypoplasia of the aortic arch with poststenotic dilation of the aorta infra-coarctation. |
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Term
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Definition
Ejection clicks
Opening Snap
Pericardial friction rub
Prosthetic valves, pacemakers |
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Term
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Definition
Pain
Pallor
Pulselessness
Paresthesias
Paralysis |
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Term
| skin changes: arterial insufficiency |
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Definition
prolonged capillary refill
loss of hair
thinning of skin
dependent rubor |
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Term
| arterial insufficiency: also check |
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Definition
Pulses
Bruits
Skin temperature
Pallor or cyanosis |
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Term
| arterial insufficiency: test |
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Definition
Raise both legs for several seconds to add force of gravity against arterial flow
Look for pallor of one extremity
Then lower legs and observe for dependent redness (rubor) in affected foot
Presence of pallor followed by rubor is a positive test |
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Term
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Definition
Vein Thrombosis (Phlebitis): Homan's Sign
Calf pain on foot dorsiflexion is called Homan's sign. This maneuver stretches calf muscles and deep veins. |
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Term
| Vein Thrombosis (Phlebitis) |
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Definition
Redness, thickening,
Midline posterior calf tenderness
Homan’s sign
Swelling
Measure circumference |
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Term
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Definition
| With ribs, interspaces, and imaginary lines, should be able to provide a REPRODUCIBLE description of locations on the chest wall |
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Term
| Are there some things you could learn about your patients cardiovascular status before you lay the stethoscope on them? |
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Definition
Smoking status
Oxygenation
Peripheral circulation |
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Term
| What do warmth and coolness mean? |
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Definition
Temp changes, compare side to side
Warmth can mean infection
Coolness can mean poor circulation |
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Term
| peripheral edema-where do you check? |
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Definition
| Check over bony prominence |
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Term
| with what part of hands do you palpate: pulses, thrill, temp |
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Definition
pulses: Palpate with fingertips… not thumbs.
thrill: Use Palmar aspect of MCPJ’s
temp: - use backs of hands to compare side to side |
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