Cardiac Exam

Question 1

What does S3 gallop mean?

Answer 1

Lub->De->Dub
S1—> S2->S3
-rapid ventricular filling
-causes cordae tendenae to vibrate harder.
-normal in you patients.
-abnormal in elderly- indicating heart failure=CHF

Question 2

What does S4 gallop mean?

Answer 2

Lub->Dub—>Ta
S4–>S1—>S2
-Always abnormal
-Rare
-Stiff Hypertrophic Ventricle
-Left ventricular failure

Question 3

What is the Bell and Diaphragm for?

Answer 3

Bell- Low pitched sounds
Diaphragm- High pitched sounds

Question 4

Auscultatory areas:

Answer 4

Aortic- right 2nd intercostal space
Pulmonic- left 2nd intercostal space.
Tricuspid- left 5th intercostal space.
Erb’s point- left, 3rd intercostal space.
Mitral-left, 6/7th intercostal space at the mid-clavicular line.

Question 5

Ask patient to lie on their left side to listen to?

Answer 5

Over mitral valve- Mitral stenosis

Question 6

Ask patient to bend forward, breathe out and hold for?

Answer 6

Over the Aortic valve - aortic regurgitation

Question 7

Murmurs?

Answer 7

STENOSIS=valve is narrowed d/t hypertrophy
-Aortic stenosis- left ventricular hypertrophy
-Mitral stenosis-left atrial hypertrophy
REGURGITATION=Valve becomes weakened
-Aortic regurgitation-left ventricular dilatation
-Mitral regurgitation-left atrial dilatation

Question 8

Heaves?

Answer 8

Precordial impulses are visible or palpable pulsations of the chest wall, which originate on the heart or the great vessels.
D/t right ventricular hypertrophy

Question 9

What is a thrill?

Answer 9

It’s a vibratory sensation felt on the skin overlying an area of turbulence and indicates a loud heart murmur usually caused by an incompetent heart valve.

Question 10

What does S1 mean?

Answer 10

-LUB
-Beginning of ventricular systole.
- Closure of the bicuspid and tricuspid
-increase intensity (anemia, fever,hyperthyroidism)
-decrease intensity (fibrosis, calcification of mitral valve)

Question 11

What does S2 mean?

Answer 11

DUB
-End of ventricular systole
-Closure of pulmonic and aortic valves.
-increased intensity (systemic hypertension, syphilis of aortic valve, mitral stenosis)
-decreased intensity (atrial hypotension, aortic stenosis, pulmonic stenosis)

Question 12

Pulses and their meaning?

Answer 12

60/100bpm
>100=tachycardia
<50=bradycardia

Question 13

Temperature check:

Answer 13

Normal:
36.5°–37.5°
Fever:
>37.8°

Question 14

Lower limb pulses and tests?

Answer 14

Pulses;
-Femoral
-Popliteal
-Posterior tibial
-Dorsalis pedis

Tests:
-Perfusion test- patient is supine with leg at 45° for 15 sec. Ask patient to sit up slowly. Blood should perfume within 10sec, if not —>poor limb circulation.
-Homan’s squeeze- dorsiflex foot and squeeze the calf—> +ve is painful.
-Jugular Venous Pressure- indirectly measuring pressure in the right atrium. D/t heart failure, pericarditis and excessive edema.

Question 15

Upper limb pulses and tests?

Answer 15

Pulses;
-Carotid
-Axillary
-Brachial
-Ulnar
-Radial

Tests;
Allen’s- apply pressure in ulnar and radial arteries and ask patient to rapidly open and close hands. Release one at a time, anything more that 5 sec indicates poor circulation.

Question 16

Blood pressure and it’s meaning?

Answer 16

(120/80)mm Hg—normal
(120-139/80-89)—pre hypertension
(140-159/90-99)—stage 1 hypertension
(>160/>100)—stage 2 hypertension

-The difference between systolic and diastolic should be 30-40mmHg—> if measurement is lower there could possibly be a TIA, occlusion of a vessel or aneurysm.

Question 17

Observation:

Answer 17

Hands:
- Marfans- CV deformities.
-peripheral cyanosis- anemia, heart disease, venous obstruction.
-Raynaud’s- Cold, pale hands.
-Hyperthyroidism- Warm, Clammy.
-Hypothyroidism- Dry, Coarse.

Finger joints:
- RA—>prone to atherosclerosis, stroke or MI.

Nails:
-Splinter hemorrhages- IE.
-Clubbing-IE.
-Spooning- iron deficiency/ anemia.
-Onchylosis- sign of heart failure.

Skin:
-Malar rash- crosses face->mitral stenosis.
-Xanathelasma- high cholesterol.

Eyes:
-Conjunctiva- pale=anemia.
-Arcus Senelis- white/grey rings around cornea—>carotid disease.
-Hypertensive Retinopathy- copper wiring, cotton wool spots, AV nicking.

Nose:
-Nostril flaring- air hunger d/t MI.

Mouth:
-mouth/tongue peripheral cyanosis- anemia, arterial disease.
-Teeth Rotting- infective endocarditis.

Question 18

Pulse abnormalities

Answer 18

Bounding-> high cardiac output, forceful beats.
D/t:
-Aortic stenosis-less blood pumped out each beat.
-Hypovolemia-low venous pressure/ventricle filling.
-Heart Failure
•hypovolemic shock, MI

Thready-> low cardiac output, weak cardiac contraction.
D/t:
-Aortic regurgitation- dilated left ventricle, pumping out more blood.
- Anemia- heart compensating for reduced RBC’s by increasing CO.
-Hyperthyroidism- too much thyroxine causes the heart to beat faster and harder.

•fever, anxiety, aortic wall stiffness and atherosclerosis.

Question 19

Causes of poor peripheral perfusion?

Answer 19

•CHF
•Atherosclerosis
•Vasoconstriction: Scleroderma, RA, Raynauds.
•Hypovolemia
•Hypotension

Question 20

Grading a murmur

Answer 20

1- difficult to hear
2-quiet
3- easy to hear
4- easy to hear with a palpable thrill
5- hear with the stethoscope barely touching chest
6- hear with stethoscope off chest

Question 21

Mitral stenosis causes?

Answer 21

Mid-systolic, low pitched, rumbling - murmur
Loud S1- feel for apex beat
Atrial fibrillation- left atrium struggles to push blood through a stenotic valve.
Rheumatic fever
Infective endocarditis

Question 22

Mitral regurgitation causes?

Answer 22

Incompetent mitral valve
Blood flowing backwards causing a pan-systolic murmur.
Associated with:
CHF- decreased ejection, backlog of blood waiting to pass through the heart.

Cause:
Idiopathic weakening with age
Infective endocarditis
Rheumatic heart disease
Marfans
Ehlers Danlos

Question 23

Aortic stenosis causes?

Answer 23

Mc encounter
Crescendo-decrescendo murmur
Can hear w stethoscope in carotid arteries and would be able to detect.
S/s:
Exertional syncope

Cause:
Idiopathic age related calcification
Rheumatic heart disease

Question 24

Aortic regurgitation causes?

Answer 24

Aortic valve incompetent
Early and diastolic murmur
Collapsing pulse
S/s:
Heart failure
Austin flint murmur, heard at apex as a early diastolic murmur.

Causes:
Idiopathic age related weakness
Ehlers Danlos
Marfans