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Cardiac Cycle
Systole
Ventricular contraction
Diastole
Atrial contraction
Auscultation Sites
Diastole
S4 S1
Systole
S2 S3
Murmurs
Cause turbulent blood flow Technique to Identify
Location heard best: aortic/pulmonic/tricuspid/mitral Timing: systole/diastole Quality: blowing/harsh/rumbling/musical Intensity: grade on scale of I-IV
Murmurs
I - Lowest intensity, barely audible II - Low intensity, but audible III Loud but without a palpable thrill IV Loud with a palpable thrill V Very Loud with palpable thrill. Audible even with the stethoscope placed on the chest with the edge of the diaphragm VI - Loudest with a palpable thrill. Audible even with the stethoscope raised above chest.
Edema
Fluid retention in interstitial spaces
Generalized Localized Pitting Nonpitting Anasarca Ascites
Palpation of Pulses
Bilateral comparison Grade+0 Absent unable to feel +1 Diminished, barely palpable +2 Normal readily detectable +3 Full pulse, increased +3 Bounding difficult to obliterate
Palpating Pulses
Dorsalis pedis Posterior tibial
Popliteal
Femoral
Intermittent Claudication
Cramping or pain in leg muscles brought on by a predictable amount of walking ( or other form of exercise) and relieved by rest. This symptom is a marker of peripheral vascular disease of the aortoiliac, femoral, or popliteal arteries. Patients often have atherosclerosis.
ISCHEMIA
A temporary deficiency of blood flow to an organ or tissue. The deficiency may be caused by diminished blood flow either through a regional artery or throughout the circulation.
ANGINA PECTORIS
An oppressive pain or pressure in the chest caused by inadequate blood flow and oxygenation to the heart muscle. It is usually produced by atherosclerosis of the coronary arteries and in Western cultures is one of the most common emergent complaints bring adult patients to medical attention. It typically occurs after (or during) events that increase the hearts need for oxygen, such as increased physical activity, a large meal, exposure to cold weather, or increased psychological stress.
LYMPHEDEMA
Edema caused from blockage of lymphatic fluid Usually unilateral Mastectomy complication
Lymphadenopathy
Enlargement of lymph nodes due to infection, allergy, or neoplasm
VARICOSE VEINS
Incompetent valves permit reflux of blood, producing dilated, tortuous veins. Unremitting hydrostatic pressure causes distal valves to be incompetent and causes worsening of the varicosity.
HOMANS SIGN
Calf pain on dorsiflexion of the foot