Cardiovascular exam lab

Always do

-pt history

-med chart review

Troponin I normal

-<.05 ng/mL

-elevation indicates acute cardiac injury

BNP/NT proBNP

-BNP: <100 pg/mL

-NTproBNP: <125 pg/mL (0-74 y.o), <450pg/mL (75-99 y.o)

-elevated BNP above 700 indicates decompensated HF

-elevated BNP 100-700 indicates compensated HF

-elevated NTproBNP-->myocardial stretch and HF

Hb

-males: 14-16.5 g/dL

-females: 12-15 g/dL

-low: low O2 carrying capacity

-high: longer exposure to low O2, may need supplemental O2

Hct

Males: 42-52%

Females: 37-47%

-low: low O2 carrying capacity

-high: longer exposure to low O2, may need supplemental O2

Platelets

-150,000-400,000

-decreased--> decreased risk of clotting and repair

-dangerous below 20,000-->risk of bleeding

D dimer

-<500 ng/mL

-elevations-->increased clotting risk

Classic cardiac symptoms

-angina

-SOB

-palpitation

-dizziness/lightheadedness

-pallor

-fatigue

**also look for cyanosis, edema and loss of body hair

Inspection/observation

-cyanosis

-hair loss

-edema

-JVD (HOB at 45 degrees, + if veins distend above clavicle), indicates HF

-support equip, lines, telemetry

physical exam

-inspection/observation

-HR

-BP

-pulses

-edema

-heart auscultation

-activity eval (6MWT)

How long do you measure a regular pulse?

-15s

How long do you measure an irregular pulse?

-60s

How long do you measure a rapidly changing pulse (ex: exercise)?

-10 s

What else should you be assessing as you take HR?

-rhythm disturbances

When do you take HR?

-rest

-during activity

-post-activity

Max HR formula for this class

-Males: 205-1/2 age

-Females: 225-age

SA node intrinsic rate

-60-100 bpm

Atrial rate (myocytes)

-60-80 bpm

AV node intrinsic rate

-40-60

Ventricular intrinsic rate

-20-40 bpm

Pulse grading

0 absent

1 weak/thready (occluded with v. little pressure)

2 normal

3 increased

4 bounding (nd lots of pressure to occlude)

palpate bilaterally

BP documentation should include

-limb

-position

-SBP/DBP

Korotkoff sounds

-phase 1: SBP

-phase 2: swishing, murmurs

-phase 3: crisper, more intense tapping

-phase 4: distint, abrupt muffling sound

-phase 5: DBP

Normal BP

-<120 AND <80

Elevated BP

-120-129 AND <80

HTN 1

-130-139 OR 80-89

HTN 2

-140+ OR 90+

HTN crisis

- >180 and/or >120

7 ways to get accurate BP at home

-use correct cuff size (too small-->add 2-10mmHg)

-put cuff on bare arm (on clothes-->add 5-50mmHg)

-arm at heart level (unsupported adds 10mmHg)

-legs uncrossed ( crossed-->adds 2-8)

-don't talk (adds 10)

-empty bladder (adds 10)

-support back/feet (adds 6)

Pitting edema scale

1+: Barely detectable impression when finger is pressed into skin

2+: Slight indentation; 15 seconds to rebound

3+: Deeper indentation; 30 seconds to rebound

4+: >30 seconds to rebound

S1 heart sound

-closure of mitral and tricuspid

-onset of ventricular systole

-best heard with diaphragm

S2 heart sound

-closure of aortic and pulmonary valves

-start of ventricular diastole

-best heard with diaphragm

S3 abnormal heart sound

-immediately after S2 (early diastole)

-sign of CHF

-indicates ventricular dysfunction

-heard at apex of heart

-pt should lay 45 degrees fwd, left sidelying

-best heard with bell

S4 abnormal heart sound

-just before S1 (late in diastole)

-assoc with atrial contraction

-increased resistance to filling

-heard at apex of heart

-best heard with bell

Murmurs

-classified according to their timing, quality, intensity, pitch, location, and radiation

Apex of heart

-S1

-loudest

-best heard with diaphragm

-onset of ventricular systole

Triscuspid area (Apex of heart)

-left 4th-5th ICS, parasternal

Mitral area (Apex of heart)

-left 5th ICS, midclavicular line

Base of heart

-S2 loudest

Aortic area (Base of heart )

-right 2nd ICS, parasternal

Pulmonic area (Base of heart )

-left 2nd ICS, parasternal

Erb's point

-left 3rd ICS, parasternal

Systolic murmur

-most common

-high pitched

-assoc with aortic stenosis

-congenital defects

Diastolic murmur

-less common

-assoc with arotic and pulmonary regurgitation

-mitral stenosis

-MV prolapse

Pericardial friction rub

-abnormal heart sound

-sign of pericarditis

-position: supine, listen over 3rd or 4th ICS

-"creaky" sound with each beat