2.1.2 Normal Heart Exam Flashcards
What is different between arteries and veins upon palpation?
Arteries will palpate and veins will not
Where is the mitral area?
Left side of patient 5th intercostal space between the mid clavicular line and the anterior axillary line
Following palpation, sustained precordial movements may indicate what?
Aortic stenosis, Volume overload, Severe cardiomyopathy, Ventricular aneurysm
What are the characteristics of mitral regurgitation murmur?
Holosystolic murmur that is best heard at the apex of the heart. It also radiates to the axilla.
Where is a mitral regurgitation murmur going to be heard best?
In the mitral area at the apex
What do you do?
This patient has mitral valve stenosis
What is the proper positioning for a cardiac exam?
The patient should be 30 degrees from horizontal and the physician should be on the patients right side
Where is an aortic stenosis murmur going to be heard best?
In the aortic area - second intercostal area on right side of chest
Where is a venous hum murmur going to be heard best?
About the head of the clavicle
What type of murmurs may radiate to the carotid?
Aortic Valve murmurs
Where is the tricuspid area?
Left side of patient fifth intercostal space between the sternum and mid clavicular line
What are you looking for when you auscultate the carotid arteries?
Carotid bruits, which are a sign of turbulent flow due to stenosis
What are the main peripheral pulses in the lower extremities?
Femoral - groin area, Dorsalis Pedis, Posterior Tibial - Ankle area
What are some special maneuvers to decrease venous return?
Valsalva Squatting to standing Increases outflow tract murmurs
What is occurring at S1?
Beginning of systole - closing of the mitral and tricuspid valves
What is a venous hum murmur?
It is continuous murmur through systole and diastole. It is associated with high flow states - pregnancy, anemia and pediatric age
What are the characteristics of mitral stenosis murmur?
Mid - diastolic murmur that is low pitched so use the bell of the stethoscope.
What are the 7 categories when characterizing a heart murmur?
Timing - systolic/diastolic, early/middle/late
Location of maximum intensity
Shape
Grade - 1 to 6
Radiation
Pitch - high/medium/low
Quality - blowing/harsh/rumbling/musical
What is the sound when percussing the heart?
It should sound dull (lecturer wasn’t too fond of percussion in a cardiac exam)
Where is a mitral stenosis murmur going to be heard best?
In the mitral area at the apex
What is the location of the pulmonic area?
Left side of patient second intercostal space between the sternum and mid clavicular line
What are the main peripheral pulses in the upper extremities?
Radial and brachial
What is an S3 sound?
Abnormal early diastolic “filling” sound Ventricular gallop - apex with the bell Heart failure
What is edema?
Swelling that persists after pressure is released
What is an S2 split?
Different closing times of the aortic and pulmonic valves. This is normal during inspiration due to extra hangout time
What is an S4 sound?
Abnormal late diastolic filling sound - heart stiffening
What is occurring at S2?
Beginning of diastole - closing of the aortic and pulmonic valves
Where is the point of maximum impulse?
Normal PMI is mid-clavicular line at 5th-6th intercostal space - thought to aid in diagnosis of CHF
What are the 4 basic parts of the cardiac exam?
Inspection, Palpation, percussion, and auscultation
When auscultating, what are you listening for in regards to rhythm and rate?
Whether the rhythm is regular vs irregular and whether the patient is bradycardic, normal or tachycardic
What is the location of the aortic area?
Right side of patient second intercostal space
What are the characteristics of a Aortic stenosis murmur?
Systolic murmur that presents in a crescendo-decrescendo pattern. It radiates to the carotids and is accompanied with a low and slow upbeat in the carotid
Jugular venous pulsations are good estimates of what?
Estimate central venous and right atrial pressure as well as RV end diastolic pressure
When assessing peripheral pulses what are you comparing?
Comparing the pulses laterally The rate and rhythm of the pulses The character of the pulses - bounding vs thready
What do you do?
Order an EKG and echocardriogram - this patient may have HOCM
What are some special maneuvers to increase venous return?
Prolonged abdominal palpation Standing to squatting Passive leg elevation Decrease ie HOCM
