Cardiovascular and Peripheral Vascular Lecture

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Questions and Answers

What is a characteristic of the S2 physiological split?

Indicates an abnormal heart rhythm

Results from changes in intrathoracic pressure (correct)

Is always present in older adults

Occurs only during exercise

Which of the following describes S3 heart sounds?

Represents a normal finding in individuals over 40

Pathological in nature regardless of age

Usually expected in people younger than 40 or in cases of cardiac issues (correct)

Often described as 'Be Lub Dub'

What causes heart murmurs?

Electrolyte imbalances in the body

Normal variations in heart sounds

Disrupted blood flow due to structural abnormalities (correct)

Regular blood flow through healthy valves

Which of the following is considered a red flag during cardiovascular assessment?

Shortness of breath Signup and view all the answers

In assessing the peripheral vascular system, which condition is NOT typically evaluated?

Cardiac tamponade Signup and view all the answers

What initiates the cardiac cycle by sending an impulse to atrial muscles?

Sinoatrial Node Signup and view all the answers

Which component transmits the SA impulse to activate the Bundle of His and Purkinje Fibres?

Atrioventricular Node Signup and view all the answers

What part of the ECG represents atrial depolarization?

P Wave Signup and view all the answers

What does the QRS complex on an ECG represent?

Ventricular systole Signup and view all the answers

What role does the Bundle of His primarily play in the heart's conduction system?

Conduct impulses through the ventricular wall Signup and view all the answers

Which part of the ECG indicates the SA to Bundle Branch conduction time?

PR Interval Signup and view all the answers

What does the T Wave indicate in relation to ventricular activity?

Ventricular diastole Signup and view all the answers

Why is it important to establish a baseline when taking vitals?

To compare during medical emergencies Signup and view all the answers

What is the ideal time to measure daily weights for a patient?

First thing in the AM, post void Signup and view all the answers

Which of the following is NOT considered an expected finding during a cardiac assessment?

Visible distension of the jugular vein Signup and view all the answers

When inspecting the neck and jugular vein, what is the ideal angle for the patient's head during the procedure?

30-45 degrees and turned left slightly Signup and view all the answers

What is the expected jugular venous pressure (JVP) relative to the sternal angle?

Less than 3 cm above the sternal angle Signup and view all the answers

Which symptom would most likely indicate a potential cardiac issue?

Fatigue and sleep changes Signup and view all the answers

Which assessment should be conducted to examine for potential fluid overload related to cardiac function?

Assessing ankle swelling and edema Signup and view all the answers

Which of the following findings would be most concerning in a cardiac assessment?

Severe chest pain radiating to the neck Signup and view all the answers

Which lifestyle factor is most relevant as a risk factor for heart disease?

Smoking history Signup and view all the answers

Which of the following is a characteristic of arteries?

High pressure and thick walled Signup and view all the answers

What is the role of valves in veins?

Prevent back-flow of blood Signup and view all the answers

What are lymph nodes and vessels responsible for?

Maintaining fluid balance and immune function Signup and view all the answers

Which structure drains lymph into the subclavian veins?

Thoracic duct Signup and view all the answers

What can limited stretch in fascia lead to?

Problems with enclosed components during inflammation Signup and view all the answers

What are common symptoms of Deep Vein Thrombosis (DVT)?

Pain, edema, and warmth Signup and view all the answers

Which of the following is NOT a component of health history analysis for peripheral vascular assessment?

Lung capacity evaluation Signup and view all the answers

What is the indication of Raynaud's phenomenon during inspection?

Comparative color, size, and quality changes Signup and view all the answers

What is the recommended position for the head of the bed during cardiac inspection?

Elevated at 30 degrees Signup and view all the answers

Which of the following correctly describes the relationship between jugular venous pulse and carotid pulse?

Jugular venous pulse drops with inspiration Signup and view all the answers

What is the primary purpose of palpating one side of the carotid artery at a time?

To avoid obstructing cerebral blood flow Signup and view all the answers

Which method is used to assess fluid in the thoracic cavity or cardiomegaly?

Chest X-ray or Echocardiogram Signup and view all the answers

Which characteristic distinguishes the jugular venous pulse from the carotid pulse regarding occlusion?

Jugular venous pulse readily occludes Signup and view all the answers

Which part of the stethoscope should be used to auscultate heart sounds?

Diaphragm Signup and view all the answers

What should be noted regarding the quality of expected findings during carotid artery assessment?

Normal rate, rhythm, quality with no adventitious sounds Signup and view all the answers

Where should the apical impulse be palpated?

5th intercostal space at the midclavicular line Signup and view all the answers

Which of the following is NOT one of the '6 Ps' of limb ischemia?

Sensitivity Signup and view all the answers

What is the clinical significance of 'polar sensation' in limb ischemia?

It shows the limb is cold compared to the other limb. Signup and view all the answers

In a clinical assessment of limb ischemia, how is 'paresthesia' best described?

As burning, tingling, or numbness indicating ischemic nerve damage. Signup and view all the answers

Which test may be used to assess pallor in a limb when examining for ischemia?

Buerger’s test Signup and view all the answers

What does 'pulselessness' indicate in a limb ischemia assessment?

Obstruction in arterial perfusion. Signup and view all the answers

What does the term 'paresthesia' refer to specifically in limb assessments?

Numbness along with burning and tingling. Signup and view all the answers

Which of the following statements about limb ischemia is true?

Chronic ischemia may result in pink coloration due to vasodilation. Signup and view all the answers

What does 'paralysis' signify in the context of limb ischemia?

A late sign of severe ischemia. Signup and view all the answers

What is the primary rationale for obtaining health history in cardiovascular assessments?

To identify lifestyle factors contributing to cardiovascular disease. Signup and view all the answers

Which of the following statements about the cardiac cycle is correct?

The PQRST waveforms relate to specific phases of the cardiac cycle. Signup and view all the answers

What is the expected apical impulse point location within the thoracic cavity?

5th intercostal space at the midclavicular line. Signup and view all the answers

Which of the following is a technique used for assessing the peripheral vascular and lymphatic systems?

Inspection, palpation, percussion, and auscultation (IPPA). Signup and view all the answers

Which finding would indicate an unexpected result during cardiovascular assessment?

Presence of a third heart sound (S3) in a young athlete. Signup and view all the answers

What is an expected finding when measuring Jugular Venous Pressure (JVP)?

Less than 3 cm above the sternal angle with no visible distension Signup and view all the answers

Which symptom is most commonly associated with potential cardiac issues?

Dyspnea Signup and view all the answers

What is the ideal method to inspect jugular vein distension?

Positioning the head at a 30-45 degree angle and turned slightly left Signup and view all the answers

Which of the following is NOT a sign of fluid overload related to cardiac function?

Pallor Signup and view all the answers

What does the presence of S4 heart sounds typically indicate?

Pathological conditions in the heart Signup and view all the answers

Which lifestyle factor serves as an important risk factor for heart disease?

Regular smoking Signup and view all the answers

Which of the following heart murmurs is classified as a diastolic murmur?

Aortic regurgitation Signup and view all the answers

What type of pain is often scrutinized in a cardiac assessment?

Radiating pain to the left arm or jaw Signup and view all the answers

Which symptom is considered a significant red flag during a cardiovascular assessment?

Shortness of breath Signup and view all the answers

What is an essential aspect of a patient’s health history relevant to cardiac assessment?

Past history of congenital heart defects Signup and view all the answers

Which condition is associated with lymphedema during a peripheral vascular assessment?

Lymphatic obstruction Signup and view all the answers

In terms of cardiac assessment, which factor is critical to monitor in patients with known heart disease?

Daily weight measurements Signup and view all the answers

What is typically observed in patients with fluid volume overload during a cardiovascular examination?

Muffled heart sounds Signup and view all the answers

What is the primary function of the sinoatrial (SA) node in the heart?

Regulating the heart rate as a natural pacemaker Signup and view all the answers

How is cardiac output calculated?

Stroke volume multiplied by heart rate Signup and view all the answers

What is a key aspect of perfusion in the context of cardiovascular function?

Delivery of blood to tissues from capillaries Signup and view all the answers

Which valve prevents blood from flowing back into the left atrium?

Bicuspid (mitral) valve Signup and view all the answers

What does the term 'stroke volume' refer to?

The volume of blood ejected from the left ventricle with each heartbeat Signup and view all the answers

What is the significance of the aortic valve during the cardiac cycle?

It facilitates oxygenated blood flow from the left ventricle to the body Signup and view all the answers

What factor could impact a patient's ability to perfuse tissue effectively?

All of the above Signup and view all the answers

The tricuspid valve primarily regulates blood flow between which two structures?

Right atrium and right ventricle Signup and view all the answers

What characteristic of the jugular venous pulse makes it different from the carotid pulse during assessment?

It drops with inspiration. Signup and view all the answers

Which technique is primarily used for assessing fluid in the thoracic cavity?

Echocardiogram Signup and view all the answers

What is the proper position for the head of the bed during cardiac inspection?

Elevated at 30 degrees Signup and view all the answers

What should be noted when auscultating heart sounds with the diaphragm of the stethoscope?

Sounds should originate from the valve closures. Signup and view all the answers

During carotid artery assessment, what should be the expected findings?

Normal rate and quality. Signup and view all the answers

What aspect differentiates the jugular venous pulse when palpated?

It is non-palpable. Signup and view all the answers

Which instruction should be given to a patient during auscultation for carotid bruits?

Hold their breath. Signup and view all the answers

What is the proper technique for palpating the apical impulse?

Palpate at the 5th ICS at the MCL. Signup and view all the answers

What does a pulse grading of +1 indicate?

Weak Signup and view all the answers

When should a Doppler be used in pulse assessment?

When the pulse cannot be palpated due to obstructions Signup and view all the answers

What is a significant indicator that requires immediate attention during pulse assessment?

Inability to hear a pulse on the Doppler Signup and view all the answers

What condition can lead to compartment syndrome?

Deep vein thrombosis (DVT) Signup and view all the answers

Which description fits a pulse grading of +4?

Bounding Signup and view all the answers

In compartment syndrome, what can result if symptoms are present for more than 6 hours?

Permanent damage Signup and view all the answers

What does the grading of a pulse help to assess?

Neurovascular strength/amplitude Signup and view all the answers

What should be considered a red flag during the evaluation of limb ischemia?

Presence of paresthesia Signup and view all the answers

Study Notes

Cardiovascular and Peripheral Vascular Lecture

Learning Outcomes: Students will be able to conduct and assess the cardiovascular and peripheral vascular systems (including lymphatics). This includes applying knowledge of anatomy and physiology related to examination of the heart and peripheral vascular systems, linking this knowledge to the concept of perfusion, identifying general survey findings and health history questions, explaining correct assessment techniques, interpreting expected heart sounds, relating assessment techniques to a head-to-toe approach, differentiating expected and unexpected findings, and documenting findings.

November 6, 2024 Class Agenda

Video: Heart Anatomy Review
Cardiac Physiology Review: Electrical Involvement and PQRST, Cardiac Cycle, Perfusion
General Survey: Health History, Physical Assessment
Physical Assessment: Peripheral Vascular and Lymphatics Assessment

Anatomy Review

Heart Position: The heart sits mostly to the left of the body, measured from the 2nd to 5th intercostal space. The base of the heart is broad and located at the top; the apex is at the bottom, in the 5th intercostal space, (the point of apical impulse).

Head and Neck Vasculature

Displays anatomical structures of arteries and veins in the head and neck region.

Physiology Review

Provides a diagram of the heart and its function. Shows blood flow through the heart and to the lungs and body.

Perfusion

The process of delivering blood from capillaries to tissues.
Cardiac output is a function of stroke volume and heart rate.

Electrical Conduction of the Heart

The SA Node is the natural pacemaker of the heart.
The AV Node transmits impulses from the SA node to the HIS and Purkinje fibers, coordinating the heart cycle.

ECG (Electrocardiogram)

ECG waves represent the electrical activity of the heart.
P wave: atrial depolarization
PR interval: SA-BB conduction
QRS complex: ventricular depolarization
T wave: ventricular repolarization

General Survey and Vitals

Includes temperature, blood pressure (and MAP), pulse, presence of deficits, and daily weights (taken first thing in the morning after voiding).
Taking accurate vitals provides a baseline for assessment.

Expected and Unexpected Cardiac Findings during General Survey

Discussion of these findings.

Peripheral Vascular System and Lymphatics

Review, assessment, and risk factors. This segment examines peripheral vascular components, including arteries, veins, and lymphatics.
The lymphatic system: Lymphedema, lymph nodes, Chylothorax

Assessing the Periphery

Assessing peripheral vascular system: (including fascial compartments), pulses, edema, compartment syndrome, and deep venous thrombosis.

Anatomy and Physiology Review; PVS and Lymphatics

Detailed review of the peripheral vascular system and lymphatic system.

A+P Peripheral Vascular

Arteries: Thick walled, elastic with high pressure; a major artery is the aorta
Veins: Thinner walled, less elastic with low pressure; have valves preventing backflow, and an example is the superior vena cava.
Capillaries: Exchange of gases and nutrients, metabolites take place between tissues and blood.

A+P Lymphatics

The lymphatic system maintains fluid balance and immune function.
Lymph drains into Thoracic and Right Lymphatic ducts, subclavian veins, and superior vena cava, which is located at the right atrium of the heart.

Fascial Compartment

Fascia are connective tissues surrounding vessels, nerves, and muscles that form compartments. Limited stretch in fascia can cause problems.

Deep Vein Thrombosis (DVT)

Includes pain, edema, warmth, weak pulses, and delayed capillary refill.
A risk for Pulmonary Embolism (PE)

Health History Analysis of S/S for Periphery

Collection of information about pain, numbness/tingling, cramping, changes in skin color, edema, and function.
Includes personal history information (medications, family history of stroke, and clots).

PVS and Lymphatics - Inspect

Inspect all extremities, comparing color, size, quality of skin, hair, and nails.

Lymphedema

A condition involving swelling in the extremities caused by lymphatic fluid buildup.

Edema

Detailed assessment of pitting and non-pitting edema, which is classified using a grading scale (0 to 4+).

Palpation for Lymphatics

Methods for palpating lymph nodes in various parts of the body (including supraclavicular, cervical, subclavian, axillary, and inguinal).

Palpation for PVS

Assessing texture, temperature, turgor, capillary refill, edema, and pulses for blood vessel function.

Pulse

Locating and assessing various pulse sites, including temporal, carotid, brachial, apical, radial, popliteal, and pedal pulse rates

Assessment of Pulses

Pulse assessment scale.

Doppler

Use of a Doppler when palpation is not effective in determining blood flow

Compartment Syndrome

Bleeding or swelling after injury can cause compartment syndrome, leading to pain and paresthesia (numbness or tingling).

Limb Ischemia (6 Ps of Limb Ischemia)

Rest pain (worse distally, relieved with dependency), pallor (skin color comparison to contralateral side), pulselessness (doppler use), polar sensation (cold compared to contralateral side), paresthesia (burning/tingling), and paralysis (sign of more advanced complications).

Infiltration and Extravasation

Infiltration and extravasation are additional forms of compartment syndrome in which IV fluids or vesicants leak into surrounding compartments.

Recall Red Flag Assessment Findings

Information relating to red flags and how to connect an interdisciplinary team, if necessary, with regards to assessment findings..

Practice, Practice, Practice

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Description

This quiz covers essential aspects of cardiovascular and peripheral vascular assessment techniques. It aims to enhance students' understanding of anatomy, physiology, and clinical evaluation related to heart health and peripheral circulation. Key topics include heart anatomy, cardiac physiology, and lymphatic system evaluation.