Cardiac Exam

Question 1

The sternal angle is ___ cm above the right atrium.

Answer 1

The sternal angle is 5 cm above the right atrium.

Question 2

To better examine the left ventricular impulse. . .

Answer 2

have the patient roll slightly to the left.

Question 3

S1

Answer 3

First heart sound. Closing of the mitral and tricuspid valves.

Question 4

S2

Answer 4

Second heart sound. Closing of the pulmonic and aortic valves.

Question 5

S1 to S2

Answer 5

Systole

Question 6

S2 to S1

Answer 6

Diastole.

Question 7

When should you be able to feel the pulse?

Answer 7

During systole (in between S1 and S2)

Question 8

S2 may occasionally be heard as. . .

Answer 8

Two distinct sounds: A2 and P2 (Aortic2 and Pulmonic2)

This is not necessarily pathological. This happens in many perfectly healthy people. It can be heard particularly in the aortic/pulmonic upper sternal areas.

Question 9

S3

Answer 9

A sound heard almost exclusively in cases of congestive heart failure.

S3 is heard in the ventricular areas in the T5 interspace.

Question 10

Normal jugular venous pressure

Answer 10

5-7 cm

Question 11

Pulses may be reported as

Answer 11

2+ : very apparent

1+ : you can find it, but it’s not obvious

Question 12

Pitting Edema

Answer 12

swelling, often bilateral with a depression or indentation in the skin called “pitting” after 1-2 sec of thumb pressure on the anterior tibiae and feet. Commonly occurs in the “dependent” (areas of the body most affected by gravity, such as lower legs and feet). It is caused by several conditions including prolonged “dependent” position of the legs, heart failure, nephrotic syndrome, cirrhosis, and malnutrition.

Question 13

Writeup of normal cardiac exam

Answer 13

Cardiac: Chest is symmetric, no scars. No cardiac heaves or lifts. No thrills appreciated. Point of maximal impulse (PMI) noted at midclavicular line, in fifth intercostal space. Normal S1 and S2, with regular rate and rhythm. S2 > S1 at the base, S1 > S2 at apex. No splitting of the heart sounds heard. No murmur. No S3 or S4, no friction rub.

Neck: No jugular venous distention or pulsations. No carotid bruits, or transmitted murmur. Carotid pulses 2/4 bilaterally.

Extremities: No rashes, swelling, color change, or cyanosis in arms or legs. No signs of venous stasis or arterial insufficiency in legs, with normal hair distribution, and no pigmentation around ankles. No clubbing in fingernails. Capillary refill is brink (<1 sec). No pitting or non-pitting edema in feet. 2+ radial and 2+ dorsalis pedis pulses bilaterally.