Advanced Physical Assessment
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| show | global> family hx, smoking, physical activity, etc- dibetetes htn
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| Step 2 and 3 screening for cardiovascular dz | show 🗑
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| Anatomy of the heart- direction of blood flow | show 🗑
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| Sequence of events in the heart | show 🗑
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| SA node | show 🗑
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| Most concerning s/s | show 🗑
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| show | excretion- increased activity or emotion
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| Pericardial comes with | show 🗑
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| show | breathing- disappears when the pt hold their breath
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| show | tenderness- costochondritis
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| GERD pain | show 🗑
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| Typical ischemic chest pain | show 🗑
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| show | thin fibrous cap- more severe pain and more prolonged (>20 minutes)- unstable, non-stemi or stemi- can occur at rest or with activity- crushing- vise-like pain- nausea, diaphoresis, impending doom, SOB, anxiety- not relieved by nitrates
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| show | Women over 65 years, are likely to report atypical symptoms such as upper back, neck, or jaw pain, SOB, PND, N/V, and fatigue
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| show | retrosternal diffuse, radiates to the left arm, jaw, back, aching, dull, pressing squeezing, vise-like, mild to severe, minutes (most important indicator), precipitated by cold, eating, effort, emotion and relieved by rest and nitro
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| What’s NOT angina | show 🗑
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| Paroxysmal nocturnal dyspnea PND | show 🗑
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| Angina | show 🗑
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| Palpitations | show 🗑
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| Edema | show 🗑
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| Fatigue or syncope | show 🗑
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| show | hx of MI
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| show | that’s premature and for females, it’s 65
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| show | tobacco- worst than etoh
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| show | radial and apical- should be exactly the same- apical can be 120 or more with atrial flutter/PVCs/tachy arrythmias- there’s an apical deficit when the radial is different
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| Orthostatic HTN | show 🗑
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| show | 2 prominent bulges (a and v wave)- order echo-prominent a wave in JVD= pulmonary HTN-– absent in atrial fibrillation-right side too much pressure- and prominent v wave= tricuspid regurgitation or ASD- atrial septal defect
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| Findings suggesting coronary artery disease-signs of hyperlipidemia | show 🗑
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| show | cyanosis- central} tongue and toes- rt to left cardiac shunt- peripheral cyanosis} fingers and toes only- low cardiac output-clubbing in cyanotic CHD
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| show | oslers nodes- red papules on the fingers and toes, janesways lesions, Roth spot (retina)
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| show | the sound that corresponds to the pulse is the 1st heart sound- systole- and that’s how you would identify a systolic murmur
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| show | valve overload- felt- differentiate between pressure and volume overload
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| Concentric vs eccentric hypertrophy | show 🗑
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| show | in the epigastric area
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| Left ventricular area for Apical Impulse (AI) | show 🗑
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| Heart is on the opposite side | show 🗑
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| The jugular vein reflects | show 🗑
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| show | the left side of the heart-the LV pumping →aorta and that has stenosis and blood will resurges back back towards the carotid
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| show | weak and strong beats- sign of left ventricular failure
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| Palpation of the anterior chest wall for | show 🗑
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| show | 2nd rt ICS
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| If you want to feel the pulmonary artery | show 🗑
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| show | Right ventricular pressure overload (pulmonary hypertension or pulmonic valve stenosis) produces an outward impulse just to the left of the sternum that occurs synchronously with the AI.- can feel It in the epigastrium- volume overload
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| show | volume and pressure overload
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| show | pulmonary or reg HTN-not much bigger in size but there’s a stronger heave in contraction- so rt ventricle is hypertrophied- concentric is when the cell is wider than longer- hypertrophied-like layers of added-
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| show | valvular regurgitation or ischemia- heart dilates- aortic/mitral/tricuspid regurg, chamber is bigger- wider-apical impulse is felt-feel the heart everywhere in the chest- eccentric hypertrophy-cell is more elongated than wide- chamber dilated
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| show | rare- Prominent pulsation accompanies dilatation or increased flow in PA- Palpable S2 points to pulmonary HTN
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| show | Prominent pulsation suggests a dilated or aneurysmal aorta Palpable S2 can accompany HTN
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| show | epigastric area. Hyperinflation of the lungs may prevent palpation of the RV in the left parasternal area. The RV impulse is palpable in the epigastrium where heart sounds are also more audible
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| show | Right ventricular volume overload (pulmonic valve regurgitation or tricuspid valve regurgitation) generates a hyperdynamic, high amplitude impulse along the lower left sternal border or at the xiphoid that occurs synchronously with the apical impulse (AI)
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| AI is also known and | show 🗑
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| show | supine and in the left lateral decubitus position.
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| Normal cardio exam of PMI | show 🗑
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| Concentric ventricular hypertrophy (Pressure overload: e.g. AS, HTN) | show 🗑
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| Eccentric ventricular hypertrophy (Volume overload: e.g. AR, M.Regurgitation) | show 🗑
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| Left ventricle can normally be felt | show 🗑
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| show | SOB/dyspnea- auscultate
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| show | S1 and S2- S3 can be heard in infants and young children and innocent murmurs
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| When to use diaphragm | show 🗑
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| show | for s3, s4, mitral stenosis murmur- low pitched sounds
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| When should a pt lie on the left side for a murmur | show 🗑
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| show | best heard when pt sits up and leans forward- diastolic murmur- most common in US
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| Most common cause of valve regurgitation murmurs in US is | show 🗑
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| show | systolic
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