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Sharlene and MB's PT party > Cardiovascular- The Exam: Pulse and Heart Rhythm > Flashcards

Cardiovascular- The Exam: Pulse and Heart Rhythm Flashcards

1
Q

What are some things you are checking when you take the history from the patient?

A

Reviewing presenting symptoms, note time of onset, progression, natre of symptoms, insight into medical condition, level of activity in increasing or abating symptoms.

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2
Q

Specific areas to check during subjective interview (think cardiac pt.)

A
  1. Chest pain, SOB
  2. Fatigue, weakness
  3. Palpitations- awareness of pt. of heart rhythm abnormalities
  4. dizziness, syncope
  5. edema- especially in dependent body parts, sudden weight gain
  6. risk factors
  7. Past medical history- along with medications
  8. social history- living sitation and support, education level, employment, life style
  9. quality of life issues- functional mobility, ADLs
  10. social habits, smoking diet, past/present level of activity
    10- observation and inspection of skin color- cyanosis, pallor, diaphoresis
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3
Q

Examine pulse: What should you note?

A

rate and rhythm

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4
Q

Examine pulse: What factors influence it?

A
  • force of contraction
  • volume and viscosity of blood
  • diameter and elasticity of vessels
  • emotions
  • exercise
  • blood temperature
  • hormones
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5
Q

Examine pulse: how long should you check pulse?

A

palpate 30 sec for normal pulse

palpate 1-2 min for irregular pulse

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6
Q

Examine pulse: Apical pulse or point of maximal impulse (PMI)

A
  • pt. supine
  • palpate 5th interspace, midclavicular vertical line (apex of the heart)
  • may displaced upward by pregnancy or high diaphragm
  • may be displaced laterally in CHF, cardiomyopathy, ischemic heart disease
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7
Q

Examine pulse: Carotid pulse

A
  • pt. supinehead elevated (that’s what the book says)
  • palpate carotid artery between SCM and trachea
  • assess one side at a time to reduce risk of brachycardia due to stimulation of carotid sinus baroreceptors> produces a reflex drop in pulse rate or blood pressure
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8
Q

Examine pulse: Brachial pulse

A
  • Palpate over brachial artery. medial aspect of antecubital fossa
  • best in infants
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9
Q

Examine Pulse: femoral pulse

A

palpate over femoral artery in inguinal region

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10
Q

Examine pulse: Popliteal pulse

A

palpate over popliteal artery, behind the knee with the knee flexed slightly

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11
Q

Examine pulse: Pedial pulse

A
  • palpate over dorsalis pedis artery, dorsal medial aspect of foot
  • used to monitor lower extremity circulation
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12
Q

Normal HR

A

Adults and teenager: 60-100 , 40-60 in aerobically trained
Children: 60-140
Newborn: average 127, range 90-164

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13
Q

Tachycardia

A

> 100

  • exercise commonly results in tachycardia
  • compensatory tachycardia can be seen with volume loss (surgery, dehydration)
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14
Q

Brachycardia

A

<60

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15
Q

What is postural tachycardia syndrome?

A

sustained HR increase equal to or greater than 30bpm within 10 min of standing (40 in teens)

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16
Q

3 pulse abnormalities

A
  1. Irregular pulse- varied force and/or frequency, may be due to arrhythmias or myocarditis
  2. Weak thready pulse- may be due to low stroke volume, cardiogenic shock
    3, Bounding full pulse- may be due to shortened ventricular systole and decreased peripheral pressure, aortic insufficiency
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17
Q

What position should pt. be in when auscultating heart sounds?

A

supine

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18
Q

Auscultation landmarks

A

1 Aortic Valve- locate the 2nd R intercostal space at sternal border
2 Pulmonic Valve- locate the 2nd L intercostal space at sternal border
3 Tricuspid Valve- locate 4th L intercostal space at the sternal border
4 Mitral Valve- locate the 5th L intercostal space at the midclavical area

19
Q

Auscultation: What is the S1 (lub) sound?

A

normal closure of mitral valve and tricuspid valves; marks beginning of systole. decreased first degree heart block.

20
Q

Auscultation: What is S2 (dub) sound?

A

normal closure of aortic and pulmonary valves; marks end of systole. Decreased in aortic stenosis

21
Q

Auscultation: Murmers (extra sounds)

A
  1. Systolic- falls between S1 and S2. May indicate valvular disease (ex:mitral valve prolapse) or could be normal
  2. Diastolic- falls between S1 and S2. Usually indicates valvular disease
  3. Grades of heart murmurs- grade 1 (softest) to grade 6 (audible w/ stethoscope off chest)
  4. Thrill- abnormal tremor accompanying a vascular or cardiac murmur; felt on palpation
22
Q

Auscultation: What is bruit?

A

adventitious sound or murmur (blowing sound) of arterial or venous origin; common in carotid or femoral arteries; indicative of atherosclerosis.

23
Q

Auscultation: explain gallop rhythm

A

abnormal heart rhythm with 3 sounds in each cycle; resembles the gallop of a horse

  • S3: associated with ventricular filling. occurs soon after S2, in older individuals may be indicative of CHF
  • S4: associated with ventricular filling and atrial contraction. Occurs before S1, indicative of CAD, MI, aortic stenosis or chronic hypertension
24
Q

Examine heart rhythm: electrocardiogram (ECG)

A

12 lead ECG provides info about rate, rhythm, conduction, areas of ischemia and infarct, hypertrophy, electrolyte imbalances, and systemic pathologies (COPD, cerebral T-waves, ect.)

25
Q

Examine heart rhythm: components of normal cardiac cycle (normal sinus rhythm)

A
  1. P wave- atrial depolarization
  2. PR interval- time required for impulse to travel from atria through conduction system to Purkinje fibers
  3. QRS wave- ventricular depolarization
  4. ST segment- beginning of ventricular repolarization
  5. T wave- ventricular repolarization
  6. QT interval- time for electrical systole
26
Q

Examine heart rhythm: calculate HR with ECG

A

number of intervals between QRS complexes in a 6 second strip and multiply by 10
use longest strip possible for irregular HR

27
Q

Examine heart rhythm: the etiology of arrhythmias

A

ischemic conditions of myocardium, electrolyte imbalance, acidosis or alkalosis, hypoxemia, hypotension, emotional stress, drugs, alcohol, caffeine

28
Q

Examine heart rhythm: where do ventricular arrythmias originate from and what do they significantly affect?

A
  1. originate from ectopic focus in the ventricles (outside normal conduction system)
  2. significant in adversely affecting cardiac output
29
Q

Examine heart rhythm: premature ventricular contractions (PVCs)

A
  • premature beat from ventricle
  • occurs occassionally in majority of normal population
  • on ECG: no P wave , a bizarre and wide QRS that s premature followed by long compensatory pause.
  • Serious PVCs: >6 perminute, paired or in sequential runs, multifocal, very early PVC
30
Q

Examine heart rhythm: ventricular tachycardia (VT)

A
  • a run of 3 or more PVCs occurring sequentially
  • very rapid hr 150-200
  • may occur paroxysmally (abrupt onset)
  • usually the result of an ischemic ventricle
  • on ECG: wide bizarre QRS waves, no P waves. -Seriously compromised cardiac output
31
Q

What is NSVT?

A

Non-sustained ventricular tachycardia

  • 3 or more consecutive beats in duration
  • terminating spontaneously in less than 30 sec.
32
Q

What is sustained ventricular tachycardia?

A

-VT>30 sec in duration and/or requiring termination due to hemodynamic compromise in less than 30 sec.

33
Q

What is VF?

A

Ventricular fibrillation

  • a pulseless emergency situation requiring emergency medical treatment: CPR, defrillation, and meds
  • characterized by chaotic activity of ventricle originating from multiple foci; unable to determine rate
  • On ECG: bizzare erratic activity w/o QRS complexes.
  • no effective cardiac output
  • clinical death in 4-6 min
34
Q

What is an atrial arrhythmia (supraventricular)?

A

rapid and repetitive firing of one or more ectopic foci in the atria (outside the sinus node)

35
Q

What characterizes atrial arrhythmias?

A
  • P waves are abnormal (variable in shape) or not identifiable (afib)
  • rhythm may be irregular : chronic or occuring paroxysmally.
  • Rate: rapid w/ atrial tachycardia (140-250); fribrillation (>300 bpm)
  • cardiac output is usually maintained if rat is controlled; may precipitate ventricular failure in an abnormal heart
36
Q

What are AV blocks?

A
  • abnormal delays or failure to conduct through normal conducting system
  • 1st, 2nd, 3rd (complete) degree AV blocks, bundle branch blocks
  • if ventricular rate is slowed, cardiac output decreased
  • 3rd degree block- complete heart block is life threatening; requires medications and pacemaker.
37
Q

What is the importance of determining ST segment changes?

A
  • With impaired coronary perfusion (ischemia or injury), the ST segment becomes depressed
  • ST segment depression can be upsloping, horozontal, or downsloping.
  • ST segment depression or elevation greater than 1 mm measured at the J point in 2 consecutive leads is considered abnormal, except in leads V2-V3
38
Q

What changes will you see in ECG with an acute MI?

A

acute ST elevations present in leads over the infarcted area

39
Q

How do potassium levels affect ECG changes?

A

Hyperkalemia- widens QRS, flattens P wave, T wave becomes peaked
Hypokalemia- flattened T waves , produces U wave

40
Q

How do calcium levels affect ECG changes?

A

Hypercalcemia- widens QRS, shortens QT interval

Hypocalcemia- prolongs QT interval

41
Q

How does hypothermia affect ECG changes?

A

elevates ST segment

42
Q

How do digitalis, quinidine, beta blockers, nitrates, and antiarrhythmic medications affect ECG

A

Digitalis- depresses ST segment, flattens or inverts T wave, QT shortens

Quinidine- QT lengthens, T wave flattens or inverts, QRS lengthens

Beta blockers- decreases HR, blunts HR response to exercise

Nitrates- increases HR

Anti-arrhythmics- prolong QRS and QT intervals

43
Q

What is Holter monitoring?

A
  • continuous ambulatory ECG monitoring via tape recording of cardiac rhythm for up to 24 hours
  • evaluates: cardiac rhythm, transient symptoms, pace maker function, and effect of medications.

Sharlene and MB's PT party (35 decks)

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