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PCM II Midterm > Approach to Cardiac Exam > Flashcards

Approach to Cardiac Exam Flashcards

1
Q

What is included in a normal heart exam?

A 
History
Physical
ECG
Xray
Lab tests
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2
Q

What are some non-specific items you should ask in heart exam history?

A

fatigue, dyspnea, chest pain, palpation, syncope

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3
Q

What does a complete cardiac DDX need to consider?

A

Underlying etiology
Anatomic abnormalities
Physiologic disturbance

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4
Q

Why is family history important in a heart exam?

A

familial clustering is common in pts with certain heart diseases (hypertrophic cardiomyopathy, prolonged QT syndrome, Marfan’s syndrome)

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5
Q

What is the order of physical assessment of cardiac function?

A 
inspection
palpation
percussion
auscultation
positioning of pt
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6
Q

Normal chest shape

A

AP diameter should be 1/2 of transverse diameter of thorax

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7
Q

Pectus carinatum

A

pigeon chest

central protrusion

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8
Q

Pectus excavatum

A

funnel chest

central depression

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9
Q

What should you inspect for on a PE?

A

precordium (trauma?)

scars, pacemaker, skeletal abnormalities

apex of heart (in 5th intercostal space)

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10
Q

What is the purpose of percussion in PE?

A

estimate cardiac size by starting far left and move medially to find cardiac dullness

if can’t feel apex of heart

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11
Q

What is the purpose of auscultation in PE?

A

S1 (mitral & tricuspid closure)

S2 (aortic & pulmonic closure)

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12
Q

What is the purpose of palpation in PE?

A

palpate for thrills which indicate blood flow causing murmurs

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13
Q

Why do you palpate for jugular venous pulse?

A

because jugular veins reflect the activity of the right side of the heart

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14
Q

Which jugular vein should you measure?

A

internal jugular vein

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15
Q

What does an elevated JVP indicate?

A

elevated RV diastolic pressure

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16
Q

What may a giant A wave indicate?

A

obstruction btwn RA & RV

increased pressure in RV

pulmonary hypertension

recurrent pulmonary emboli

AV dissociation

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17
Q

What does the C wave indicate?

A

backward push by closure of TV during isovolumetric systole & by impact of carotid artery adjacent to JV

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18
Q

What does an “X” wave indicate?

A

passive atrial filling & atrial relaxation (blood flows into RA from vena cava & triscupid valve is closed)

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19
Q

When do you see a steep X descent?

A

cardiac tamponade & constrictive pericarditis

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20
Q

When do you see a prominent V wave?

A

in TR & pulmonary hypertension

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21
Q

What does a slow Y descent suggest?

A

obstruction to RV filling

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22
Q

When do you see increased JVP?

A 
SVC obstruction
severe heart failure
constrictive pericarditis
cardiac tamponade
RV infarction
restrictive cardiomyopathy
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23
Q

Which heart sounds are abnormal?

A

S3 & S4

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24
Q

S3 heart sound

A

due to high pressures & abrupt deceleration of inflow across mitral valve @ end of rapid filling phase

(normal in children)

Ken-Tuck-Y

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25
Q

S4 heart sound

A

atrial gallop from forceful contraction of atria against stiffened ventricle (low compliant)

diastolic sound (Ten-Nes-See)

26
Q

Where do you listen for mitral valve?

A

apex of heart

5th left ICS at mid clavicular line

27
Q

Where do you listen for tricuspid valve?

A

4th left ICS @ LSB

28
Q

Where do you listen for aortic v?

A

2nd ICS to R of sternum

29
Q

Where do you listen for pul v?

A

2nd ICS L of sternum

30
Q

Murmur grading system

A 
1-barely audible
2-soft, but easily heard
3-loud w/o thrill
4-loud w/ thrill
5-loud w/ minimal contact of stethoscope
6-loud, can be heard w/o stethoscope
31
Q

Normal right atrial pressure

A

0-8 mmHg

32
Q

Normal right ventricle pressure

A

25 mmHg

33
Q

Normal pulmonary artery pressure

A

30/12

34
Q

Normal systolic vascular resistance

A

900-1500 dynes/second/cm

35
Q

Normal vascular resistance

A

155-255 dynes/second/cm

36
Q

Normal pulmonary wedge pressure

A

8-15 mmHG

37
Q

normal CO

A

3.5-7 liters/min

38
Q

Normal cardiac index

A

2.5-4 L/m

39
Q

What is the most important part of a CV assessment?

A

taking a good patient history

40
Q

What should you first inspect about your pt w/ CV cc?

A

need to make sure the pt is stable

41
Q

What would distended neck veins suggest?

A

filling up with pressure & area of concern that needs to be addressed

42
Q

What is Levine sign?

A

pt is holding chest & abdomen

sign of heart attack or unstable discomfort in chest

43
Q

What anatomic abnormalities can contribute to pt complain?

A

which chamber involved

which valve affected

is pericardium involved

has there been an MI

44
Q

What heart disease is genetically acquired?

A

hypertrophic cardiomyopathy

assoc w/ increase in septal hypertrophy compared to rest of ventricle

outlet obstruction

45
Q

What is Marfan’s syndrome?

A

Connective tissue disorder

pts prone to aortic aneurysms & sudden death

46
Q

What is prolonged QT syndrome?

A

prolonged QT interval & more prone to arrythmias

47
Q

Acromegaly

A

prone to cardiac issues b/c have bi-ventricular dysfunction

48
Q

Cushing’s disease

A

prone to hypertension & cardiac disease b/c elevated cortisol

49
Q

Down’s syndrome

A

pre-disposition to congential heart disease

50
Q

What does clubbing of nails suggest?

A

interstitial lung disease & congenital heart disease

51
Q

What do hemorrhages under nails suggest?

A

new pulmonary emboli or endocarditis

52
Q

How are temperature and HR related?

A

for every 1 degree above normal, increase HR by 10 bpm

53
Q

Barrel chest

A

AP diameter is equal to transverse diameter of chest

COPD

54
Q

Inspection landmarks

A

Suprasternal notch

Sternal angle

Midclavicular line

Ant axillary line

55
Q

What is the normal PMI (point of maximal impulse)

A

4th-5th intercostal space @ mid-clavicular line

56
Q

How do you determine central venous pressure?

A

measure distance of IJV from sternal notch & add 5cm (which is distance of RV from sternal notch)

gives you jugular venous pressure

57
Q

What does the A wave indicate?

A

R atrial contraction (tricuspid valve is open)

coincides w/ S1

58
Q

Why is the S2 sound split during inspiration?

A

because as you inhale, increase venous return to heart

takes time for venous return to get up into vessel

59
Q

What may bilateral edema indicate?

A

heart, lung, kidney disease

60
Q

What is a vscan?

A

ultrasound to monitor valve function

PCM II Midterm (15 decks)

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