Cardiac and Peripheral Vascular System Assessment

Comprehensive vocabulary flashcards covering cardiac and peripheral vascular anatomy, assessment landmarks, heart sounds, circulatory disorders, and physical examination techniques.

Diastole

The relaxation phase of the cardiac cycle where the ventricles fill with blood; it constitutes approximately two thirds ($\frac{2}{3}$) of the cardiac cycle and represents the lower number (denominator) of a blood pressure reading.

Systole

The contraction phase of the cardiac cycle during which blood pumped from the ventricles fills pulmonary and systemic arteries; it constitutes one third ($\frac{1}{3}$) of the cycle and represents the top number (numerator) of a blood pressure reading.

First Heart Sound ($S_1$)

The "lub" sound that signals the beginning of systole, created by the closure of the atrioventricular (AV) valves (tricuspid and mitral/bicuspid) to prevent backflow into the atria; heard loudest at the apex.

Second Heart Sound ($S_2$)

The "dub" sound that signals the end of systole and the beginning of diastole, created by the closure of the semilunar valves (aortic and pulmonic); heard loudest at the base.

Third Heart Sound ($S_3$)

A dull, low-pitched extra sound heard in early diastole during rapid ventricular filling immediately after $S_2$; often called a ventricular gallop, heard best with the bell at the apex, and caused by vibrations from increased atrial pressure and volume overload.

Fourth Heart Sound ($S_4$)

A soft, very low-pitched presystolic sound occurring at the end of diastole just before $S_1$ when atria contract against a noncompliant, stiff ventricle; sounds like "ten-ne-ssee" and is best heard with the bell in the left lateral position.

Pericardial Friction Rub

A high-pitched, scratchy sound resembling sandpaper heard on auscultation caused by inflammation of the pericardial sac (pericarditis); best heard at the apex using the diaphragm of the stethoscope.

Stethoscope Diaphragm

The larger, flat side of the stethoscope chestpiece designed most effectively for transmitting high-frequency sounds, such as normal heart sounds, lung sounds, and bowel sounds.

Stethoscope Bell

The smaller, cupped side of the stethoscope chestpiece designed most effectively for transmitting low-frequency sounds, such as bruits, murmurs, and $S_3$ or $S_4$ gallops.

Heart Murmur

A gentle blowing or swooshing sound heard on the chest wall caused by turbulent blood flow or collision currents passing through cardiac chambers or valves.

Stenosis

A valvular condition in which a heart valve fails to open fully when it should be open, restricting blood flow.

Regurgitation

A valvular defect where a heart valve fails to close completely when it should be shut, allowing backward flow of blood.

Carotid Artery Pulse

A central arterial pulse located in the groove medial to the sternocleidomastoid muscle alongside the trachea; should be palpated gently one side at a time to avoid compromising cerebral arterial perfusion.

Jugular Venous Distention (JVD)

The visible engorgement of the external jugular veins above the clavicle at or above a $45^\circ$ angle, reflecting elevated right atrial pressure, volume overload, and right-sided heart failure.

Left-Sided Heart Failure

Cardiac failure characterized by backflow of blood into pulmonary circulation, presenting with pulmonary congestion, dyspnea, orthopnea, paroxysmal nocturnal dyspnea, cough, crackles, wheezes, and pink blood-tinged sputum.

Right-Sided Heart Failure

Cardiac failure characterized by backflow of blood into the systemic venous circulation, presenting with jugular venous distention (JVD), dependent peripheral edema, ascites, hepatomegaly, splenomegaly, and anorexia.

Arteriosclerosis

The progressive age-related thickening, stiffening, and loss of elasticity of arterial walls that contributes to an increase in systolic blood pressure and pulse pressure.

Orthostatic Hypotension

A sudden drop in blood pressure accompanied by lightheadedness or dizziness occurring when a person moves from a supine or sitting position to a standing position.

Paroxysmal Nocturnal Dyspnea (PND)

Sudden awakening from sleep with severe shortness of breath, requiring the patient to sit upright; commonly associated with heart failure and fluid redistribution.

Point of Maximal Impulse (PMI) / Apical Pulse

The localized pulsation created as the left ventricle rotates against the chest wall during systole, palpated using one finger pad at the fifth intercostal space at the left midclavicular line.

Thrill

A palpable vibration over the precordium or vascular access sites that signifies turbulent blood flow and accompanies severe murmurs.

Pulse Amplitude Grade 0

A pulse amplitude description indicating an absent pulse.

Pulse Amplitude Grade 1+

A pulse amplitude description indicating a pulse that is palpable, but thready, weak, and easily obliterated.

Pulse Amplitude Grade 2+

A pulse amplitude description indicating a normal, easily identified pulse that is not easily obliterated.

Pulse Amplitude Grade 3+

A pulse amplitude description indicating an increased pulse requiring moderate pressure for obliteration.

Pulse Amplitude Grade 4+

A pulse amplitude description indicating a full, bounding pulse that cannot be obliterated.

Aortic Valve Auscultation Area

The cardiac auscultatory site located at the second right intercostal space at the right sternal border.

Pulmonic Valve Auscultation Area

The cardiac auscultatory site located at the second left intercostal space at the left sternal border.

Erb's Point

The auscultatory location at the third intercostal space along the left sternal border where $S_2$ is frequently heard well.

Tricuspid Valve Auscultation Area

The cardiac auscultatory site located at the fourth intercostal space along the left sternal border.

Mitral Valve Auscultation Area

The cardiac auscultatory site located at the fifth intercostal space along the left midclavicular line.

Carotid Bruit

A blowing, swooshing sound heard over a carotid artery using the stethoscope bell, indicative of turbulent blood flow caused by arterial narrowing or atherosclerotic plaque.

Clubbing

Soft tissue swelling of the terminal phalanges where the normal $160^\circ$ angle between the nail base and nail bed is lost or exceeds $180^\circ$; associated with chronic hypoxia, heart diseases, and respiratory pathology.

Capillary Refill

An assessment of peripheral perfusion and cardiac output evaluated by depressing and blanching the nail bed; normal return of color occurs within $2$ to $3\text{ seconds}$.

Epitrochlear Lymph Node

A lymph node evaluated in the depression above and behind the medial epicondyle of the humerus to check for lymphatic drainage abnormalities of the hand and forearm.

Popliteal Pulse

An arterial pulse palpated deep in the popliteal fossa by anchoring the thumbs on the knee and pressing curled fingers firmly forward against the bone lateral to the medial tendon.

Posterior Tibial Pulse

An arterial pulse palpated by curving fingers around the groove immediately behind and below the medial malleolus of the ankle.

Dorsalis Pedis Pulse

An arterial pulse palpated using very light pressure on the dorsum of the foot just lateral to and parallel with the extensor tendon of the great toe.

Pitting Edema Grade 1+

Mild pitting edema demonstrated by a slight indentation with no perceptible swelling of the leg.

Pitting Edema Grade 2+

Moderate pitting edema where the indentation subsides rapidly after releasing pressure.

Pitting Edema Grade 3+

Deep pitting edema where a visible indentation remains for a short time and the leg looks visibly swollen.

Pitting Edema Grade 4+

Very deep pitting edema where the indentation lasts a long time and the extremity is severely swollen.

Varicose Veins

Dilated, tortuous superficial vessels (commonly within the saphenous system) resulting from incompetent valves that allow abnormal pooling and backward flow of blood.

Doppler Ultrasonic Probe

A handheld transducer device coupled with transmission gel placed at a $90^\circ$ angle to detect weak peripheral pulses and low blood pressure by amplifying pulsatile sounds.

Arterial Insufficiency (PAD)

A peripheral vascular condition caused by narrowed arteries leading to ischemic pain (intermittent claudication that worsens with activity and eases with rest), cool skin, pallor, shiny thin skin, hair loss, and dark ulcers with defined margins.

Venous Insufficiency (PVD)

A peripheral vascular condition marked by inadequate return of blood to the heart, causing achy, tired cramping that worsens with standing and improves with leg elevation, warm extremities, edema, brownish skin discoloration, and irregular ulcers.

Deep Vein Thrombosis (DVT)

A blood clot (thrombus) that forms inside a deep vein of the leg or pelvis, presenting with unilateral calf or leg swelling, localized warmth, redness, and pain.

Pulmonary Embolism (PE)

A life-threatening complication occurring when a deep vein thrombus breaks loose, travels through the heart, and occludes a pulmonary artery; symptoms include dyspnea, chest pain worsening with inspiration, tachycardia, and hemoptysis.

Wells' Score for DVT

A validated clinical prediction tool evaluating specific risk factors (e.g., active cancer, immobilization, asymmetric calf swelling $>3\text{ cm}$, pitting edema) where a total score of $\ge 2$ indicates that DVT is likely.