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20 Cards in this Set

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jvp

right atrial pressure/CVP


decreases with blood loss


increases with heart failure, pulmonary HTN,


tricuspid stenosis




Obstructive lung dz-increases on expiration




hypovolumic-lie flat

S3

early diastole


right left sternal border


left apex


left lateral side position


after S2

S4

late diastole


left apex


just before S1


heard with bell held tightly-low freq


sign of ventricular distress

palpate for heaves, lifts, thrills

use palm of finger pads held flat

lifts and heaves

sustained impulses usually produced by an


enlarged right of left ventricle or atrium.




If present you will feel the impulse rhythmically lift your finger.

Thrills

press the ball of your hand firmly on the chest to chest for buzzing or vibrating sensation from


underlying vascular turbulence.




Presence of a thrill changes the grading

S1 and S2 palpation




S3 and S4 palpation

Using firm pressure, place you right hand on the chest wall. With your left index finger and middle finger, palpate the carotid artery.


**just before carotid upstroke




Apply lighter pressure at the cardiac apex.


**follows carotid upstroke

Apical impulse


Left ventricular area

2.5cm normal


>4 or 5 left ventricular overload




Increase in amplitude with hyperthyroid, left ventricular overload




LVH, aortic stenosis, HTN

Impulse of


Left sternal border 3,4,5


Right ventricular area

Increase in right ventricular overload, right atrial septal defect, pulmonic stenosis, pulmonary HTN.




if obstructive pulmonary dz-the impulse is felt in the epigastrium.

Impulse of


pulmonic area


Left 2nd Interspace

Increased in pulmonary HTN

Impulse of


Aortic Area


Right 2nd interspace

Increased in Systemic HTN


pulsation here suggests dilated or aortic anuresym.

palpation

Used to estimate cardiac size except if you cannot feel the apical impulse.

Diaphragm


high pitch

Clicks/snaps


S1/S2


Aortic and mitral regurg


pericardial friction rub


bruits

Bell


low pitch

S3/S4


mitral stenosis


murmurs


apply lightly with just enough pressure to get a seal. Pressing too firmly makes it function more like a diaphragm.

left lateral position

S3/S4 mitral murmurs

Sit up, lean forward, stop breathing

Aortic murmurs

Extra sounds in systole

ejection sound and systolic click

Extra sounds in diastole

Opening snap, S3 and S4

Standing squatting

identifies mitral valve prolase-shortens murmur


distinquishes Hypertropic Cardiomyopathy (decreases murmur) from aortic stenosis (increases murmur)

Valsalva/standing

Increased in mitral proplase




HC-decreases with squatting, increases with


valsava/standing


HC-Only systolic murmur to increase with


Valsalva.