Heart Sounds
The beginning of systole.
Closing of mitral + tricuspid valves.
What is the first heart sound (S1)?
Right 2nd intercostal space.
What is Aortic?
Carries deoxygenated blood from lower extremities to the right side of the heart.
What is the inferior vena cava?
Just below inguinal ligament halfway between pubis and anterior/superior iliac spines.
What is femoral pulse?
Small, firm (shotty), mobile, and nontender.
What are palpable lymph nodes in healthy infants and children?
Firmly press on skin over tibia or medial malleolus for 5 seconds and release.
What is how to check for edema?
The index of peripheral perfusion + cardiac output.
Normal <2 seconds.
>2 seconds = vasoconstriction or decreased cardiac output.
What is capillary refill?
End of systole, beginning of diastole.
Closing of aortic + pulmonic valve.
Aortic component slightly precedes the pulmonic component.
What is the second heart sound (S2)?
Left 2nd Intercostal Space.
What is Pulmonic?
Palpable vibration that signifies turbulent blood flow.
What is cardiovascular thrill?
With the leg extended but relaxed, anchor thumbs on the knee and curl your fingers around into the popliteal fossa.
What is popliteal pulse?
Prolonged bed rest, prolonged immobilization, and heart failure increase this risk in the older adult.
What is deep vein thrombosis (DVT) and subsequent pulmonary embolism (PE)?
Mild pitting, slight indentation, no perceptible swelling of the leg.
What is 1+ pitting edema?
Deficient supply of oxygenated arterial blood to a tissue caused by obstruction of a blood vessel.
What is ischemia?
A rapid rush of blood from the atrium to the ventricle as it starts relaxing.
Can be a normal finding in an athlete, child, or during pregnancy.
Can be abnormal, a sign of pulmonary embolism.
What is the third heart sound (S3)?
Left 3rd intercostal space.
What is Erb's point?
Blowing, swishing sound indicating blood flow turbulence.
- Normally none is present.
What is a bruit?
Curve fingers around medial malleolus and feel the tapping right behind it in the groove between the malleolus and Achilles tendon.
What is posterior tibial pulse?
The dorsalis pedis and posterior tibial pulses may become more difficult to find.
Trophic changes associated with arterial insufficiency (thin, shiny skin; thick-ridged nails; loss of hair on lower legs) also occur.
What are normal occurrences with the aging adult?
Moderate pitting, indentation subsides rapidly.
What is 2+ pitting edema?
Presents with unilateral swelling of the affected leg, tenderness to severe pain, possibly warmth and redness from accompanying inflammation, and possibly superficial venous dilation.
What is deep vein thrombosis (DVT)?
The sudden slowing of blood flow by the ventricle as the atrium contracts.
May be a sign of diastolic heart failure or ischemia.
What is the fourth heart sound (S4)?
Left 4th intercostal space.
What is Tricuspid?
A pressure wave that is generated by each systole pumping blood into the aorta.
Located between the trachea and sternomastoid muscle.
What is carotid artery pulse?
Just lateral to and parallel with extensor tendon of the big toe.
What is dorsalis pedis pulse?
Peripheral blood vessels grow more rigid with age.
What is arteriosclerosis?
Deep pitting, the indentation remains for a short time, leg looks swollen.
What is 3+ pitting edema?
Deposition of fatty plaques on the intima of the arteries.
What is atherosclerosis?
The velocity of blood increases (e.g., in exercise).
The viscosity of blood decreases (e.g., in anemia).
Structural deficits in the valves (e.g., dilated chamber).
What are causes for murmurs?
Left 5th intercostal space (mid-clavicular)
What is Mitral?
Empties unoxygenated blood directly into superior vena cava.
No valve separates superior vena cava from right atrium, so these veins tell us about the right side of the heart.
What is jugular venous pulse and pressure?
Medial aspect of the antecubital fossa at the line of the elbow joint.
What is brachial pulse?
A hole between the atria of the heart, which closes within 1 hour after birth.
What is the foramen ovale?
Very deep pitting, the indentation lasts a long time, leg grossly swollen and distorted.
What is 4+ pitting edema?
This is bilateral when the cause is generalized (heart failure) or unilateral when it is the result of a local obstruction or inflammation.
What is edema?