Phys Di II - Exam 2 (EKG + Vascular)

EKG paper measurements

small boxes = 0.04 sec

large squares = 0.2 sec + 0.5 mV

5 large squares = 1 sec

15 large squares = 3 sec

Ventricular rhythm on EKG

look at R wave to R wave

Atrial rhythm on EKG

look at P wave to P wave

If p waves are not present, what does the patient require

a pacemaker

PR interval

from beginning of P wave to beginning of QRS

What is normal for a QRS complex

1 or 2 waves can be absent

ST segment

should be flat line and make it to the bottom of the EKG (zero)

Atrial (auricular flutter)

saw tooth appearance

atrial cx in excess 200 bpm

multiple p waves for each QRS

racing heart (palpitations), shortness of breath, dizziness

Sinus bradycardia

<60 bpm HR

slow but normal EKG

good cardiovascular conditioning, drugs, heart block

Atrial fibrillation

quivering/irregular HR

irregular spasms of atria w/NO P waves

lead to blood clots, stroke, HF

fluttering feeling in chest

Heart block - 1st degree

PR interval longer than 0.20 sec

benign and asymptomatic

etiology - intrinsic AVN disease, enhanced vagal tone, acute MI, myocarditis, hypokalemia, hypomagnesmia

Heart block - 2nd degree type 1 (Wenckenbach/Mobitz 1)

benign

PR interval increases with each beat until a QRS is missed

due to conduction block at AV node

Heart block - 2nd degree type 2 (Mobitz 2)

PR interval stays the same but QRA complex dropped

failure of conduction of

Palpable and sometimes visible arterial pulses are the result of

ventricular systole (pressure wave)

Time it takes for wave to be felt in dorsal pedis + RBC migration

takes 0.2 sec for wave to be felt in dorsal pedis

takes 2 sec for RBC to travel same distance

The activity of the right side of the heart is transmitted back through the

jugular veins as a pulse (visualized only)

• three peaks and two descending slopes

Jugular venous pulse components - a wave

result of a brief backflow of blood to vena cava during right atrial contraction

Jugular venous pulse components - c wave

transmitted impulse from vigorous backward push produced by closure of tricuspid valve during ventricular systole

Jugular venous pulse components - v wave

caused by increasing volume and concomitant increasing pressure in right atrium

after c wave in late ventricular systole

Jugular venous pulse components - x slope

caused by passive atrial filling

Jugular venous pulse components - y slope

reflects the open tricuspid valve and the rapid filling of ventricle

Ductus arteriosus closes in first

12-14hrs of life

Foramen ovale closes after

pressures shift

In pregnant women, what happens to their blood pressure

decreases

Aterial walls in older adults

lose elasticity and vasomotor tone

Pulse amplitude characteristics

+0 = absent, not palpable

+1 = diminished, barely palpable

+2 = expected

+3 = full, increased

+4 = bounding, aneurysmal

Three P’s of occlusion

pain

pallor

pulselessness

Pain that results from muscle ischemia in PAD

claudication

Normal BP

<120 mmHg systolic

AND

<80 mmHg diastolic

Elevated BP

120-129 mmHg systolic

AND

<80 mmHg

HTN Stage 1

130-139 mmHg systolic

OR

80-89 mmHg diastolic

HTN stage 2

>140 mmHg systolic

OR

>90 mmHg diastolic

Can the jugular venous pressure be palpated

NO! - Only visualized

Measuring jugular venous pressure

horizontally from meniscus of top of blood column

vertically from the sternal angle

add 5 cm

Jugular venous pressure should be less than

9cm (more = sign of HF)

Hepatojugular reflux is a sign of

right sided HF

Central venous pressure (hand veins) grading

before sternal angle = low venous pressure

at sternal angle = normal venous pressure

above sternal angle = high venous pressure

Homan sign

calf pain with passive dorsiflexion of the foot

Edema grading

+1 = slight pitting, disappears rapidly, 2mm

+2 = deeper pitting, disappears in 10-25 sec, 4 mm

+3 = noticeably deeper, last 60 sec, 6 mm

+4 = very deep, lasts 2-5 min, 8mm or more

Brawny edema

non-pitting edema of chronic venous insufficiency

Capillary refill should be

less than 2 seconds

What is common in children

venous hum (using bell)

• turbulence of blood flow in internal jugular veins

Venous thrombosis occurs less commonly in children and is most often associated with placement of

venous access devices (port in chest)

HTN in children is most commonly caused by

kidney/renal disease, coarctation, or phenochromocytoma

Pregnant women vascular changes

CO increases

jugular a and v waves easier to see (pressure remains normal)

BP decreases

What should you tell older adults to do to decrease their blood pressure

exercise

What part of the stethoscope do you use to detect bruits

bell

Alternating pulse (pulsus alternans) cause

left ventricular failure

Pulsus bisferiens cause

aortic stenosis combined with aortic insufficiency

Bigeminal pulse cause

disorder of rhythm

Large, bounding pulse cause

exercise, anxiety, fever, hyperthyroidism, atherosclerosis

Paradoxic pulse (pulsus paradoxus) cause

premature cardiac contraction

tracheobronchial obstruction

bronchial asthma

emphysema

pericardial effusion

constrictive pericarditis

Water-hammer pulse (Corrigan pulse)

patent ductus arteriosus

aortic regurgitation

Temporal arteritis (giant cell arteritis)

inflammation of branches of aortic arch (including temporal arteries)

ischemia of masseter, tongue, optic nerve (tongue and jaw pain)

>50 adults

polymyalgia rheumatica of hips, neck, shoulders

headache in temporal region on one or both sides

Arterial aneurysm

1.5x the normal diameter

4x more common in men

severe ripping pain (mid-back pain = thoracic aorta)

bruit over aneurysm

How can you see an aneurysm on an x-ray

calcifications on the LEFT side

Arteriovenous fistula

congenital or acquired via catherization

may result in aneurysmal dilation

continuous bruit/thrill over area

edema may develop in involved extremity

Peripheral artery disease (PAD)