...
Is there fever? If there is fever, one should look for yellow fever, diphtheria, cerebral abscess, or meningitis. Perhaps the fever is related to increased intracranial pressure ... DIAGNOSTIC WORKUP
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Is it acute? Acute reduction of the pulse of an extremity may be due to an arterial embolism, dissecting aneurysm, or fracture of the limb.
Does it involve the upper ... DIAGNOSTIC WORKUP
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Is it in the upper or lower extremities? Diminished pulse in the upper extremities should suggest dissecting aneurysm, embolism, fracture, arteriovenous fistula, ... DIAGNOSTIC WORKUP
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Is the rate normal, rapid, or slow? A rapid rate would suggest supraventricular tachycardia, ventricular tachycardia, atrial flutter, ... DIAGNOSTIC WORKUP
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Could the murmur be extracardiac in origin? Extracardiac murmurs include the pericardial friction rub and cardiorespiratory murmurs.
Is the ... DIAGNOSTIC WORKUP
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Bradycardia is defined as heart rate of less than 60 beats per minute. It is a common finding that often does not require treatment in the absence of symptoms.
Differential Diagnosis
... Workup and Diagnosis ... Treatment
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Unequal pulses is a difference in blood pressure measurements between both arms or between the arms and the legs. The presence of unequal pulses can help diagnose significant underlying disease. A thorough... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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The patient should be asked to describe the heart rhythm and to demonstrate it by either saying or tapping the speed and rhythm of the sensation. Additionally, teaching the patient to measure his or her pulse... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Pulse pressure is the difference between systolic and diastolic blood pressures. Wide pulse pressure is a difference greater than 60–70 mmHg. This often results from conditions... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Diastolic heart murmurs are never normal and should always be further evaluated, in contrast to systolic murmurs, which are commonly benign or due to rapid flow rates. The part of the cardiac... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Systolic heart murmurs, in contrast to diastolic murmurs, may be normal or abnormal, although when coupled with a heave they are always abnormal. The part of the cardiac cycle that the murmur falls into (e.g., early,... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Bradycardia is a slow pulse (<90 in infants and <60 in children and adolescents). Causes range from the benign (athletic heart) to the life threatening (sepsis, severe heart block). Assessing the child's ABCs is the first'>>... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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... Bradycardia (a heart rate below 60 beats/min) is not infrequently found during a routine physical examination. Visualizing the conduction system of the heart recalls the sick sinus syndrome, atrioventricular (A-V
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... The first consideration on hearing a heart murmur is to determine whether the murmur is functional or organic. Certainly, the low-grade systolic murmurs tend to be functional; if the murmur changes or
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... Anatomy is once again the simplest way to recall the many causes of an absent or diminished pulse. By visualizing the arterial tree, we can recall the various causes. Beginning at the top of the tree, we have the heart,
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... Bradycardia refers to a heart rate of less than 60 beats/minute. It occurs normally in young adults, trained athletes, and elderly people as well as during sleep. It's also a normal response to vagal stimulation caused by coughing,... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pictures
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... Murmurs are auscultatory sounds heard within the heart chambers or major arteries. They’re classified by their timing and duration in the cardiac cycle, auscultatory location, loudness, configuration, pitch, and quality.
... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Pictures
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... Pulse pressure, the difference between systolic and diastolic blood pressures, is measured by sphygmomanometry or intra-arterial monitoring. Normally, systolic pressure exceeds diastolic by about 40 mm Hg. Narrowed... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers
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... Pulse pressure is the difference between systolic and diastolic blood pressures. Normally, systolic pressure is about 40 mm Hg higher than diastolic pressure. Widened pulse pressure — a... Emergency interventions ... Medical causes ... Special considerations ... Pediatric pointers ... Geriatric pointers
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... An abnormal pulse rhythm is an irregular expansion and contraction of the peripheral arterial walls. It may be persistent or sporadic and rhythmic or arrhythmic. Detected by... Emergency interventions ... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers ... Pictures
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... An absent or a weak pulse may be generalized or affect only one extremity. When generalized, this sign is an important indicator of such life-threatening conditions as shock and... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Pictures
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... A biferious pulse is a hyperdynamic, double-beating pulse characterized by two systolic peaks separated by a midsystolic dip. Both peaks may be equal or either may be larger; usually, however, the first peak is taller or more... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers
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... Pulsus paradoxus, or paradoxical pulse, is an exaggerated decline in blood pressure during inspiration. Normally, systolic pressure falls less than 10 mm Hg during inspiration. In pulsus paradoxus, it... Emergency interventions ... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers ... Pictures
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... Systolic
Early systolic
Physiologic (innocent)
Small ventricular septal defect
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... Regular rhythm at normal rates
Normal sinus rhythm
Accelerated junctional rhythm
 
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... Bradycardia refers to a heart rate of less than 60 beats/minute. It occurs normally in young adults, trained athletes, and elderly people as well as during sleep. It’s also a normal response to vagal stimulation caused by coughing,... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Pictures
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Murmurs
(Professional Guide to Signs & Symptoms (Fifth Edition))
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... Murmurs are auscultatory sounds heard within the heart chambers or major arteries. They’re classified by their timing and duration in the cardiac cycle, auscultatory location,... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
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... Pulse pressure, the difference between systolic and diastolic blood pressures, is measured by sphygmomanometry or intra-arterial monitoring. Normally, systolic pressure exceeds diastolic by about 40 mm Hg. Narrowed... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers
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... Pulse pressure is the difference between systolic and diastolic blood pressures. Normally, systolic pressure is about 40 mm Hg higher than diastolic pressure. Widened pulse pressure... Emergency Interventions ... Medical causes ... Special considerations ... Pediatric pointers ... Geriatric pointers
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... An abnormal pulse rhythm is an irregular expansion and contraction of the peripheral arterial walls. It may be persistent or sporadic, and rhythmic or arrhythmic. Detected by palpating the radial or carotid pulse, an abnormal... Emergency Interventions ... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers ... Pictures
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... An absent or weak pulse may be generalized or affect only one extremity. When generalized, this sign is an important indicator of such life-threatening conditions as shock and... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Pictures
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... A bisferious pulse is a hyperdynamic, double-beating pulse characterized by two systolic peaks separated by a midsystolic dip. Both peaks may be equal or either may be larger; usually, however, the first peak is taller or more... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers
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... Pulsus paradoxus, or paradoxical pulse, is an exaggerated decline in blood pressure during inspiration. Normally, systolic pressure falls less than 10 mm Hg during inspiration. In pulsus paradoxus, it falls... Emergency Interventions ... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers
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... Produced by large waves of pressure as blood ejects from the left ventriclewith each contraction, a bounding pulse is strong and easily palpable and may be visible over superficial peripheral arteries. It’s... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers
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Bradycardia
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
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... Paul C. Riggle and Richard W. Harper
Bradycardia, which is defined as a heart rate below 60 beats/minute, results from abnormalities in impulse formation or failure... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment
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Heart Murmur, Diastolic
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
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... David E. Anisman and Gerald F. Farnell
A diastolic murmur is a finding that provides a clue to an underlying disease process. Unlike their systolic counterparts ... Approach ... History ... Physical examination (PE) ... Testing ... Diagnostic assessment ... Pictures
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Heart Murmur, Systolic
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
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... Dale Bishop
Systolic murmurs can herald significant clinical deterioration and sudden death, or they can represent stable or clinically insignificant conditions. Although technologic advances in cardiac... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment ... Pictures
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... Differential Overview
Sinus Bradycardia
❑ Hypothyroidism
❑ Hypervagotonia
❑ Hypersensitive carotid... Diagnostic Approach ... Clinical Findings
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...
Differential Overview
Phenomena
❑ Irregularly irregular pulse
❑ Asymmetric pulses
❑... Diagnostic Approach ... Clinical Findings ... Pictures
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... Differential Overview
Phenomena
❑ Elevated jugular venous pressure
❑ Low jugular venous pressure
... Diagnostic Approach ... Clinical Findings ... Pictures
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... Differential Overview
❑ Aortic regurgitation
❑ Pulmonic regurgitation
❑ Mitral stenosis
❑ Tricuspid stenosis ... Diagnostic Approach ... Clinical Findings ... Pictures
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... Differential Overview
❑ Systolic ejection murmur
❑ Mitral regurgitation
❑ Mitral valve prolapse
❑ Aortic... Diagnostic Approach ... Clinical Findings ... Pictures
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... Differential Overview
❑ Aortic stenosis/aortic insufficiency
❑ Pericardial friction rub
❑ Pulmonary arteriovenous fistula ... Diagnostic Approach ... Clinical Findings
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Bradycardia
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
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... Bradycardia refers to a heart rate of less than 60 beats/minute. It occurs normally in young adults, trained athletes, and elderly people as well as during sleep. It’s also a normal response to vagal stimulation caused by coughing,... Assessment ... History ... Physical examination ... Pediatric pointers ... Geriatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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Murmurs
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
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... Murmurs are auscultatory sounds heard within the heart chambers or major arteries. They’re classified by their timing and duration in the cardiac cycle, auscultatory location,... Assessment ... History ... Physical examination ... Pediatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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... Pulse pressure is the difference between systolic and diastolic blood pressures. Normally, systolic pressure is about 40 mm Hg higher than diastolic pressure. Widened pulse pressure — a... Assessment ... History ... Physical examination ... Pediatric pointers ... Geriatric pointers ... Medical causes ... Nursing considerations ... Patient teaching ... Pictures
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... An abnormal pulse rhythm is an irregular expansion and contraction of the peripheral arterial walls. It may be persistent or sporadic and rhythmic or arrhythmic. Detected by palpating the radial or carotid pulse, an abnormal... Assessment ... History ... Physical examination ... Pediatric pointers ... Medical causes ... Nursing considerations ... Patient teaching ... Pictures
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... Pulsus paradoxus is an exaggerated decline in blood pressure during inspiration. Normally, systolic pressure falls less than 10 mm Hg during inspiration. In pulsus paradoxus, it falls more than 10 mm Hg. (See ... Assessment ... History ... Physical examination ... Pediatric pointers ... Medical causes ... Nursing considerations ... Patient teaching ... Pictures
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... Bradycardia refers to a heart rate of less than 60 beats/minute. It occurs normally in young adults, trained athletes, and elderly people as well as during sleep. It’s also a normal response to vagal... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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Murmurs
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
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... Murmurs are auscultatory sounds heard within the heart chambers or major arteries. They’re classified by their timing and duration in the cardiac cycle, auscultatory location,... Emergency Actions ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
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... Pulse pressure, the difference between systolic and diastolic blood pressures, is measured by sphygmomanometry or intra-arterial monitoring. Normally, systolic pressure exceeds diastolic by about 40 mm Hg.... History ... Physical assessment ... Medical causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
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... Pulse pressure is the difference between systolic and diastolic blood pressures. Normally, systolic pressure is about 40 mm Hg higher than diastolic pressure. Widened pulse pressure — a difference of more than 50... Emergency Actions ... History ... Physical assessment ... Medical causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... An abnormal pulse rhythm is an irregular expansion and contraction of the peripheral arterial walls. It may be persistent or sporadic, and rhythmic or arrhythmic. Detected by palpating the radial or... Emergency Actions ... History ... Physical assessment ... Medical causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
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... An absent or weak pulse may be generalized or may affect only one extremity. When generalized, this sign is an important indicator of such life-threatening conditions as shock and arrhythmia. Localized... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
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... A bisferiens pulse is a hyperdynamic, double-beating pulse characterized by two systolic peaks separated by a midsystolic dip. Both peaks may be equal or either may be larger; usually, however, the first peak is taller or more... History ... Physical assessment ... Medical causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
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... Pulsus paradoxus, or paradoxical pulse, is an exaggerated decline in blood pressure during inspiration. Normally, systolic pressure falls less than 10 mm Hg during inspiration. In... Emergency Actions ... History ... Physical assessment ... Medical causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
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... Produced by large waves of pressure as blood ejects from the left ventriclewith each contraction, a bounding pulse is strong and easily palpable and may be visible over superficial peripheral... History ... Physical assessment ... Medical causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
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... Normal murmursare due to turbulence of normal blood flow. A normal murmur does not result insymptoms. Cardiovascular exam, chest radiograph, and ECG are normal.Other... Principal Causes of Heart Murmurs (Asymptomatic) ... Clinical Features and Diagnosis ... Diagnostic Approach ... References
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... Bradycardia refers to a heart rate of less than 60 beats/minute. It occurs normally in young adults, trained athletes, and elderly people as well as during sleep. It's a normal response to vagal stimulation caused by coughing,... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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... Murmurs are auscultatory sounds heard within the heart chambers or major arteries. They're classified by their timing and duration in the cardiac cycle, auscultatory location, loudness, configuration, pitch, and quality.
Timing... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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... Pulse pressure, the difference between systolic and diastolic blood pressures, is measured by sphygmomanometry or intra-arterial monitoring. Normally, systolic pressure exceeds diastolic by about 40 mm Hg. Narrowed pressure—a... History and physical examination ... Medical causes ... Nursing considerations ... Patient teaching
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... Pulse pressure is the difference between systolic and diastolic blood pressures. Normally, systolic pressure is about 40 mm Hg higher than diastolic pressure. Widened pulse pressure—a difference of more than 50 mm Hg—commonly... Medical causes ... Nursing considerations ... Patient teaching
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... An abnormal pulse rhythm is an irregular expansion and contraction of the peripheral arterial walls. It may be persistent or sporadic and rhythmic or arrhythmic. Detected by palpating the radial or carotid pulse, an abnormal... History and physical examination ... Medical causes ... Nursing considerations ... Patient teaching
... READ MEDICAL BOOK EXCERPTS ONLINE » (free access, no registration)
... An absent or a weak pulse may be generalized or affect only one extremity. When generalized, this sign is an important indicator of such life-threatening conditions as shock and arrhythmia. Localized loss or weakness of a pulse that... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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... A biferious pulse is a hyperdynamic, double-beating pulse characterized by two systolic peaks separated by a midsystolic dip. Both peaks may be equal or either may be larger... History and physical examination ... Medical causes ... Nursing considerations ... Patient teaching ... Pictures
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... Pulsus paradoxus, or paradoxical pulse, is an exaggerated decline in blood pressure during inspiration. Normally, systolic pressure falls less than 10 mm Hg during inspiration. In pulsus paradoxus, it... History and physical examination ... Medical causes ... Nursing considerations ... Patient teaching
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... Produced by large waves of pressure as blood ejects from the left ventricle with each contraction, a bounding pulse is strong and easily palpable and may be visible over... History and physical examination ... Medical causes ... Nursing considerations ... Patient teaching
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...
Bradycardia (a heart rate below 60 beats per minute) is not
infrequently found during a routine physical examination. Visualizing the
conduction system of the heart recalls the... Pictures
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...
The first consideration on hearing a heart murmur is to determine
whether the murmur is functional or organic. Certainly, the low-grade
systolic murmurs tend to be... Pictures
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...
Anatomy is once again the simplest way to recall the many causes of an
absent or diminished pulse. By visualizing the arterial tree, we can recall
the various causes. Beginning at the top of the tree, we have... Pictures
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...
To develop a list of causes of unequal pulses, let’s trace the arterial
system from its origin in the heart to its termination in the extremities.
Heart. Here is the source of arterial emboli
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