Cardiac Flashcards
What is the 5 finger method for cardiac exam?
history physical ecg x-ray lab tests
What are the aspects of the cardiac exam?
• Inspection • Jugular Venous Pressure (JVP) • Precordial Palpation • Percussion • Auscultation-Heart Sounds • Grading System of Murmurs • ECG • Echocardiogram • X-rays • Lab tests – Pressures – Hemodynamic measurement
What are some cardiac Non specific history elements you should look out for?
Fatigue, dyspnea, chest pain, palpations, syncope –
non specific
What aspects of history MUST you consider during a cardiac diagnosis?
- Underlying etiology – hypertensive, ischemic,
congenital, infections - Anatomic abnormalities
- which chamber involved - which valve is affected - is pericardium involved - has there been a MI - The physiologic disturbance – is arrhythmia present – is
CHF present - FAMILY HISTORY: hypertrophic
cardiomyopathy, Marfan ’s syndrome, prolonged QT
syndrome
What is the proper sequence of a cardiac function exam? What should the Pt be wearing ;) ? How should they be positioned?
- Inspection 2. Palpation 3. Percussion 4. Auscultation
Quiet room
Gown patient (do not listen through clothing)
Sitting, supine, left lateral decubitus, leaning forward, standing
What physical exam aspects are important for cardiac exam that are not on the chest? (face, nails, body, etc)
Face – acromegalic, cushnoid, Down’s syndrome, hyperthyroid, myxedema Jaundice – yellow Cyanosis – blue Pallor – pale, anemia, shock Nails – clubbing, hemorrhages Body habitus – tall, short Hydration – Blood pressure, weight Temperature
What is: Barrel Chest Pectus Carinatum Pectus Excavatum and what are they indicative of
Barrel Chest: COPD, increased A-P diameter
Pectus Carinatum: central protrusion
Pectus Excavatum: central depression
What are the S1 and S2 sounds? When my S2 split?
S1 • MV closure 1st component • TV closure 2nd component • Beginning of systole • Loudest at apex S2 • Aortic valve closure 1st component Pulmonic valve closure 2nd component • Loudest at the base • End of systole S2 could split during inspiration due to increased venous return
Where do you feel the PMI ( Point of Maximal Impulse) or apical impulse?
– Supine or left lateral decubitus
– Normal: 4th-5th intercostal space at the Mid-clavicular line
-Feeling left ventricle, tapered inferior tip = cardiac apex
What do Jugular Vein visibility given you an indication about? What is JVP? What is a normal JVP?
Jugular Veins reflect the activity of the right side of the
heart
Level of JVP visibility gives an indication of the RAP
Internal jugular (IJ) is better than external jugular (EJ)
What is JVP? What is a normal JVP? What does an elevated JVP symbolize?
Jugular Venous Pulse (JVP
Normal: 0-9
Increase JVP in: – SVC obstruction – Severe heart failure – Constrictive pericarditis, cardiac tamponade, RV infarction – Restrictive cardiomyopathy
When do you see a giant A wave?
- Obstruction between RA and RV (i.e. T.S., Right atrial
myxoma) - Increased pressure in RV (i.e. P.S.)
- Pulmonary hypertension
- Recurrent pulmonary emboli 5. A-V dissociation (complete heart block, V.T.) (cannon ‘a’
waves) . RA contracts against the closed TV.
What is the C wave indicative of?
Backward push by closure of TV during isovolumetric
systole and by impact of carotid artery adjacent to the JV.
What is the ‘X wave’? What is a steep X descent indicative of?
X: Passive atrial filling and atrial relaxation. Blood flows
into the RA from the cava and closure of TV
Steep X descent in cardiac tamponade and constrictive
pericarditis
When is the V wave? When is it prominent/what causes this?
Atrial Filling
Cause: – Increasing volume and pressure in RA when TV closed
Prominent V wave in TR and pulmonary hypertension
