Cardiac Assessment Flashcards
Erb’s point
point of transition where S2 or S1 sounds are louder; above the point S2>S1, below S1 >S2
Aortic listening post
2nd ICS on R
Pulmonary valve listening post
2nd ICS on L
Tricuspid valve listening post
5th ICS on R
Mitral valve listening post
5th ICS on L
S1 sound
AV valve closure
S2 sound
semilunar valve closure
Wide physiologic S2 split
increase in splitting during inspiration; caused by pulmonic stenosis or RBBB or mitral regurgitation
Fixed S2 splitting
wide splitting that does not vary with respiration; caused by ASD and RV failure
Paradoxical splitting S2
appears on expiration and disappears on inspiration; aortic valve closure is abnormally delayed, often indicative of LBBB
S3 sound
low pitched sound best heard at apex, normally occurs in children but indicative of LV failure or volume overload in people over 40
S4 sound
low pitched sound best heard at apex, reflects atrial contraction into a non-compliant ventricle; found in aortic stenosis, hypertension, hypertrophic cardiomyopathy, coronary artery disease
Systolic murmur at RUSB with a reduced carotid pulse
aortic stenosis
Systolic murmur at LLSB that does not accentuate with inspiration
VSD
Systolic murmur at LLSV that does accentuate with inspiration
tricuspid regurgitation
Holosystolic murmur at cardiac apex
mitral insufficiency
Systolic click with or without a murmur at cardiac apex
mitral valve prolapse
Diastolic murmur at RU or L midsternal border
AI
Diastolic murmur at RLSB in left lateral decubitus position
mitral stenosis, opening snap!
Normal aortic valves become stenotic at what age?
> 75 years of age
Congenital bicuspid aortic valves become stenotic at what age?
40-70 years
Classic triad of aortic stenosis
heart failure, angina, syncope
Heart sounds associated with aortic stenosis
S4 gallop, mid-to-late peaking ejection murmur at RUSB or suprasternal notch that radiates to the neck, S2 split
Gallavardin effect
AS murmur transmitted to apex
Systolic ejection murmur becomes …. with squating
louder
Prognosis of AS pt with angina
5 years
Prognosis of AS pt with syncope
3 years
Prognosis of AS pt with HF
2 years
Native acute AR is caused by..
flail leaflet due to endocarditis, type A aortic dissection, trauma
Prosthetic valve AR caused by…
tissue valve leaflet rupture, mechanical valve closure problem, infection
Presentation of pt with acute AR
severe pulmonary edema and CO
Medical therapy for severe AR
vasodilators, ACEis and ARBs used for sx management
TR can be caused by…
rheumatic heart disease, endocarditis, carcinoid, congenital disease
Mitral stenosis is most commonly due to…
rheumatic fever
Most common congenital defect in children…
VSD
Clinical presentation MVP
thin, younger female; palpitations, dyspnea, exercise intolerance, dizziness
Water-hammer or Corrigan pulse
rapid rise and fall with elevated systolic and low diastolic pressure
Hill sign
leg systolic pressure >40mmHg
VSD murmur
loud, harsh holosystolic murmur in 3rd and 4th ICS
Correct way to measure BP
avoid caffeine, tobacco, alcohol 30 min prior to measurement, rest quietly for 5 minutes, feet flat on floor, back supported, no talking, arm at level of heart
Obtain orthostatic vital signs when concerned about…
dehydration, blood loss, syncope/near syncope
How long should a pt lay down to take orthostatic VS?
at least 5 minutes
Positive orthostatics
pulse INCREASE of 10 bpm or greater, BP decrease of 20 mmHg or greater
Cap refill >2 seconds may indicate…
decreased volume, decreased CO, peripheral vascular disease
JVD measurement
position pt 30-45 degrees, turn head from area being tested and look for pulsating jugular veins near suprasternal notch, measure height and add 5cm
6 P’s of limb ischemia
paraesthesia, perishing cold, pulselesness, pain, paralysis, pallor
