Cardiac Exam Flashcards
What does S3 gallop mean?
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
What does S4 gallop mean?
Lub->Dub—>Ta
S4–>S1—>S2
-Always abnormal
-Rare
-Stiff Hypertrophic Ventricle
-Left ventricular failure
What is the Bell and Diaphragm for?
Bell- Low pitched sounds
Diaphragm- High pitched sounds
Auscultatory areas:
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.
Ask patient to lie on their left side to listen to?
Over mitral valve- Mitral stenosis
Ask patient to bend forward, breathe out and hold for?
Over the Aortic valve - aortic regurgitation
Murmurs?
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
Heaves?
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
What is a thrill?
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.
What does S1 mean?
-LUB
-Beginning of ventricular systole.
- Closure of the bicuspid and tricuspid
-increase intensity (anemia, fever,hyperthyroidism)
-decrease intensity (fibrosis, calcification of mitral valve)
What does S2 mean?
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)
Pulses and their meaning?
60/100bpm
>100=tachycardia
<50=bradycardia
Temperature check:
Normal:
36.5°–37.5°
Fever:
>37.8°
Lower limb pulses and tests?
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.
Upper limb pulses and tests?
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.
Blood pressure and it’s meaning?
(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.
Observation:
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.
Pulse abnormalities
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.
Causes of poor peripheral perfusion?
•CHF
•Atherosclerosis
•Vasoconstriction: Scleroderma, RA, Raynauds.
•Hypovolemia
•Hypotension
Grading a murmur
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
Mitral stenosis causes?
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
Mitral regurgitation causes?
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
Aortic stenosis causes?
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
Aortic regurgitation causes?
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
