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ECOS 2 Post-Midterm > Approach to Cardiac Exam > Flashcards

Approach to Cardiac Exam Flashcards

1
Q

5 finger method

A 
History
Physical
EKG
X-ray
Labs
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2
Q

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

A

Familial!

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3
Q

What are some familial heart diseases?

A

Marfan’s syndrome
Long QT
Hypertrophic Cardiomyopathy

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4
Q

What is the order of the cardiac physical exam?

A

Inspection
Palpation
Percussion
Auscultation

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5
Q

What is the order of the cardiac physical exam?

A

Inspection
Palpation
Percussion
Auscultation

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6
Q

When you auscultate, it should be on?

A

BARE SKIN

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7
Q

Inspecting the patient’s ____ is also important

A

Face

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

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8
Q

Barrel chest

A

Increased A-P diameter

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9
Q

Barrel chest is seen with what condition?

A

COPD

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10
Q

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

A

1:2

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11
Q

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

A

1:1

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12
Q

Thrill

A

Turbulent blood flow causing murmurs

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13
Q

Where is the Point of Maximal Impulse (PMI)?

A

Left 5th ICS at the mid-clavicular line

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14
Q

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

A

Supine or Left lateral decubitus

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15
Q

Percussion can estimate?

A

Cardiac size

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16
Q

With percussion, you should start where and move where?

A

Start far left (resonance)

Move medially until the heart is present (dull)

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17
Q

S1

A

Mitral and tricuspid valves CLOSE

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18
Q

Where is S1 the loudest?

A

Apex

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19
Q

S1 signifies?

A

Beginning of ventricular systole

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20
Q

S2

A

Aortic and pulmonic valves CLOSE

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21
Q

Where is S2 the loudest?

A

Base

22
Q

What heart sound can be split?

A

S2

23
Q

When is S2 split?

A

During inspiration

24
Q

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

A

Pulmonic valve closes later

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

25
Q

S3

A

Due to high pressures and rapid filling across the mitral valve

26
Q

When is S3 normal?

A

In children

27
Q

S4

A

Due to forceful atrial contraction against stiffened ventricles

28
Q

Which heart sounds are not normal in adults?

A

S3 and S4

29
Q

Ken-Tuck-Y

A

S3

30
Q

Ten-Nes-see

A

S4

31
Q

When is S4 normal?

A

Athletes

32
Q

Where is aortic valve closure sound heard?

A

Right 2nd ICS next to sternum

33
Q

Where is pulmonic valve closure sound heard?

A

Left 2nd ICS next to sternum

34
Q

Where is tricuspid valve closure sound heard?

A

Left 4th ICS next to sternum

35
Q

Where is mitral valve closure sound heard?

A

Left 5th ICS mid-clavicular line

36
Q

Murmur grading system (1-6)

A 
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
37
Q

What do jugular veins reflect?

A

Activity of right side of heart

38
Q

Which jugular vein is better for the jugular venous pulse?

A

Internal

39
Q

What does the jugular venous pulse (JVP) indicate?

A

Right atrial/ventricular pressure

40
Q

How is the Jugular Venous Pulse (JVP) taken?

A
  • 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)
41
Q

What is a normal range for Jugular Venous Pulse?

A

0-9

42
Q

Increased JVP indicates?

A

Increased right ventricular pressure

43
Q

Order of Jugular venous curve waves?

A

AC(x descent)V(y descent)

44
Q

A wave

A

Atrial contraction

45
Q

C wave

A

Backward push of closed tricuspid valve during isovolumetric contraction

46
Q

X descent

A

Passive right atrial filling with closed tricuspid valve

47
Q

V wave

A

Atrial filling

48
Q

Y descent

A

Passive right ventricular filling with open tricuspid valve

49
Q

Which jugular venous wave coincides with S1?

A

A wave - atrial contraction

50
Q

Giant A waves are seen with?

A

Increased right ventricular pressure

ex. pulmonary hypertension

51
Q

A steep X descent is seen with?

A

Cardiac tamponade and pericarditis

atrial filling

52
Q

A slow Y descent is seen with?

A

Obstruction to ventricular filling

ECOS 2 Post-Midterm (6 decks)

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