18: Approach To Cardiac Exam Flashcards
PQRST in taking a cardiac history
Proximity, quality, radiation, severity, timing
Positions a pt can be in to auscultate the heart
Sitting, supine, left lateral decubitus, leaning forward, standing
What does PMI stand for?
Point of maximal impulse
How to do a jugular venous pulse exam
- Place pt in a supine position to let veins engorge -> raise to 30-45 degrees
- Estimate JVP by measuring the angle from the top of the venous pulsation to the bottom of the sternum (?)
- Greater than 9 is abnormal
Most common cause of elevated JVP
Elevated RV diastolic pressure
Some conditions where a giant A wave would be seen on the jugular venous pressure wave
- Obstruction between RA and RV
- Increased RV pressure
- pulmonary HTN
- Recurrent PE
- AV dissociation (heart block)
What conditions do you see a steep X (JVP wave) in?
Cardiac tamponade, constrictive pericarditis
In what condition is there a prominent V wave on JVP wave?
Pulmonary HTN
Deep Y on JVP wave suggests?
severe TR (?)
Conditions with increased JVP
SVC obstruction, severe heart failure, constrictive pericarditis, cardiac tamponade, RV infarct, restrictive cardiomyopathy
What causes S3 heart sound?
High pressure and abrupt deceleration of inflow across mitral valve at end of rapid filling phase
What causes S4 heart sound?
Atrial gallop from forceful contraction of atria against a stiffened ventricle
Sound words for S3 and S4
S3: ken-tuck-ee
S4: ten-nes-see
How to grade pulses (review)
0: absent
1: barely palpable
2: average
3. Strong
4: bounding
How to grade edema
0: absent
1: barely detectable and non-pitting
2: slight indentation (4mm)
3: deeper indentation (6mm, can take 1min to return)
4: very marked indentation (8mm, can take 2-5 mins to return)
