Cardiac Cycle and Heart Assessment

Cardiac Cycle & Assessment

• Heart sounds auscultated best at the base of the heart are aortic and pulmonic valve closures.
• Electrical stimulus sequence in the cardiac cycle: SA node, AV node, Bundle of His, Bundle Branches.
• Jugular venous pulsations 5 cm above the sternal angle (head of bed at 45 degrees) indicates elevated pressure related to heart failure.
• Blood pressure of 100/70 mm Hg in a 5-month pregnant woman (previously 124/80 mm Hg) is an expected change due to peripheral vasodilation.
• An increase in systolic blood pressure is an expected hemodynamic change related to age.

Heart Disease Risk Factors

• Major risk factors for heart disease: smoking, hypertension, obesity, diabetes, high cholesterol.
• Blowing or swishing sound over the carotid artery indicates blood flow turbulence.

Physical Examination

• Apical impulse is typically palpated at the fifth left intercostal space at the midclavicular line in healthy adults.
• A "thrill" is a palpable vibration.
• Laterally displaced apical impulse, palpable over a wide area, indicates volume overload, such as in mitral regurgitation.
• When auscultating the carotid artery for bruits, use the bell of the stethoscope with light pressure, and have the patient hold their breath briefly.

Hypertension & Venous Disease

• African-Americans have the highest prevalence of hypertension worldwide.
• A person on bed rest for 4 days is at the highest risk for developing venous disease.
• Increased warmth, swelling, redness, tenderness, and a positive Homan’s sign in the right leg of a bedridden patient requires emergency referral due to risk of pulmonary embolism.
• An ABI of 0.60 indicates moderate insufficiency.
  • Normal ABI range: 0.90-1.30.
  • ABI under 0.90: difficulty getting blood to legs and feet.
  • ABI 0.41-0.90: mild to moderate peripheral artery disease.
  • ABI 0.40 and lower: severe disease.

Abdomen & Spleen

• An enlarged spleen should not be palpated because it can rupture easily.
• A protuberant abdomen is bulging and stretched in appearance.
• Hypoactive bowel sounds can be caused by peritonitis.
• Abdominal pulsations between the xiphoid and umbilicus are likely normal abdominal aortic pulsations.
• Auscultation precedes percussion and palpation of the abdomen to prevent distortion of bowel sounds.
• Bowel sounds are usually high-pitched, gurgling, irregular sounds.
• A tympanic percussion note in the umbilical region is a normal finding.
• Sharp pain along the costovertebral angles indicates kidney inflammation.
• Black, tarry stool indicates gastrointestinal bleeding.
• Before reporting “silent bowel sounds,” listen for at least 5 minutes.
• Assess for Murphy’s sign to check for inflammation of the gallbladder (cholecystitis).
• A dull percussion note above the right costal margin of about 10 cm is a normal finding in abdominal assessment.
• Lactose intolerance is more prevalent in African-American adults in the U.S.

Appendicitis Testing

• Assessing for appendicitis:
  • Test for Blumberg’s sign.
  • Perform iliopsoas muscle test.

Umbilicus

• An enlarged and everted umbilicus, midline with no skin color change, suggests an umbilical hernia.

Additional Information

• Thin, shiny, atrophic skin indicates arterial insufficiency.
• Fluid wave test is used to check for ascites.
• The kidney and small intestine are located in the LUQ (Left Upper Quadrant)
• Oral contraceptives are associated with hypertension.
• Hypertension is associated with preload.
• S4 heart sound is heard in aging adults.
• Symptoms of pregnancy:
  • Hard Stool
  • Nausea
  • Vomiting
  • Peripheral Edema
• The 5 A's is a common model in clinical medicine
  • Ask
  • Advice
  • Assist
  • Assess
  • Arrange
• Symptoms include Fatigue, dyspnea, edema
• Swishing, blowing sounds are called Bruits
• When assessing stomach think of the meals, "What they ate in the day"
• Symptoms of heart failure: Sweating, headache, nausea
• DVT is associated with the lower leg or feet