Cardiac

Question 1

Heart valves

Answer 1

A: aortic (only one on right)
P: pulmonic
T: tricuspid
M: mitral

Question 2

Jugular venous pulse

Answer 2

• head at degree angle
• shine light
• look for rapid pulse with each heartbeat
• always check bilaterally
• press 5cm above sternum to eliminate pulsations and rule out carotid origin

Question 3

where should JVP be

Answer 3

• 3-4 cm from highest point to sternal angle

- 10 cm indicates elevated JVP (fluid build-up = CHF)

Question 4

capillary refill

Answer 4

pinch finger (foot in peds). Should “pink up” quickly

Question 5

neck exam

auscultate for bruits

Answer 5

• place bell on carotid pulse
• ask pt to hold breath while you check for carotid
• tell pt to breathe again when done
• hear backflow/squishing sound = plaque buildup

Question 6

Heart sounds - murmurs

Answer 6

• turbulent blood flow through incompetent valves
• whooshing, swishing, or blowing sound
  can be:
• stenotic (narrowed)
• calcific (stiff)
• incompetent (incomplete closing)

Question 7

murmur grading

Answer 7

1 - very faint
2 - soft
3 - heard all over precordium
4 - loud, with palpable thrill
5 - very loud, with thrill
6 - very loud, with thrill, may be heard with stethoscope entirely off chest

Question 8

pulses

Answer 8

• carotid
• brachial and radial
• femoral and popliteal
• dorsalis pedis and posterior tibialis

Question 9

assess for the following when taking pulse

Answer 9

• amplitude of pulse
• contour of the pulse wave
• variations in amplitude
• palpable thrill

Question 10

pulse grading

Answer 10

4/4 - bounding
3/4 - increased
2/4 - brisk, expected 
1/4 - diminished, weaker than expected
0/4 - absent, unable to palpate (peripheral vascular disease or DM)

Question 11

Point of maximal impulse

Answer 11

• normally located in the 4th or 5th intercostal space, medial to the midclavicular line
• less than side of quarter
• displaced = LVH, cardiomyopathy, CHF, pregnancy

Question 12

Pitting edema

Answer 12

fluid buildup in legs

could indicate CHF or liver condition

Question 13

common diagnosis

Answer 13

• coronary artery disease
• heart failure
• arrhythmias

Question 14

Sx of heart failure you need to pay attention to

Answer 14

• shortness of breath
• syncope (passing out due to drop in BP)
• sweating
• lots of chest pressure
• NO self care –> refer at this point