Term
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Definition
Is cyanosis present?
Is it central or peripheral?
Temperature
Warmer
fever, thyrotoxicosis
LEs cool/UEs warm
intermittent claudiation
Rash: erythema marginatum and in fever can be possible rheumatic fever
Xanthomata |
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Term
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Definition
stony hard yellowish masses usually near extenser tendors
Possible familial hypercholesterolemia |
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Term
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Definition
| Splinter Hemorrhages signify bacterial endocarditis |
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Term
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Definition
xanthelasma shows high cholesterol
Arcus senilis is high cholesterol |
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Term
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Definition
| acute endocarditis associated with palatal petechia |
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Term
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Definition
Any visible cardiac motions?
Pectus excavatum
Caved-in chest
Marfan’s syndrome, MVP
Pectus carinatum
Pigeon breast
Marfan’s syndrome |
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Term
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Definition
Changes in pressure of right atrium
A wave
Atrial contraction
C wave
TV closure
X descent
Atrial relaxation
V wave
Atrial filling
Y descent
Atrial emptying |
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Term
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Definition
Giant A wave(atrial cxtn)
TS, PS, Cor pulmonale
Prominent X descent(atrial relaxation)
Pericardial tamponade, Constrictive pericarditis
Large V wave(atrial filling)
TR
Slow Y descent(atrial emptying)
TS |
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Term
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Definition
Locate path of IJ vein
Pulsation varies with respiration
Increases with inspiration
Decreases with expiration
Pulsation is obliterated with gentle pressure
Multiple wave forms are seen
have the patient valsalva |
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Term
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Definition
A reflection of right atrial pressure(RAp) or central venous pressure(CVP)
Normal RAp= 8mmHg
Note: 1mmHg=1cm
Right atrium is 5 cm below sternal angle |
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Term
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Definition
Examine IJ pulse in the neck
Determine the location of the highest oscillation of the IJ pulsation
If IJ pulsation is not detectable, use the external jugular(EJ) vein point of collapse(not very reliable)
Extend a fixed object horizontally from the point of highest JV oscillation
Place a cm ruler vertically from the sternal angle
Note where the horizontal object crosses the ruler
This distance above the sternal angle(or right atrium) is the JVP
It is measured in centimeters(recall 1cm=1mmHg) |
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Term
| Increase JVP (Increase volume to RA) |
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Definition
Causes
Right heart failure
Constrictive Pericarditis
Tricuspid Stenosis
Severe Pulmonic Stenosis |
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Term
| decrease JVP (decrease volume to RA) |
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Definition
Causes
Dehydration
Hemorrhage |
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Term
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Definition
RV failure have dilated sinusoids in liver
Pressure on liver pushes blood our of the sinusoids into inverior vena cava
Cause further distension of neck veins
Pt supine, mouth open, breath normally, place hand over liver in RUQ and aplly firm progressive pressure for 10 sec |
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Term
| Assessment of Hepatojugular Reflux |
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Definition
Normal response: Neck veins show a transient increase in distention followed by a fall to baseline during later part of compression
Abnormal response: Neck veins remain distended during the entire duration of compression; distention falls rapidly when hand suddenly released |
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Term
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Definition
Percussion wave
The rate of flow in the artery
Occurs during peak flow velocity
Tidal Wave
Related to pressure in the vessel
Occurs during peak syst pressure
Dicrotic notch
Brief, sharp rise in aortic curve
Caused by vibrations that are transmitted to the aorta wall with abrupt closure of the aortic valve |
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Term
| palpation of carotid artery |
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Definition
First, auscultate for bruits with the diaphragm
If a bruit is present, do not palpate the carotid artery!!
Avoid pressure on the carotid sinus
Never press both arteries at the same time(duh!)
Have pt lie down with head of bed at 30 degree angle
Inspect the neck for carotid pulsations
Then place your left index and middle fingers on RCA, press posteriorly, and feel for pulsations
Press just inside the medial border of a well-relaxed SCM, roughly at the level of the cricoid cartilage |
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Term
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Definition
Contour
Amplitude
Thrills & Bruits |
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Term
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Definition
Refers the shape and speed of the wave
Speed of upstroke, the duration of its summit, and the speed of the down stroke |
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Term
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Definition
Upstroke is brisk, smooth, & rapid; follows S1
Summit is smooth, rounded, and roughly midsystolic
Down stroke less abrupt than upstroke |
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Term
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Definition
(Hypodynamic)
SV and/or PVR
Heart failure, hypovolemia, severe Aortic Stenosis, cardiogenic shock
Exposure to cold, severe heart failure |
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Term
| bounding carotid upstroke |
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Definition
Hyperdynamic)
increase SV and/or decrease PVR
Fever, anemia, hyperthyroidism, Aortic Regurgitation, Patent Ductus Arteriosis and AV fistulas
Stiffened aortic walls (aging, ASCVD) |
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Term
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Definition
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Term
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Definition
Alternating strong and weak beats
Left ventricular failure (S3) |
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Term
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Definition
Alternating strong and weak beats
Left ventricular failure (S3) |
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Term
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Definition
decrease pulse amplitude on inspiration (> 10 mm Hg)
Pericardial tamponade, constrictive pericarditis, COPD |
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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
Inspection of the anterior chest may reveal the location of the point of maximum impulse(PMI)
Occasionally the ventricular movements of a left sided S3 or S4 may be noted |
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Term
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Definition
PMI
Localized motion
Generalized motion
Thrills |
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Term
PMI assessment
point of maximual impulse |
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Definition
Locates the left border of the heart
Represents the brief early pulsation of the LV as it moves anteriorly during systole and touches the chest wall
In most pts the apical impulse is the point of maximum impulse(PMI)
If PMI cannot be felt with the pt sitting, the pt should be re-evaluated while supine and in the left lateral decubitus position
Location
Diameter
Amplitude
Duration |
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Term
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Definition
| Ventricular hypertrophy 2º to overload (HTN) |
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Term
| Lateral displacement of PMI |
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Definition
Congestive heart failure (CHF)
Cardiomyopathy
Ischemic heart disease |
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Term
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Definition
| Pregnancy, elevated left hemi-diaphragm |
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Term
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Definition
Palpate in all four main cardiac areas with fingertips to assess any localized motion
Assess for heaves, lifts, or thrills |
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Term
| Generalized motion-palpate |
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Definition
Done after chest palpated with fingertips
Use the ball of the hand to feel for any heaves or lifts(sustained outward motion)
Indicates size of RV
Again, palpate each of the four main cardiac areas |
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Term
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Definition
Thrills are the superficial vibratory sensations felt on the skin overlying an area of turbulence
The presence of a thrill indicates a loud murmur i.e.)AS, PDA, occasionally MS
They are generally palpated in pt positions that accentuate the murmur
Adds little to dx but alerts the examiner as to what will be heard |
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Term
| Abnormalities of Left ventricle |
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Definition
| Pmi displacement, changes in PMI diameter, and amplitude duration |
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Term
| Abnormalities of right ventricle |
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Definition
A marked increase in amplitude with little or no change is duration occurs in chronic volume overload of the RV i.e.)ASD
An impulse with increased amplitude and duration occurs with pressure overload of the RV i.e.) PS or pulmonary HTN |
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Term
| pulmonic area abnormalities |
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Definition
A prominent pulsation here often accompanies dilatation or increased flow in the pulmonary artery
A palpable S2 suggests pulmonary HTN |
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Term
| aortic area abnormalities |
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Definition
Aortic Area
A pulsation here suggests a dilated or aneurysmal aorta
A palpable S2 suggests systemic HTN |
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Term
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Definition
When the apical impulse cannot be felt, percussion may be your only tool i.e.)large pericardial effusion
Cardiac dullness occupies a large area
Starting from the left mid-axillary line, percuss from resonance toward cardiac dullness in the 3rd, 4th, 5th, and possible 6th interspaces |
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Term
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Definition
Proper auscultation requires a quiet area
Never listen through clothing
Always inspect and palpate before auscultation |
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Term
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Definition
Apply lightly to the skin
Better for low pitched sounds
I.e.) gallop rhythms, murmur of AV stenosis |
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Term
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Definition
Press tightly to the skin
Better for high pitched sounds
I.e.) valve closure, systolic events, regurgitant murmurs |
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Term
| auscultation of cardiac areas |
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Definition
Examiner should be on the right side of the pt
Listen in the aortic, pulmonic, tricuspid, and mitral areas(Apt. M)
Do not necessarily limit auscultation to just these areas
Start at any area and “inch” the stethoscope over the precordium from area to area
Same way everytime to Every patient |
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Term
| standard position for auscultation |
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Definition
Supine
Left lateral decubitus
Upright
Upright, leaning forward |
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Term
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Definition
| Listen at the apex and LLSB with the bell to determine if present |
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