Become a Creator today!Start creating today - Share your story with the world!
Start for free
00:00:00
00:00:01
Episode 5: Cardiovascular/Peripheral Vascular Assessment
128 Plays9 months ago
In this episode we covered the essential components of central and peripheral cardiovascular assessments. We also covered a brief summary of several common heart diseases.
FB Group: https://www.facebook.com/groups/1415202242471170/
References:
Bonow, R. O., Nishimura, R. A., & Thompson, A. (2014). Valvular heart disease. Journal of the American College of Cardiology, 63(22), 2438-2488.
Cleveland Clinic. (2021). Coronary artery disease. Retrieved from https://my.clevelandclinic.org/health/diseases/16898-coronary-artery-disease
Kirchhof, P., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., ... & Zeppenfeld, K. (2016). 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. European Heart Journal, 37(38), 2893-2962.
Nishimura, R. A., Otto, C. M., Bonow, R. O., Carabello, B. A., Erwin, J. P., Guyton, R. A., ... & Thomas, J. D. (2014). 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology, 63(22), e57-e185.
Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey, D. E., Drazner, M. H., ... & American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. (2017). 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure. Journal of the American College of Cardiology, 70(6), 776-803.
Dains, J., Baumann, L., & Scheibel, P. (2024). Advanced health assessment and clinical diagnosis in primary care (7th ed.). Elsevier.
Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P. (2024). Bates’ Guide to Physical Examination and history taking. Wolters Kluwer.
ChatGPT was used to help curate some sources and information.
Recommended
Transcript
Introduction to Health Assessment Podcast
00:00:00
shermanappel
Hello and welcome to another episode of the Advanced Practice Nurse Mastery Podcast with Jackson Jorgensen. I'm going to be your host. um I am a critical care registered nurse, nationally certified in the United States. um And I'm also currently a family nurse practitioner student at Baylor University.
00:00:17
shermanappel
ah My efforts on this podcast are endp independent of either of those affiliations and the goal is really just to bring ah both myself and hopefully you guys closer to mastering content related to specifically with this series health assessment as nurse practitioners. So hopefully you guys find this episode useful.
Understanding the Cardiovascular System
00:00:35
shermanappel
We are going to be going over the cardiovascular system. We'll do both peripheral cardiovascular assessment as well as assessment of the heart itself. um We're also going to cover a few common heart problems ah that you might encounter in your practice, ah including risk factors, physical ah presentation, laboratory findings, and we're also going to cover heart sounds that might be associated with them, which is I feel like a weak point for many nurses.
00:01:02
shermanappel
So if ah any of that sounds useful to you, feel free to continue listening. If not, move on. You have more important things to do with your time, I'm sure. ah Thank you for your participation, though. All right, beginning with our cardiovascular assessment.
Conducting a Cardiovascular Assessment
00:01:18
shermanappel
and As you walk into the room, inspection, you're going to look at their general appearance, okay?
00:01:23
shermanappel
um Do they look like they are having a hard time? Are they diaphoretic? Are they pale? Are they flushed? Are they having difficulty breathing? ah Do they look like they're generally in a weak state of health? If they stand up, are they already short of breath? you know what What's going on with this patient externally that you can see? um Other general things that you're going to want to measure, you're going to want to get a blood pressure. You're going to want to see their heart rate. um Those reveal a lot of things about the person's cardiovascular health.
00:01:53
shermanappel
And then this is one this is one that is mentioned in my courses that I've been studying, but I'm not really sure how common it is, at least in the primary care realm. I feel like it's not very commonly assessed, but they talk about estimating jugular venous pressure, which is a specific skill in cardiovascular assessment. um If you guys work in cardiology, but please let me know if you use this method or if the clinicians you work with use it. Basically, you have the patient's head of bed at 60 degrees.
00:02:23
shermanappel
You measure from the sternal angle to the peak of oscillation in the right internal jugular vein, um and 0 to 3 centimeters on that estimated measurement is considered normal. A note on that, they say that to distinguish between the jugular and the carotid, the jugular is usually not palpable and can be occluded with light pressure, whereas the carotid is palpable and always will require significantly more pressure to occlude.
00:02:48
shermanappel
um Let's see, if you're measuring different, there's two different ways to measure. Basically, you can take that zero to three centimeters, or you can add five centimeters to it, and that that gives you from the right atrium to the point that you're looking at. um I don't know the the differences between the two measurement ah ways as far as what's considered more accurate, more common in documentation.
00:03:14
shermanappel
And I also don't know how commonly this is actually used because whenever I've been to a primary care appointment myself, I've never had them measure this jugular maintenance pressure and I've never seen it been done even in the ICU. And I work in a cardiothoracic unit as well as ah regular medical ICU. So I haven't seen any clinicians doing this. So if you guys have seen it, let me know. I'd love to hear more about it. And lastly, you're also going to just obviously inspect the anterior chest wall.
The Art of Auscultation
00:03:42
shermanappel
um inspecting the anterior chest wall, you're going to be looking for, uh, anything that is abnormal. So filling for, um, heaves or thrills or palpable cardiac beats. Um, the patient may complain of like, uh, palpitations and you probably be able to fill that. Um, all right. So that, that concludes kind of inspection of your, uh,
00:04:11
shermanappel
into your chest while just looking at it to see if there's anything abnormal. Auscultation is next, so you're going to auscultate. You guys may have heard the ape to man p mnemonic to help you remember each of the points that need to be auscultated on your assessment. So that the ape to man is aortic, pulmonic, herbs point, mitral valve, and ah apex. um And remember anatomy-wise, the apex of the heart is not the top.
00:04:38
shermanappel
ah Like you might consider the apex of a movie plot or the apex of a mountain. The apex of the heart is actually at the bottom of our chest, bottom left. um And you can think of that as like where the heart heart is pointing. So the point of the heart is your apex. um So you're going to auscultate at each of these points. The aortic you'll find on the second intercostal space on the left side of the sternum.
00:05:06
shermanappel
And then on the other side directly across from that is the pulmonic Down to rib, herbs point, down to rib and mitral, down to rib and a little bit further to the left So this is now the fifth intercostal space is the apex And if you listen at each of those points with both the bell and the diaphragm of your stethoscope That would be a pretty complete assessment of the heart itself as far as the oscultation is concerned um You guys have probably heard the normal charting for that as well, which is S1 and S2 are audible with no additional sounds. um So S1 and S2 is referring to the classic lub-dub sounds of your heart. um If there's anything else or there's a difference in character to those sounds, that would be important. It's something you want to note in your charting. um A note on these sounds, murmurs are attributed generally to turbulent blood flow.
00:05:59
shermanappel
um So if you're hovering over, let's say, the pulmonic valve and you hear this turbinal ah turbulent blood flow, you may be having a patient that has an incompetent pulmonic valve. um If you have it over the mitral, same idea. um You can also have um different sounds if there's like structural deformities at any of these areas. So maybe a person has a patent frame in O' Valley where they're having blood flow across the septum of the heart inappropriately. um You can also hear if you're assessing children, very, very young children, if they don't have a fully formed heart, you'd be able to hear some some pretty strange sounds.
00:06:44
shermanappel
and Moving on, you we already talked a little bit about palpating the precordium and noting any t thrills or heaves. but you're also going to want to note exactly where the point of maximum pulse is. That's important because if it's anywhere other than, and this is ah with an asterisk, if it's anywhere other than the fifth intercostal space to the left side of the chest, just about the mid clavicular line, and then you may have to do some further assessment because this patient could be experiencing cardiomegaly, but in pregnant women it's not uncommon for the heart to be shifted around a little bit because you have
00:07:20
shermanappel
you know, an entire fetus taking up a significant space of their abdomen pushing all the organs around. So and in a pregnant woman having having that ah point of maximum impulse or where the apex of the heart is, isn't an immediate red flag.
00:07:37
shermanappel
um We're going to also talk about the carotid arteries. So when you're palpating the carotid arteries, It's important that you only palpate one at a time and don't massage them. Two reasons for this. Obviously, if you're palpating the carotid arteries and you include them, you don't want to include <unk> includede this person's carotid arteries. ah You're cutting off blood flow to the brain, that could be an issue. Second, don't like massage it being like, oh yeah, that is the carotid artery and like filling around their neck doing some
00:08:09
shermanappel
pretty heavy massaging because you could be ah at risk of dislodging an atherosclerotic plaque and then that would throw the patient's plaque up into their brain and you could end up with an ischemic stroke.
00:08:20
shermanappel
So be cautious while palpating the carotid
Recognizing Cardiac Red Flags
00:08:23
shermanappel
artery. You may also listen to the carotid artery with your stethoscope so that you can assess if there's any bruise, which is another ah word that essentially just means turbulent blood flow through the artery. And that could show stenosis or um possible occlusion, just anything that would cause turbulent but blood flow through that artery.
00:08:45
shermanappel
ah I wanted to mention a few red flag symptoms. If your patient presents with serious chest pain that's unrelieved by their typical routine of pain control, ah palpitations, shortness of breath, edema, or ah reporting syncope or fainting, then those are all red flag symptoms for an acute cardiac ah exacerbation of what whatever underlying pathology they might have, and they probably need to be admitted so that can get worked up and assessed.
00:09:14
shermanappel
I want to talk about when we say thrill, some people aren't really familiar with that means. So if the carotid artery or the apical pulse have a thrilling quality, it essentially means that it vibrates like a paring cat. Another term with cardiovascular assessment is pulses alternens, which is where a force alternates between the beats and it can be indicative of left ventricular dysfunction. So you might have one very strong pulse and then a weak one and then a very strong pulse and then a weak one.
00:09:43
shermanappel
ah The cause of that may be irregular rhythm on their heart. It could be that there's some filling issues or some valvular issues, ah but that that is the term for that phenomenon would be pulses alternatives. And then a paradoxical pulse is a drop in normal systolic blood pressure with inspiration. um It can be indicative of pericardial tamponade, which is an important thing to notice because that is in an emergency and you know they would likely need it ah surgical intervention pretty quickly.
00:10:14
shermanappel
um So if the blood pressure drops while they inspire, you'll be able to see this on a art line. You may not catch it in other cases, ah then that would be indicative of pericardial tamponade.
00:10:29
shermanappel
All right, so we're going to step it back to chest pain. Chest pain is the most common symptom of coronary heart disease. ah When the patient is reporting chest pain to you, you need to use open-ended questions to investigate the precipitating factors, intensity, whether it radiates.
00:10:45
shermanappel
um associated symptoms, timing, and relieving factors. um Women are more likely to report atypical symptoms, like they might report pain in their upper back, neck, or jaw, and they could have a peroxosmal nocturnal dyspnea, which means that they yeah wake up with difficulty breathing for no reason at night. like They can't identify why. like They didn't have a nightmare. They're not waking up out of that. They just wake up with this severe difficulty breathing.
00:11:12
shermanappel
And then nausea or vomiting may be common as well as fatigue in women, more more so than men. But you want to make sure that you're using these open-ended questions because you may be dealing with a patient that doesn't really like to give out health information. So you're going to want to ah pull as much as you can out of them. So rather than saying, like, how is your chest pain? They say good or bad. Even though that's an open-ended question, you're going to need to do some more probing and allow for them to expound upon other things.
00:11:42
shermanappel
related to their chest pain.
Peripheral Pulse Assessment
00:11:46
shermanappel
um
00:11:50
shermanappel
Moving on from chest pain, we're going to get into assessing our peripheral vascular system. um So there's a few findings on this that would be concerning from a central cardiac standpoint, and that would be if you have severe severe edema in the peripheral extremities, um then that would be an issue. Also, ah when you're doing your assessment of the lungs, you could probably hear pulmonary edema as well. You'd be able to hear that tightness and breathing. um And so there's a few different you know clues from the rest of the body that the heart may not be functioning appropriately.
00:12:26
shermanappel
um Regardless, you're going to note all peripheral pulses that you can if you're doing a very thorough assessment. This would include your radial pulses, your ulnar pulses, your brachial pulses, ah your popliteal pulses behind your knees. It would include femoral pulses. You would also include the dorsalis pedis, which is on the base of the foot, um as well as the posterior tibial pulses, which is right behind the internal malleolus, the medial malleolus of the ankle.
00:12:56
shermanappel
So ah you should be able to palpate all of those arteries. It would also include auscultation of some of the arteries that you wouldn't be able to palpate, such as the renal and iliac arteries in your abdomen. um So there's a lot of arteries to assess when you're looking at per peripheral vascular assessment.
00:13:17
shermanappel
um You wouldn't just know anything that's anomalous about any of those sites. There's a grading scale for pulses. um I've seen it vary from facility to facility, but generally plus two is the normal reading of ah of an artery. So if you if you see our pulse two, plus two pulses on that any of your documentation, that would be normal. um Plus one is slightly weak, whereas a plus three is like a bounding pulse.
00:13:44
shermanappel
um You're also going to assess at this time any arterial venous grafts that the patient might have, especially for dialysis. um You'll auscultate for bruise over those. and you know It's not abnormal to have a thrill as well as a very audible turbulent blood flow through an arterial venous graft. In fact, that's what you want to hear, which is the reverse of what you want to hear over any of those arteries or artery palpation sites.
00:14:10
shermanappel
so that it kind of includes most of your actual hands-on auscultation inspection of the peripheral vascular system. If you're looking if you know edema, which is that classic swelling, ah it could be dependent, it could be cardiogenic edema. Pulmonary edema, if you're considering all the pulse sites as well as listening and auscultating over the pulses that you can't palpate, that's a pretty good coverage for your peripheral vascular assessment.
00:14:37
shermanappel
um If you noted any other signs of peripheral vascular disease, such as ah really ruddy skin color, hair loss on the lower legs, um very, very thick skin or thin skin, um very fragile skin, any varicosities, meaning like varicose veins, those would all be abnormal and should be noted on your peripheral vascular assessment.
00:15:05
shermanappel
But having done all of that, you ah have now put together a pretty complete assessment between your cardiovascular of the heart as well as peripheral vascular system. So let's go ahead and hop into our abnormal ah or pathological diseases that I wanted
Coronary Artery Disease Indicators
00:15:20
shermanappel
to cover. We're going to go over the coronary artery disease, artery disease a heart failure, atrial fibrillation, aortic regurgitation, and mitral valve stenosis or regurgitation.
00:15:32
shermanappel
um So with these five, we're going to start with coronary artery disease. Risk factors include hypertension, hyperlipidemia, diabetes, smoking, a family history of coronary artery disease, obesity, and physical inactivity, so a sedentary lifestyle. um Physical findings, often asymptomatic until you get to the advanced stages. In fact, I believe there is a grading scale for how severe the disease is.
00:15:59
shermanappel
They have grading skills for everything here, but I'm not super familiar with it. And for our purposes, if you have a patient with coronary artery disease, you've probably already caught it in a late stage um with the physical manifestations. So once they are in that late stage, you're going to see chest pain, shortness of breath, and fatigue. Laboratory findings would reveal elevated troponins during an acute coronary syndrome, abnormal electrocardiogram, especially you'd note ST segments changes. So if they had a elevated ST, you may have heard of a STMI or STEMI. So this is where you have an elevated s ST segment as well as, sorry, so a STEMI is a ST segment elevation in the presence of myocardial infarction, which is
00:16:46
shermanappel
ah slightly different from a non-stemmy, which is where you do not have that same ST elevation. And that ST elevation is just reflective of cardiac ischemia, um meaning that they're not getting good enough blood flow to their heart tissue itself, ah which is causing the troponin to be elevated, and that's what you'll see in those labs.
00:17:11
shermanappel
um heart sounds, you may hear an S4 gallop due to in decreased compliance of the left ventricle. If the left ventricle isn't capable to pump well enough, you might hear a gallop, which is a ah kind of a lub-dub-de, lub-dub-de, lub-dub-de. If you're hearing a galloping quality to it, and you may think, huh, maybe we should look for coronary artery disease. And that's according to the clinic Cleveland Clinic, an article they put out in 2021.
00:17:43
shermanappel
um Heart failure, this is next. You may have heard two types of heart failure. You have left side and right side heart failure. um You may have both in one patient ah as they often precipitate each other. um Risk factors include coronary artery disease. disease coronary artery disease, hypertension, diabetes, um either type 1 or type 2, valvular heart disease, previous myocardial infarction, obesity, and age. So as you get older, you're more likely to get heart failure. Physical findings, this varies depending on which side of the heart is failing. um So if you have right-sided heart failure, ah you may experience um the peripheral edema. you may get
00:18:31
shermanappel
and it jugular venous distension, paroxysmal nocturnal dyspnea, fatigue still. Whereas if you have left-sided, you're going to have a lot more of the difficulty breathing, ah pulmonary edema, jugular venous, sorry, ah crackles on lung oscultation would be the you know the key finding for that pulmonary edema, um as well as ah shortness of breath on any level of activity.
00:19:00
shermanappel
The amount of activity you're able to do without symptoms indicates your level of heart failure. So early stage or stage one heart failure ah is like you're able to do most things, but if you exert yourself, you get pretty severe shortness of breath. And it progresses all the way to, I think they have think they have four stages now, um where at rest you're already short of breath and having difficulty and you know just breathing. ah Laboratory findings or other ah you know imaging might be elevated B-type nitrietic peptide, BNP, or N-terminal pro-BNP. Those are both laboratories that you could send off, and if they came back elevated, you might say that this person is possibly experiencing heart failure. um You could do an echocardiogram. If they have an echocardiogram and it shows reduced ejection fraction, which is where
00:19:53
shermanappel
the amount of heart or sorry the amount of blood ejected from the left ventricle during systole is reduced. Most people I believe is 50 to 60 or 50 to 70 percent. Anything less than that then they may have ah heart failure with a reduced ejection fraction, though it is possible to have heart failure with a preserved ejection fraction. We call that heart failure in the presence in the presence of a preserved ejection fraction, ah which is an interesting, ah and my opinion, an interesting finding and in those disease processes. Heart sounds, you may hear the S3 or S4 sounds, depending on the type and severity of the heart failure. So S3 would be a ventricular gallop. You might expect to hear that in your
00:20:38
shermanappel
ah left-sided or left ventricular heart failure and then S4 would be an atrial gallop and you may hear that in your right-sided heart failure. All interesting findings. Moving on from heart failure, we have atrial fibrillation or AFib. A lot of people
Atrial Fibrillation and Its Implications
00:20:56
shermanappel
just live in AFib and they don't even know about it. And I'm gonna get on a little soap box about AFib because it's a risk factor for so many other fatal diseases, it's just not worth not treating. So if you have a patient that comes in with atrial fibrillation,
00:21:09
shermanappel
and they have any ah sort of risk for you know a cardiovascular event, um please, please treat that. So risk factors include hypertension, heart failure, coronary artery disease, valvular heart disease, ah increased age, obesity, alcohol use, and hyperthyroidism.
00:21:29
shermanappel
On physical assessment, you'll find a irregularly irregular pulse. So this means that it's constantly changing how quick it's beating and and how often. And you also know the patient may report palpitations, dizziness, fatigue, and dyspnea. It's important to understand the pathology behind each of these. So I'll explain briefly atrial fibrillation. Essentially, the atrium is just ah what, well, the word fibrillate means to basically quiver.
00:22:00
shermanappel
So the atrium is just quivering, which doesn't give you a good atrial kick, which is going to decrease your overall cardiac output um because that and impairs your ventricular filling. um And if the ventricles aren't filled to the optimal point, then they have a difficult time actually squeezing that blood out of the heart. um So really atrial fibrillation is an issue for that case. And because you get poor ventricular filling and ejection, you can end up with clots forming either in the atria or the ventricles.
00:22:30
shermanappel
um And if those become dislodged, then they ah can cause one or two things depending on the side of the heart where they developed. If it developed on the left side of the heart, then it is going to be ejected. It'll likely go straight up the carotid artery to the brain and cause a cerebrovast to their event. um If it's on the right side of the heart, you're dislodged to the clot, you are likely going to cause a pulmonary amble embolism.
00:22:54
shermanappel
So those are two very fatal, very common occurrences that can be prevented by adequately treating and understanding atrial fibrillation. um Laboratory findings, the electrocardiogram will show that irregularly irregular rhythm with distinct lack of P waves. So you'll note this. You won't be able to measure a P, R interval. and It'll be irregular so you likely won't even be able to measure R to R. You'll just be able to see the QRS complex and a T wave. um You won't notice any P waves. And if it gets very, very quick, you may not even see the T waves. And that would be
00:23:32
shermanappel
This is an ICU condition. ICU level would be AFib with RVR, AFib with a rapid or ventricular rhythm, which is potentially fatal. And it quickly you can but cause this patient to spiral downwards. But that's that's ICU. I'll leave that out. We're talking about primary care here.
00:23:51
shermanappel
Let's see, we talked about electrocardiogram. You can do echocardiography to assess the structural well-being of the heart. If there's something wrong structurally with the heart that could cause the AFib, that would be important to understand.
Valve Disorders: Aortic and Mitral
00:24:03
shermanappel
You can also do a thyroid function tests, as hyperthyroidism is a common ah risk factor for AFib. Heart sounds, you will hear ah absence potentially of S1 due to the irregular rhythm, ah according to Kirchoff.
00:24:18
shermanappel
and their colleagues in 2016. Although, also I'm going to be citing all of the stuff that I'm pulling for the diseases in the show notes. So if you're curious where I'm getting this information from, it'll be there. um Aortic regurgitation is the next. So an aortic regurgitation risk factors include rheumatic heart disease by cuspid aortic valves, which is where you only have two on the aortic valve instead of three. Usually it's a tricuspid valve.
00:24:46
shermanappel
and then Infective endocarditis, so the issue there being that if you have two, let's call it wings to that valve instead of three, ah it's you're more at risk for that valve to become incompetent and have backflow into the heart.
00:25:04
shermanappel
and
00:25:08
shermanappel
Let's see, I already mentioned the bicuspid aortic valve. We're going to talk about if you have infective endocarditis, that bit would be a risk for aortic regurgitation that can damage the aortic valve and and result in backflow. Also aortic dissection. ah So an aortic root dissection, this is a very fatal disease process. And I feel like aortic regurgitation is probably the least of your concerns if you have aortic dissection. But you will hear aortic regurgitation potentially on that because it may split all the way down to the valve.
00:25:38
shermanappel
and If you have aortic dissection in a patient, this is a serious issue and they have immediate interventions because they they will bleed out very quickly from that aortic dissection. um Connective tissue disorders, think like Marfan syndrome, anything that influences the way that tissues specifically form.
00:26:00
shermanappel
Physical and laboratory findings include dyspnea, fatigue, palpitations, a widened pulse pressure. um let see Laboratory findings include echocardiogram showing regurgitate flow. So on the echocardiogram, they can actually watch how blood flows through the heart um and through the chambers and through the valves.
00:26:19
shermanappel
So ordering an echocardiogram can help you determine what's going on and in the heart. If you do here, ah in this case, for aortic regurgitation, the heart sounds would be diastolic, decrescendo murmurs over the left sternal border. um And it could be polysystolic. So during systole, you could already have regurgitation flowing back, but especially during diastole, as that's when the valve is supposed to be closed.
00:26:48
shermanappel
um
00:26:50
shermanappel
Anyways, you'd be able to measure that on an echocardiogram. You could say, hey, this sounds weird. Let's get an EKG or an echocardiogram. And then they'd be able to show you how blood is flowing through the heart. And you'd be able to see that regurgitation. Same for, I think, we're going to talk about nitrile valve regurgitation next. ah You'd also be able to see that on your echocardiogram. So very useful tool for a diagnosing heart disease.
00:27:18
shermanappel
um For mitral valve stenosis and regurgitation, very similar risk factors, rheumatic fever or a fever that causes rheumatic heart disease, um infective endocarditis, and then mitral valve prolapse or myocardial infarction would all lead to stenocers or regurgitation being present in the heart there. ah You may also have degenerative valve diseases that could be in play. Physical findings include dyspnea, orthopnea,
00:27:50
shermanappel
hemoptysis, atrial fibrillation. ah Laboratory findings would be the same thing, echocardiogram showing ah regurgitant flow, or you may also be able to see thickened mitral valve leaflets, which decreases the compliance of that valve, um and increased left atrial pressure.
00:28:14
shermanappel
heart sounds, you'd be able to hear a diastolic rumble with an opening snap, and this would be more audible close to the apex.
00:28:24
shermanappel
um So that's all for mitral stenosis. Regurgitation, similar findings, except you'd be seeing the regurgitant flow rather than the thickened leaflets, and you'd end up with the Hollis dystolic murmur heard at the apex radiating to the axilla. So from The apex of the heart always ah all the way to the armpit, you'd be able to hear ah this holistic stolic murmur. And that is according to Nishimura and their colleagues. So that is a good overview of a few different heart diseases and how you might assess them. I just want to put in a little plug.
00:29:02
shermanappel
that you should go through. I think in my last podcast I put a link to a YouTube video showing all the lung sounds. I would encourage you to go through and find a YouTube video that works for all the heart sounds as well. Become very familiar with what the abnormal and normal sounds of the heart are like so that when you are in clinic ah you're able to make those determinations with skill. i Make you look a lot less stupid than you might feel if you were to say, hey, this sounds weird on your charting. You could instead give a distinct ah answer to the character quality and type of sounds you're hearing. um And then that's useful diagnostic information as we've seen in the aortic regurgitation and mitral valve stenosis regurgitation. So.
00:29:46
shermanappel
Make sure that you learn your heart sounds well and pay attention to those.
Podcast Conclusion and Feedback Request
00:29:50
shermanappel
um That's about all that I have for content for this podcast. Please let me know if there's anything that you guys would like covered in more depth. um You can reach me at Jackson dot.Jorgensen, J-A-X-O-N dot.J-O-R-G-E-N-S-E-N at gmail dot.com if you have any notes on the show. I would love feedback. This is my first time doing podcasts.
00:30:11
shermanappel
As I said, it's for you guys. Just as much as is it is for me, I want to master a health assessment in this case. And I'm hoping that by doing these podcasts, it puts pressure on me to present to you guys. um And that that helps me to know the content better myself. So please let me know if you guys have any feedback. Thank you.