HA Cardiovascular and Peripheral Vascular

Mediastinum

The central compartment of the chest cavity located between the lungs

Precordium

The area of the antior chest wall overlaying the heart and lower thorax

Intercostal Space (ICS)

Space between the ribs that houses the intercostal muscles

Apical Impulse

5th ICS, left mid-clavicular, the brief outward pulsation felt on the chest wall when the heart's left ventricle contracts, it is the pulse at the apex of the heart

Point of Maximum Impulse (PMI)

The point on the chest wall where the heartbeat can be felt most strongly

Diastole

Aortic valve closed, mitral valve opened, blood flows from the left atrium into relaxed left ventricle

Systole

Aortic valve open, ejection of blood from the left ventricle into aorta, mitral valve closed

Arrhythmia

Abnormal heart rhythm

Heart Murmur

Extra unusual blowing or swishing sound that can be expected or caused by heart disease - turbulent blood flow

What always causes a diastolic heart murmur?

Heart Disease

Systolic Murmur

Occurs after S1

Diastolic Murmur

Occurs after s2, always indicates heart disease

Cardiac Thrill

Palpable vibration that can accompany a cardiac murmur or cardiac malformation

Cardiac Bruit

Blowing/swishing sound that indicates obstructed peripheral flow

Venous Stasis

A condition in which blood pools or stagnates in the veins, usually in the lower legs, because the veins struggle to pump back up to the heart

Coronary Heart Disease (CHD)

The RESULT of CAD, a condition where the major blood vessels supplying the heart become narrowed or blocked

Coronary Artery Disease (CAD)

This is the PROCESS of affecting the blood vessels, a condition where plaque, made up of cholesterol or other substances, builds up inside the arteries commonly caused by artherosclerosis

Artherosclerosis

Caused by plaque buildup, a disease in which plaque (a sticky substance made of cholesterol, fat, and calcium) builds up in your arteries

Arteriosclerosis

Due to the thickening and stiffening of the wall, a general term for the thickening, hardening, or loss of elasticity of the arterial walls which restricts blood flow to organs and tissues

5 Precordium Auscultation Sites

Aortic, pulmonic, erb's point, tricuspid, mitral

Aortic Auscultation Site

2nd intercostal space, right sternal border

Pulmonic Auscultation Site

2nd intercostal space, left sternal border

Erb's Point

3rd intercostal space, left Sternal border

Tricuspid Auscultation Site

5th intercostal space, lower left Sternal border

Mitral Auscultation Site

5th intercostal space, left midclavicular line

What is the acronym for remembering the cardiac auscultation sites?

All (Aortic), People (Pulmonic), Enjoy (Erb's Point), Time (Tricuspid), Magazine (Mitral)

S1

the first heart sound, heard when the atrioventricular (mitral and tricuspid) valves close

S2

The second sound, heard when the pulmonary and aortic semilunar valves close

Where is the S1 sound loudest?

Apex

Where is the S2 sound loudest?

base

Which sound marks the beginning of systole?

S1

Which sound marks the beginning of diastole?

S2

S3

Low frequency third heart sound after S2 that can be heard with bell of stethoscope if it is present (not a normal finding)

S4

Low frequency fourth heart sound just before S1 that can be heard with bell of stethoscope if present (not a normal finding)

What causes heart murmurs?

Defective heart valve or increase blood volume

What does a heart murmur sound like when auscultated?

Musical, blowing, harsh, rumbling, and can best be heard on the precordium

Valve Stenosis

Narrowing or stiffening of valve

Valve regurgitation

Backwards blood flow through the valve

How are heart murmurs graded?

Grade 1-6, based on volume of murmur and ease of finding sound

What is a grade 4 murmur?

Medium intensity with a palpable thrill

What equipment is necessary to conduct a precordium assessment?

Stethoscope (with diaphragm and bell) and adequate lighting

What equipment is necessary to conduct a peripheral vascular assessment?

Doppler, paper tape measure, tourniquet, blood pressure cuff, stethoscope

What considerations should be made for cardiac assessments?

Draping for privacy and room temperature (cold and hot temperatures can affect results)

Jugular Vein Distension

Enlarged jugular vein

How do you assess for a JVD?

Position patient head of bed to 45 degree angle, ask patient to turn head to the left so you can inspect the right jugular vein (then do the opposite)

Why do you not palpate both carotid arteries at once?

You can cause patient to pass out

What are expected findings from a precordium assessment?

HR of 60-100, regular rhythm, S1 and S2 sounds present

What are expected findings from a peripheral vascular assessment?

Normal 2+ pulses, pulses present in all locations, minimal to no edema

Deep Vein Thrombosis

DVT, blood clot in leg

Why are DVTs so dangerous?

They can break off and go to lungs causing an pulmonary embolism

Pulmonary embolism

clot or other material lodges in vessels of the lung

Who is at risk for getting DVTs?

Most hospitalized patients, immobile patients, dehydrated, older adults, pregnant/postpartum/women on birth control, post operative patients (especially those who had knee or hip replacement)

What are the peripheral pulse locations?

Carotid, radial, brachial, dorsalis pedis, posterior tibial, femoral, popliteal

Carotid pulse

Bilateral on the neck along the outside of the trachea

Brachial Artery Pulse

In the inner crease of the elbow (antecubital fossa), between the biceps and triceps

Radial Artery Pulse

On the thumb side (lateral) side of the inner wrist

Ulnar Artery Pulse

Inner (medial) side of the wrist on the palm side in line with the pinky finger

Femoral Artery Pulse

In the groin, midway between the pubic bone and anterior superior iliac spine

Popliteal Artery Pulse

Deep in the popliteal fossa directly behind the knee

Dorsalis Pedis Artery

On the top of the foot, typically lateral to the extensor tendon of the big toe

Posterior Tibial Artery

Just behind and below the medial malleolus (the inside of the ankle bone)