CARDIO

OLDCARTSS
SOCIAL HX
PAST PATIENT HX
COMMON CONCERNING SYMPTOMS: chest pain, palpitations,
shortness of breath, orthopnea, paroxysmal nocturnal dyspnea
JVP measurement of elevation at highest oscillation point of
JVP (pressure in the right Atrium)
Ruler and a piece of paper
Turn head slightly to the left
Raise or lower head of the bed until you can see the pulsations of
the Internal JVein..posterior to the SCM soft, rapid, undulating
pulsations
Carotid pulse vigorous thrust
IJV pulses rarely palpable and eliminated by pressure (descends
with inspiration)..carotid are always palpable and not eliminated
by pressure

JVP ANGLE IS SUPPOSED TO BE 1 cm ABOVE THE STERNAL

ANGLE at HEAD OF OG BED ELEVATED TO 30 degrees
ABNORMAL IF >3-4 cm ABOVE THE STERNAL ANGLE
>7-8 cm in total distance above the RA (bed
elevated to 30
degrees)

ASSESSING THE CAROTID PULSE

Dont press both carotids at the same time

Increase pressure until you feel maximal pulsation..decrease
pressure until you feel arterial pulse contour (speed of upstrake,
speed of downstroke)
You can hear PURRING CAT during palpation
With stethoscope listen for bruit narrowing

APICAL IMPULSE is brief systolic beat ususally found in the left

fifth interspace about 8 cm from the midsternal line
Observe anterior chest heaves or thrills

Identify apical impulse with finger pads

Check for thrills..ball of your hands in same locations

Apical impulse point of maximal impulse.. use palmar surface

of your fingertips.. LOCATION DIAMETER AND AMPLITUDE
If difficult..move patient to left lateral side.. decubitus position ..if
still cant find it..exhale fully ..hold his breath..measure the
diameter in cms
Small..quarter size


HEART SOUNDS

S1 CLOSURE OF MITRAL VALVE

S2 CLOSURE OF AORTIC VALVE
VENTRICULAR SYSTOLE BETWEEN S1 AND S2
VENTRICULAR DIASTOLE BETWEEN S2 AND S3
ABNORMAL SOUNDS OF S3 AND S4 CAN BE HEARD IN EARLY AND
LATE DIASTOLE
AUSCULTATION OF HEART SOUNDS

left 4th and 5th interstitial spaces and apex with the bell
AORTIC AREA LEFT STERNAL 2ND ICS (S1 and S2LOUDER)
PULMONIC AREA INSPIRATORY SPLITTING (A2 and P2)..DURING
EXPIRATION THEY ARE FUSED INTO S2
DOWN THROUGH 3RD ICS AND S2 DIMINISHES WHILE S1 GETS
LOUDER
APEX AREA S1 LOUDER THAN S2
SWITCH TO THE BELL AND LISTEN HERE:

FOR S3..TIP PATIENT INTO DECUBITUS POSITION (BRINGS LV

CLOSER TO THE CHEST WALL) AND LISTEN WITH THE BELL..AND
THEN CHECK THE APICAL IMPULSE ..PUT THE BELL BACK ON
IT..S3 IS DIASTOLIC DYSFUNCTION/CHF
HEART MURMUR
Systolic murmur between s1 and s2
o Midystolic murmur aortic stenosis begins after s1 and
stops before s2
o Pansystolic murmur starts with s1 and stops at s2
without a gap between murmur and heart sounds
(whooshing sound)
Diastolic murmurs between s2 and s1
o Early diastolic murmur in aortic regurgitation starts right
after s2 then fades into silence before the next s1.
Decrescendo.
o Middiastolic murmur in mitral stenosis and starts a short
time after s2
o Sitting up..exhale completely..hold the breath out..listen
with the diaphragm from left second ICS till the apex for
the high blowing, decrescendo, diastolic murmur in Aortic
regurgitation