Normal heart sounds are?
S1 and S2
S1 First heart sound happens when …?
closure of the semi-Lunar valves singling the begining of systole
S2 Second heart sound happens when … ?
Closure of semi lunar valves signals end of systole
Health History regarding heart
- Chest pain?
- Dyspnea ( trouble breathing)
- Orthopnea (trouble breathing while laying flat
- cough, fatigue, edema, nocturia
- Cynosis or pallor
- CArdiac history
- Family history
- Personal habits
Pulses and Locations
Radial ( outside wrist)
Ulnar( Inside wrist)
Brachial ( inside elbow)
What questions do you ask with chest pain ? ( 6 )
- Do you have any ?
- How would you describe it?
- How is it brought on?
- Any other symptoms that occur with it ?
- Does anything make the pain worse ?
- What brings you relief ?
What questions do you ask with Dyspnea (7)
- Do you have Shortness of Breath?
- What type of activity and how long brings on SOB ?
- Does it come on unexpectedly?
- Is it constant?
- Does position effect it?
- Does it wake you up at night ?
- Does it effect daily living ?
What questions do you ask it Orthopnea (1)
- How many pillows do you use when laying down or sleeping ?
What questions do you ask with Cough (7)
Do you have one?
- How long have you had it ?
- Is it related to a time of day ?
- what type of cough?
- Does it happen more with activity?
- does rest or medication relieve it ?
- Do you cough up muscos ?
What questions do you ask with Fatigue?(3)
- Do you seem to tire easily ?
- When did the fatigue start ?
- Related to time of day ?
Questions regarding cyanosis or pallor (1)
Do you every notice your facial skin turning blue or ashen ?
What questions do you ask in regard to edema ?
- Any selling in feet or legs?
- when did you first notice it?
- Any recent change?
- what time of day does the swelling occur?
- how much would you say there is?
- does it go away with rest?
- Are both legs equal ?
What questions do you ask in regards to Nocturia?
Do you wake up at night with the urge to urinate ?
What questions do you ask in regards to Cardiac history ?
- History of hypertension?
- high cholesterol?
- ever had heart disease?
- ever had a heart attack?
- most recent ECG
What area would i auscultate the aortic valve?
Second right interspace
What area would i auscultate the pulmonic valve
Second left interspace
What area would I auscultate the tricuspid valve
Fifth intercostal space left lower sternal boarder.
What area would I auscultate for the mitral valve
Fifth interspace left midclavicular line.
Describe how to inspect and palpate the apical pulse
- Inspect whether you are able to see the apical impulse in the fourth or fifth intercostal space.
- located the apical pulse by using 1 finger pad, ask patient to exhale and hold it or roll patient over to the left to find it
Describe how to palpate the precordium
Use palmar aspects of 4 fingers
palpate over apex, left sternal border, and base.
search for any other pulsations, if their are any note timing.
What is a pulse Deficit why is it significant?
Occurs when there are fewer pulses then there are heartbeats
this signals weak contractions of the ventricles
usually occurs with arterial fibrillation, premature beats and heart failure.
Unilateral distention of the jugular vein
Local cause like kinking or aneurysm
Full distended external jugular vein
above 45 degrees warn of increased CVP as with heart failure.
Apical Pulse is found where?
fourth or fifth left intercostal space in or at the midclavicular line
