Cardiac and non-peripheral vascular assessment

What should inspect of the anterior thorax?

• skin: for oxygenation/lesions/chest shape

• visualize heave/lift at apical pulse site (PMI- Point of Maximal Impulse)

What should you palpate in the anterior thorax?

Valves

• Aortic, Pulmonic, Tricuspid, Mitral valves

  • palpate for landmarks for auscultation (include Erb’s point)

  • palpate for a THRILL @ the site of auscultation for each valve

What is a thrill?

turbulence (turbulent blood flow) FELT due to a murmur

What is a bruit?

the sound of turbulent blood flow in a blood vessel

What is a murmur?

blowing/swishing sound from turbulent blood flow in the heart

What are the landmarks for heart sounds?

1. Aortic valve: R of sternum at 2nd intercostal space

2. Pulmonary valve: L of sternum at 2nd intercostal space

3. Erb’s Point: L of sternum at 3rd intercostal space

4. Tricuspid Valve: L of sternum at 4th intercostal space

5. Mitral valve: L of sternum at 5th intercostal space

Where is the apical pulse located?

• aka Point of Maximal Impulse

• @ mitral valve, location 5th intercostal space, mid clavicular line

What are the different heart rhythms?

• Regular

• Regularly irregular: repeats

• Irregularly irregular: all over the place

What is the S1 heart sound?

• “lub”

• louder at apex

• closure of atrioventiruclar (AV) valves: tricuspid and mitral

What is the S2 heart sound?

• “dub”

• louder at base

• closure of the semilunar valves: aortic and pulmonic

Where is S1 and S2 equal?

Erb’s Point

How should you ausculate the valves?

• start at base and move in Z to apex

• listen w/ BOTH the diaphragm and the bell

  • diaphragm APE to Man- hear valve closrures

  • Bell APE to Man- hear murmurs

How do you grade a murmur?

1. slightest possible murmur, frquenlty overlooked

2. slight murmur, shouldn’t be missed under optimal conditions

3. moderate murmur, no palpable thrill

4. loud murmur with a palpable thrull

5. very loud murmur with an easily palpable thrull

6. extremely loud murmur, can be heard with the stethoscope not even touching the chest wall, extrmely rare, palpable

• Only 4,5,6 are palpable

What should you inspect of the neck vessels?