Chapter 19: Cardiovascular Assessment

Chapter 19: Cardiovascular Assessment Anatomy Review Heart · 2nd-5th intercostal spaces · in mediastinal space · between lungs + diaphragm · base vs. apex Blood Flow · RA → RV → LA → LV · TPMA "toilet paper my assets" · superior vena cava, inferior vena cava, pulmonary artery, pulmonary veins, aorta ECG (Electrocardiogram) · note: depolarization = systole, repolarization = diastole P: atrial depolarization PR interval: AV nodal delay/conduction QRS: ventricular depolarization and atrial repolarization T: ventricular repolarization Cardiac Cycle closes TM Open · review cycle from A&P PA ↑ closes * · S1 (lubb) = closure of tricuspid + mitral valves PA & TM open * · S2 (dubb) = closure of aortic + pulmonic valves · Preload: end-diastolic volume in ventricles (amount of blood in ventricles) ↳ increased stretch increases contractility · afterload: the pressure the heart pumps against · stroke volume: the amount of blood ejected (average 80mL/beat) · Cardiac output (CO)= HR x SV ↳ average CO = 4-8 L/min Focused Health History · Assessment of risk factors Physical Assessment ↳ smoking · inspection ↳ blood pressure and cholesterol ↳ initial survey ↳ diet, exercise, stress management ↳ jugular venous pressure ↳ family history · auscultation · Past history (surgery or illness) ↳ auscultate carotid arteries for bruits · chest pain/discomfort/pressure/tightness ↳ heart sounds · radiating pain · palpation · dyspnea/orthophed/paroxysmal nocturnal dyspnea ↳ carotid arteries · cough ↳ 5 heart locations · diaphoresis · fatigue, sleep changes · edema Urgent Assessment: LOC, lightheadedness, shortness of breath, chest pain, fluid volume overload (large venous pressure), ECG changes Jugular Veins · inspect at 30-45° angle in bed ↳ look for pulsation/distension ↳ right side of patient · jugular venous pressure ↳ shows the central venous pressure in right atrium ↳ use tangital lighting from a 45° angle to emphasize the pulsations ↳ using a ruler and flat paper, measure the distance of the highest point of distension from the sternal angle - should be <3cm above sternal angle Carotid Arteries · inspect for double stroke with S1 and S2 · auscultate for bruits while patient holds their breath ↳ bruits are swooshing sounds that blood makes through narrowed arteries · Palpate the carotid arteries ↳ ONE AT A TIME → risk for obstructing blood to brain ↳ do not massage carotid sinus → bradycardia · normal: rate, rhythm, quality, no adventitious sounds, strength +2 Jugular Vs. Carotid Jugular · rarely palpable · readily occludes · pulsations fall with inspiration · biphasic waveform (2 pulses) · drops when sitting Precordium - Heart · inspection: Bed 30°, tangital lighting + penlight ↳ look for heaves/lifts · palpation ↳ R&L 2nd ICS, L 3rd, 4th, 5th and apex ↳ apex should be PMI ↳ feel for heaves, lifts, or thrills (vibrations) · percussion (Imao we use x-rays now) · auscultation ↳ aortic: right and ICS ↳ pulmonic: left 2nd ICS ↳ erbs point: left 3rd ICS ↳ tricuspid: left 4th and 5th ICS ↳ mitral (apex): left 5th ICS Carotid · palpable · does not occlude W/pressure · pulse unchanged by breathing · single pulsation · not affected by position Erb’s point Heart Sounds * · Lubb (S1) signals start of systole ↳ closure of AV values → tricuspid & mitral · Dubb (S2) signals start of diastole ↳ closure of semilunar values → aortic & pulmonary