Advanced Cardiac Exam Flashcards

1
Q

Risk assessment for CAD

A

History:

  • FHx
  • Smoking
  • Diet
  • Physical Activity
  • Lipids (cholesterol especially)
  • Diabetes

Exam:

  • Blood pressure
  • Peripheral artery disease
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1
Q

Jugular venous pulse diagram

A
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2
Q

Pulsus paradoxus

A
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3
Q

Important setup for getting a proper blood pressure

A

Be sure to check in left arm with mechanical cuff after patient has been sitting and resting for > 5 min, back and feet supported and arm supported at/near heart level.

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4
Q

While talking to a patient, always take a mental note of ____.

A

While talking to a patient, always take a mental note of conversational dyspnea.

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5
Q

Areas that may have significantly impaired perfusion or blood flow in heart failure

A
  • Base of lung (crackles of PE)
  • Lower extremity edema
  • Calf and forearm temperature
  • Capillary refill time
  • Dependent rubor
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6
Q

Dependent rubor

A

Fiery to dusky-red coloration visible when the leg is in a “dependent position,” but not when it’s elevated above the heart. Caused by peripheral arterial disease.

To test for dependent rubor, position the patient supine and elevate the legs 60 degrees for 1 minute; then examine sole color.

The longer dependent rubor takes to reappear, the worse the PAD

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7
Q

Allen’s Test

A

Test for collateral circulation within the hand

  1. Place thumbs over the radial and ulnar arteries in the wrist
  2. Have the patient pump their hand until it is white
  3. Release one thumb
  4. Watch for capillary refill (normal is 3-5 seconds)
  5. Repeat steps 1-4 for the other artery
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8
Q

Consolidation vs Effusion

A
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9
Q

You have a patient with severe emphysema in clinic and are trying to listen to their heart, but are having trouble hearing due to their hyperinflated lungs. What can you ask them to do to help you hear?

A

Lean left or lean forward

This will bring the apex of the heart closer to the chest wall, with less intervening lung space.

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10
Q

Precordium lift or heaves

A

Forceful cardiac contractions that cause a slight to vigorous movement of sternum and ribs. These will be associated with a palpable thrill.

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11
Q

The JVP is essential for distinguishing ___ from ___ in patients with dyspnea, ascites, or edema.

A

The JVP is essential for distinguishing cardiopulmonary disease from liver or kidney disease in patients with dyspnea, ascites, or edema.

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12
Q

Lewis method of CVP estimation

A

45 degree angle

Tell the patient to exhale (increases the sensitivity and minimizes error)

of cm the CVP is above the sternal angle + 5 cm

Anything <8 cm H2O is normal.

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13
Q

Percussion of the heart

A

Percussion of the heart detecting a cardiothoracic ratio > 0.5 is highly sensitive (~97%), but not as specific (~61%) to cardiomegaly as one would hope.

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14
Q

Carotid pulse analysis

A
  • Palpation:
    • 2+
    • 1+
    • Doppler
  • Auscultation:
    • Bruit or no?
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15
Q

For a thorough cardiac exam, you should palpatae . . .

A

. . . everywhere you auscultate. At least if you hear a murmur, see if there is a palpable thrill there.

Also along the LSB for the right ventricle heave

16
Q

What is this called?

A

Pectus excavatum

17
Q

The bell is really mostly to hear. . .

A

S3 and S4, usually at LLSB

18
Q

Order of operations for careful auscultation of the heart (at each location)

A
19
Q

S2 louder than S1 at apex is concerning for __.

A

S2 louder than S1 at apex is concerning for pulmonary HTN.

20
Q

Inspiration increases preload in . . .

A

. . . mostly the RV

21
Q

Paradoxical splitting

A

Splitting heard at base with diaphragm upon expiration

Happens if aortic valve closes late at baseline. May indicate aortic stenosis or left bundle branch block.

22
Q

If you hear extra sounds at the apex, they are likely to be ___.

If you hear them at the upper sternal borders, they are likely to be ___.

A

If you hear extra sounds at the apex, they are likely to be gallops.

If you hear them at the upper sternal borders, they are likely to be S2 split.

23
Q

Grade 4 of above systolic murmurs are. . .

A

. . . associated with a palpable thrill

24
Q

Maneuvers to exaggerate murmurs

A
25
Q

Locations to auscultate for heart murmurs

A
26
Q

Shape of JVP

A
27
Q

If you are having trouble telling systole and disatole apart, what can you use as a guide?

A

The pulse! Pulse will happen during systole

28
Q

Physiologic splitting

A
29
Q

Paradoxical splitting

A
30
Q

Wide splitting

A
31
Q

Fixed splitting

A
32
Q

Where do you listen for splitting?

A

The base (the great vessel areas)

33
Q

Describing a heart murmur

A
  • Intensity
  • Timing
  • Shape
  • Location
  • Radiation
  • (Maneuvers)
34
Q

Mitral prolapse and HCM maneuvers

A
35
Q

Murmur summary table

(AS, AR, MS, MR, MVP, TR, HCM)

A
36
Q

If you can’t tell whether what you’re looking at is the carotid or the jugular, how can you check?

A

Change the angle of the patient.

The jugular’s height will change with angle. The carotid’s will not.

37
Q

Hepatojugular reflux

A

Distension of the neck veins precipitated by the maneuver of firm pressure over the liver. It is seen in tricuspid regurgitation, heart failure due to other non-valvular causes, and other conditions including constrictive pericarditis, cardia tamponade, and inferior vena cava obstruction