CIRCULATORY AND LYMPHATIC SYSTEMS

Landmarks

Cardiac Cycle
Systole
Ventricular contraction

Diastole
Atrial contraction

Auscultation Sites

Memory aid for Valves

Normal Heart Sounds

Extra Heart Sounds

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.

Pericardial Friction Rub

Location: left sternal border Sound: grating, muffled, high-pitched and transient Cause: pericardial inflammation

Carotid Artery Assessment

Auscultation of carotid arteries Bell of stethoscope Abnormal findings
Bruit Palpable thrill

Edema
Fluid retention in interstitial spaces
Generalized Localized Pitting Nonpitting Anasarca Ascites

Assessment of Pitting Edema

1+ Barely detectable - 2 mm (millimeter) 2+ Indents 2 - 4 mm 3+ Indents 5 - 6 mm 4+ Indents more than 8 mm

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

Jugular Venous Distension

Normally present at 0-40 elevation Dehydration: HOB flat and JVD absent Volume overload when present at 45 How to assess

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

Venous Stasis Ulcer

A venous stasis ulcer is an ulcer caused by the stoppage of the normal flow of blood.

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

DEEP VEIN THROOMBOSIS (DVT)

A blood clot within the deep veins usually of the leg (calves) Bedrest indicated No rubbing Anticoagulates