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Measuring and monitoring vital signs
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
Note that the apex beat (site shown in Figure 4.5) can be listened to with a stethoscope, and it is located to the left side of the sternum over the heart. The apex beat may be measured when the person has a cardiac condition and is usually measured along with the radial beat. Two healthcare workers are required to perform this skill. With the person either sitting or lying still, they use the same watch over 1 min. Healthcare worker 1 counts the radial pulse and healthcare worker 2 counts the apex beat of the heart, listening with a stethoscope (Figure 4.5). The measurement is usually recorded as apex (A) and radial (R), for example, A72, R72. The numbers should be the same but in some instances, the pulse will differ, for example, A80, R72. This situation is known as a pulse deficit. People who have atrial fibrillation sometimes show these observation variations.
Cardiovascular
Published in Ian Mann, Alastair Noyce, The Finalist’s Guide to Passing the OSCE, 2021
An example of your presentation may be: This well-looking, 70-year-old gentleman is sitting comfortably at rest. There are no paraphernalia around the bed indicating why this gentleman may be in hospital. There are no peripheral stigmata of cardiovascular disease. His pulse rate is 68 beats per minute and regular. The pulse is of low volume and appears to be slow rising. The blood pressure of 118/95 indicates a narrow pulse pressure. On inspection of the chest, I can see a well-healed sternotomy scar. There is also a scar on the medial aspect of the right leg, indicating venous harvesting. The apex beat is in the 5th intercostal space, mid-clavicular line. There is a loud ejection systolic murmur best heard in the aortic area in expiration that radiates to the carotids. The lung bases are clear, and there is no peripheral oedema. These findings are consistent with a gentleman who has undergone a coronary artery bypass graft and who also has a murmur of aortic stenosis. There are no signs of heart failure or endocarditis.
Mitral Regurgitation
Published in K. Gupta, P. Carmichael, A. Zumla, 100 Short Cases for the MRCP, 2020
K. Gupta, P. Carmichael, A. Zumla
In uncomplicated mitral regurgitation the apical first heart sound is faint, and is replaced by a loud blowing, pansystolic murmur which may radiate to the axilla. The apex beat, though displaced, is often strong and localized, suggestive of a degree of ventricular hypertrophy. The intensity of the heart murmur correlates poorly with the severity of the regurgitation. Common symptoms include fatiguability, exertional and nocturnal dyspnoea.
AL amyloidosis presenting as inflammatory polyarthritis: a case report
Published in Modern Rheumatology Case Reports, 2021
Muhammad Shoaib Momen Majumder, Shamim Ahmed, Md. Nahiduzzamane Shazzad, Mohammad Mamun Khan, Syed Atiqul Haq, Mohammed Kamal, Md. Sohrab Alam, Johannes J. Rasker
On physical examination, the patient was found moderately pale looking, all vital signs were normal. His pulse rate was 80/min, regular with normal volume, blood pressure 120/70 mm of Hg, respiratory rate 18/min, there was no lower limb edoema or lymphadenopathy. There were papules and plaques over the periocular, perinasal, and perioral area, macroglossia with indentation of the tongue, pinch purpura in the oral cavity (Figures 1 and 2). Nail dystrophy was present in some of his fingers. There was no organomegaly, apex beat was situated in the 5th intercostal space along the midclavicular line. Musculoskeletal examination revealed localised, mildly tender, soft tissue swelling of variable size and shape (largest one was 5Х3 cm, Figure 3 over the wrist) over flexor and extensor aspects of wrists and back of knees. Both shoulders were swollen (shoulder pad sign positive, Figure 4), tenderness was present over MCPs, wrists, elbows, and shoulders. He had an antalgic gait. Active and passive movements of wrists and shoulders were painful and restricted. Flexion contracture (30 degrees) was present in the left elbow.
Evolution of out-of-hospital emergency cardiac care: Heart attack therapy for a retired president helped modernize American emergency medical services
Published in Baylor University Medical Center Proceedings, 2019
Nathaniel P. Rogers, Richard S. Crampton
Our wee hours, predawn team included C-ARS EMTs Lynwood McCauley and John R. Miles, also a medical student; as well as Dr. Robert Harris; Deaton Smith, a third-year medical student; and myself. We found President Johnson sweating profusely with chest pain radiating to the left shoulder and neck. When chest pain had awakened him at 2:30 am, he took an antacid and six sublingual nitroglycerin tablets without relief. Examination disclosed a blood pressure of 165/90 mm Hg, no jugular vein distention, a regular heart rhythm with premature beats, a forceful apex beat, a loud fourth heart sound, a single second sound, no murmur, no friction rub, and rales at both lung bases. He quickly responded to our intravenous morphine 4 mg injection and oxygen by mask. Next, intravenous lidocaine 100 mg abolished his R on T early coupled ventricular premature beats. His 12-lead ECG showed anterior Q waves with ST segment elevation indicative of acute anterior myocardial infarction (Figure 2). On the spot, LBJ’s wife Lady Bird wisely phoned Dr. J. Willis Hurst of Atlanta so that we could discuss LBJ’s cardiac history. Hurst had cared for LBJ during his 1955 heart attack and recalled it as inferior infarction. Thus, we both realized that LBJ had a new site of acute infarction.
Chronic tuberculous empyema in an 8-year-old boy
Published in Paediatrics and International Child Health, 2020
Yang Wen, Yu Zhu, Zongrong Gong, Min Shu, Chaomin Wan
On examination, his temperature was 36.6°C, heart rate 90/min and respiration rate 25/min. His height was 129 cm (around the 25th percentile) and weight was 25 kg (around the 25th percentile). Both the trachea and apex beat were shifted to the right side of the chest. There was dullness to percussion and diminished breath sounds in the left lung but no crackles or wheezing. There was no clubbing of the fingers, peripheral lymphadenopathy or hepatosplenomegaly. A BCG scar was detected on the upper left arm.