Cardiac Exam Flashcards
What is the proper sequence of a cardiac exam?
inspection, palpation, percussion, and auscultation
Where do you look to find the apex of the heart?
5th ICS on the left, about 1 cm medial to the MCL
What is a thrill?
turbulent blood flow causing murmurs
When do you percuss during a cardiac exam and why?
to estimate the cardiac size when PMI is not detectable
How should you percuss during a cardiac exam?
you start far left and then move medially to find cardiac dullness
What is the S1 sound representing?
the mitral and tricuspid valve closing; beginning of ventricular systole
what is the S2 sound representing?
the aortic and pulmonary valve closure; marks the end of systole and beginning of diastole
What do the jugular veins reflect?
the activity of the right side of the heart
what is the level of JVP visibility an indication of?
the right atrial pressure
when looking at the JVP, which one is better?
internal jugular is better than external jugular
How do you look for the JVP?
place patient in supine position and then raise to 30-45
what is normal JVP?
0-9
What is the most common cause of an elevated JVP?
elevated RV diastolic pressure
what is the A wave caused by?
right atrial contraction; the tricuspid valve opens
when is a giant a wave seen?
when there is increased pressure in the right ventricle, pulmonary hypertension, recurrent pulmonary emboli, or when the right atrium contracts against the closed TV
what is the c wave caused by?
backward push by closure of TV during isovolumetric systole and by impact of carotid artery adjacent to the JV
what is the x wave caused by?
passive atrial filling and atrial relaxation; blood flows into the RA from the cava and closure of the TV
when do you see a steep X descent?
in cardiac tamponade and constrictive pericarditis
What causes the V wave?
atrial filling; increasing the volume and pressure in the RA when the TV is closed
when might there be a prominent V wave?
in tricuspid regurgitation and pulmonary hypertension
What is the Y descent/ slope caused by?
opening the TV and rapid RV filling in RV diastole
when might there be a deep Y descent/slope?
in severe tricuspid regurgitation
when might there be a slow Y descent/slope?
if there is an obstruction to RV filling
What causes an S3 sound?
high pressures and abrupt deceleration of inflow across the mitral valve at the end of the rapid filling phase
What causes an S4 sound?
atrial gallop from forceful contraction of atria against a stiffened ventricle
what is the first component of the S1 sound?
MV closure
what is the second component of the S1 sound?
TV closure
where is S1 the loudest?
at the apex
what is the first component of the S2 sound?
AV closure
what is the second component of the S2 sound?
PV closure
where is S2 the loudest?
at the base of the heart
Where do you listen to the aortic valve?
right 2nd ICS at the sternal border
where do you listen to the pulmonary valve?
left 2nd ICS at the sternal border
where do you listen to the TV?
at the left 4th intercostal space at the sternal border
where do you listen to the MV?
left 5th ICS at the mid clavicular line
What is a grade 1 murmur?
barely audible
what is a grade 2 murmur?
soft but easily heard
what is a grade 3 murmur?
loud without a thrill
what is a grade 4 murmur?
loud with a thrill
what is a grade 5 murmur?
loud with minimal contact between stethoscope and chest- thrill
what is a grade 6 murmur?
loud can be heard without a stethoscope-thrill
