11.28 B Flashcards
What are the three primary, overarching reasons for performing a CV exam?
- assessment of a complaint or symptom
- define physiologic state
- screen for disease
What are the four aspects of a CV exam?
inspection, palpation, percussion, auscultation
During a CV exam, how should the patient be positioned?
at 30 degrees from horizontal
The carotid upstroke should be ____ and ____ with a normal velocity of ____.
rapid and synchronous with a normal velocity of 30-180 cm/s
Ascultation of the carotid arteries is checking for what?
turbulent flow due to stenosis
The jugular venous pressure is a good measure of what pressure?
the central venous pressure which is the right atrial pressure
Clinicians underestimate jugular venous pressure by how much compared to cath measurements?
by approximately 3 cm H2O
Describe the venous pulse?
there are two falls, the X and the Y, thus it often looks to flutter or wavey
Where is the radial pulse?
on the wrists
Where is the brachial pulse?
just above the elbows
Where is the posterior tibial pulse?
on the medial side of the ankle
Where is the dorsalis pedis pulse?
between the first and second tow
Pitting edema is graded on a scale of what?
1+ to 4+
Grade 2+ pitting edema is characterized by what?
pitting of 4-6 mm
What three vertical lines in the chest help guide where to listen for heart sounds?
- sternum
- mid-clavicular line
- anterior axillary line
Palpation of the chest is looking for what?
heaves and thrills
What is the apical impulse?
the point of maximal impulse where you can best feel the heart beating
The apical impulse can be found where?
mid-clavicular line at the 5th or 6th intercostal space
If the apical impulse is found lateral to the mid-clavicular line, it predicts what?
low ejection fraction
What are sustained precordial movements?
movements that sustain past S2
What are sustained precordial movements indicative of?
aortic stenosis, volume overload, severe cardiomyopathy, or ventricular aneurysm
An S3 sound is indicative of what?
heart failure
An S4 sound is indicative of what?
a stiff heart secondary to long-term hypertension
Which sound is the lub and which is the dub?
S1 = lub, S2 = dub
An S3 sound is generated by what defect?
it is an abnormal early diastolic filling sound
An S4 sound is generated by what defect?
an abnormal late diastolic filling sound
What are some common ways to describe and characterize murmurs?
- timing
- location of maximal intensity
- grade/amplitude
- radiation
- pitch
- quality
- shape (crescendo or decrescendo)
Are diastolic or systolic murmurs more common?
systolic
Are diastolic or systolic murmurs more commonly disease?
diastolic murmurs are always disease
What’s the main difference between a grade 3 and a grade 4 murmur?
a grade 4 is characterized by a palpable thrill
What are the three basic murmurs?
- aortic stenosis
- mitral regurgitation
- mitral stenosis
Describe an aortic stenosis murmur.
- crescendo-decrescendo
- radiates to carotids and accompanied by a slow and low
- chief complaint was often shortness of breath, angina, or syncope
Describe a mitral regurgitation murmur.
- lower pressure so quieter and lower pitched
- holosystolic
- best heard at apex
- radiates to the axilla
Describe a mitral stenosis murmur.
- mid-diastolic
- low pitched (heard with the bell)
- best heard at the apex
What is the cause of a venous hum?
high blood flow for the anatomy
Describe a venous hum.
- continuous
- best heard above the head of the clavicle
- associated with high flow states like pregnancy, anemia, and pediatric age
- benign
An S3 is also known as a what?
ventricular gallop
An S4 is also known as a what?
an atrial gallop
Describe an S3 sound.
- Ken-Tuc-Ky
- early diastolic sound
- vest heard at the apex with the bell
Describe an S4 sound.
- Ten-Ne-See
- late diastolic sound
- beast heard at the apex or LLSB with bell
S2 splitting is the result of what?
a difference in closing time of the pulmonic and aortic valves
In an S2 split, which sound is heard first?
the S2a (aortic valve first)
Why would you want to decrease venous return?
to increase the sound of outflow tract murmurs like HOCM
What are some ways to decrease venous return and increase the sound of an outflow tract murmur?
valsalva or have the patient move from squatting to standing
What are some maneuvers for increasing venous return during a CV exam to change the amplitude of specific murmurs?
- prolonged abdominal palpation
- standing to squatting
- passive leg elevation
Edema is indicative of a problem with either of what two organs?
heart or liver
