Approach to Cardiac Exam

Question 1

5 finger method

Answer 1

History
Physical
EKG
X-ray
Labs

Question 2

What aspect of the patient’s history is common with certain heart diseases?

Answer 2

Familial!

Question 3

What are some familial heart diseases?

Answer 3

Marfan’s syndrome
Long QT
Hypertrophic Cardiomyopathy

Question 4

What is the order of the cardiac physical exam?

Answer 4

Inspection
Palpation
Percussion
Auscultation

Question 5

What is the order of the cardiac physical exam?

Answer 5

Inspection
Palpation
Percussion
Auscultation

Question 6

When you auscultate, it should be on?

Answer 6

BARE SKIN

Question 7

Inspecting the patient’s ____ is also important

Answer 7

Face

- Down’s syndrome, cushnoid, hyperthyroid syndromes have heart problems

Question 8

Barrel chest

Answer 8

Increased A-P diameter

Question 9

Barrel chest is seen with what condition?

Answer 9

COPD

Question 10

Ratio of A-P diameter to transverse diameter in healthy people

Answer 10

1:2

Question 11

Ratio of A-P diameter to transverse diameter in COPD patients

Answer 11

1:1

Question 12

Thrill

Answer 12

Turbulent blood flow causing murmurs

Question 13

Where is the Point of Maximal Impulse (PMI)?

Answer 13

Left 5th ICS at the mid-clavicular line

Question 14

Point of Maximal Impulse is best heard when the patient is in what position?

Answer 14

Supine or Left lateral decubitus

Question 15

Percussion can estimate?

Answer 15

Cardiac size

Question 16

With percussion, you should start where and move where?

Answer 16

Start far left (resonance)

Move medially until the heart is present (dull)

Question 17

S1

Answer 17

Mitral and tricuspid valves CLOSE

Question 18

Where is S1 the loudest?

Answer 18

Apex

Question 19

S1 signifies?

Answer 19

Beginning of ventricular systole

Question 20

S2

Answer 20

Aortic and pulmonic valves CLOSE

Question 21

Where is S2 the loudest?

Answer 21

Base

Question 22

What heart sound can be split?

Answer 22

S2

Question 23

When is S2 split?

Answer 23

During inspiration

Question 24

With a splitting S2, which valve closes later and why?

Answer 24

Pulmonic valve closes later

- Due to more time for right ventricle to deliver blood to lungs during inspiration

Question 25

S3

Answer 25

Due to high pressures and rapid filling across the mitral valve

Question 26

When is S3 normal?

Answer 26

In children

Question 27

S4

Answer 27

Due to forceful atrial contraction against stiffened ventricles

Question 28

Which heart sounds are not normal in adults?

Answer 28

S3 and S4

Question 29

Ken-Tuck-Y

Answer 29

S3

Question 30

Ten-Nes-see

Answer 30

S4

Question 31

When is S4 normal?

Answer 31

Athletes

Question 32

Where is aortic valve closure sound heard?

Answer 32

Right 2nd ICS next to sternum

Question 33

Where is pulmonic valve closure sound heard?

Answer 33

Left 2nd ICS next to sternum

Question 34

Where is tricuspid valve closure sound heard?

Answer 34

Left 4th ICS next to sternum

Question 35

Where is mitral valve closure sound heard?

Answer 35

Left 5th ICS mid-clavicular line

Question 36

Murmur grading system (1-6)

Answer 36

``` 1 - barely audible 2 - soft 3 - loud 4 - loud WITH thrill 5 - loud with minimal contact, WITH thrill 6 - loud with no contact, WITH thrill ```

Question 37

What do jugular veins reflect?

Answer 37

Activity of right side of heart

Question 38

Which jugular vein is better for the jugular venous pulse?

Answer 38

Internal

Question 39

What does the jugular venous pulse (JVP) indicate?

Answer 39

Right atrial/ventricular pressure

Question 40

How is the Jugular Venous Pulse (JVP) taken?

Answer 40

- Lay patient supine to allow veins to engorge - Raise to 30-45 degrees - Measure top of venous pulse to sternal notch - Add that distance to the distance from the sternal notch to the right ventricle (usually 5)

Question 41

What is a normal range for Jugular Venous Pulse?

Answer 41

0-9

Question 42

Increased JVP indicates?

Answer 42

Increased right ventricular pressure

Question 43

Order of Jugular venous curve waves?

Answer 43

AC(x descent)V(y descent)

Question 44

A wave

Answer 44

Atrial contraction

Question 45

C wave

Answer 45

Backward push of closed tricuspid valve during isovolumetric contraction

Question 46

X descent

Answer 46

Passive right atrial filling with closed tricuspid valve

Question 47

V wave

Answer 47

Atrial filling

Question 48

Y descent

Answer 48

Passive right ventricular filling with open tricuspid valve

Question 49

Which jugular venous wave coincides with S1?

Answer 49

A wave - atrial contraction

Question 50

Giant A waves are seen with?

Answer 50

Increased right ventricular pressure | ex. pulmonary hypertension

Question 51

A steep X descent is seen with?

Answer 51

Cardiac tamponade and pericarditis | atrial filling

Question 52

A slow Y descent is seen with?

Answer 52

Obstruction to ventricular filling