Cardiac Exam

Question 1

Preload

Answer 1

End diastolic pressure- at the end of diastole. Stretching of the ventricles to their widest prior to contraction

Question 2

Afterload

Answer 2

Tension or stess on the wall of the left ventricle during ejection. Aortic pressure L. ventricle must overcome to eject blood.

Question 3

Systole

Answer 3

Ventricular contaction. Mitral and tricuspid closed, aortic and pulmonic open

Question 4

Diastole

Answer 4

Ventricular relaxation. Mitral and tricuspid open, aortic and pulmonic closed

Question 5

S1

Answer 5

Closure of mitral and tricuspid valves. Beginning of systole. Best heard at Apex

Question 6

S2

Answer 6

Closure of aortic and pulmonic. Beginning of diastole. Best in pulmonic and aortic areas.

Question 7

S3

Answer 7

Rapid ventricular filling. Vibration causing dissension of ventricles early in diastole.

Question 8

S4

Answer 8

Forceful atrial ejection into distended ventricle. Heard with patients with rigid ventricular walls

Question 9

Murmur

Answer 9

Prolonged extra heart sounds. Diseased valves- stenosis, regurgitation- anatomic disorders of valves. Not always pathologic. Grade 1-6. Grade 4+ is palpable thrill.

Question 10

Bruit

Answer 10

Turbulent blood flow caused by abnormality in vessel. Bell

Question 11

PMI

Answer 11

Typically at apex. May be elsewhere if heart is enlarged or hypertrophied

Question 12

Thrill

Answer 12

Palpable murmur. Congenital or valvur abnormalities Turbulent blood flow. Assoc with audible murmur. Ulnar surface of hand- cat purring sensation.

Question 13

Heave/ Lift

Answer 13

Sustained palpable movements localized in precordium. Increased intensity of systolic contraction - Rt ventricular hypertrophy- more force req to squeeze blood out. Palpate 5 areas assoc with heart valves

Question 14

Situs Inversus/ dextrocardia

Answer 14

Heart transplaced to right side of thorax. Congenital

Question 15

S3 Gallop

Answer 15

Occurs in early diastole. Forced dilation of ventricle due to excess blood from atria. Can be normal or pathologic. Mitral regurgitation, mitral stenosis, heart failure, decreased ventricular compliance

Question 16

S4 Gallop

Answer 16

Late stage diastole. Atrial kick- final 20% of output delivered to ventricle. Non compliant ventricle due to hypertrophy, MI, cardiomyopathy. Bell

Question 17

Rub

Answer 17

Dx-Pericarditis. Heart beating against inflamed pericardium. continuous and diffuse. 3 components- 1 systolic, 2 diastolic

Question 18

Click

Answer 18

Mid to late systole. Mitral valve prolapse or late systolic murmur. Diaphragm at apex.

Question 19

Snap

Answer 19

Opening of Mitral and Tricuspid (AV) valves- due to thickening of leaflets. Stenosis, rheumatic heart disease. Diaphragm

Question 20

Ejection Sounds

Answer 20

Abnormal dilation or calcification of aortic or pulmonic valves. Pulmonic decrease with respirations

Question 21

Stethoscope

Answer 21

Bell and diaphragm to listen at 5 points, bruits,

Question 22

Pen light

Answer 22

Tangential lighting for PMI

Question 23

Ruler

Answer 23

Measurement from PMI to MSL

Question 24

Inspection

Answer 24

Apical pulse, pulsations, heaves/lifts, scarring, cyanosis, PMI

Question 25

Palpation

Answer 25

PMI, Heaves/lifts/thrills

Question 26

Auscultation

Answer 26

5 pts- bell & diaphragm (S1, S2, rathe, rhythm, regularity, murmur), bruits in abd, carotid, illiac, renal and femoral arteries

Question 27

Percussion

Answer 27

Not done

Question 28

Physiologic splitting

Answer 28

Splitting of S2 (A2 and P2) during inspiration. Normal

Question 29

Pathologic splitting- Paradoxic

Answer 29

Two distinct heart sounds during EXPIRATION. Delay in closure of A2. Left bundle branch block.

Question 30

Pathologic splitting- Fixed

Answer 30

Does not vary with respirations. Wide splitting of A2 and P2. Atrial septal defect and right ventricular failure.

Question 31

Dyspnea

Answer 31

breathing discomfort that varies in intensity. Issues with gas exchanges in CV- disease with L. heart, pulm. vasc, pericarditis,

Question 32

Diaphoresis

Answer 32

Sweating. Due to MI

Question 33

Syncope

Answer 33

Transient loss of consciousness. Rapid, short. Arrythmias- tachy and brady, stenosis

Question 34

Cyanosis

Answer 34

Blue color on extremities and lips due to insufficient blood supply.

Question 35

Orthopnea

Answer 35

SOB when lying flat. Heart failure.

Question 36

Claudication

Answer 36

Pain, impairment and discomfort with walking due to insufficient blood supply.

Question 37

xanthelasma

Answer 37

waxy yellow deposits on skin around eyes dues to increased levels of cholesterol

Question 38

Paroxysmal nocturnal dyspnea

Answer 38

inability to breath while laying down, not relieved by elevating position. Due to CHF

Question 39

Chest pain

Answer 39

discomfort in chest, caused by a wide variety of cardiac issues. Often begins during activity, food, stress and cold weather

Question 40

Addl Organ Systems with CV complaints

Answer 40

GI (indigestion, cholecystitis), psych. (anxiety, depression), musculoskeletal (trauma, overuse), Resp., peripheral vasculature.

Question 41

hypotension

Answer 41

< 90/ 60 mmHg- leads to inadequate blood supply to tissues. Lightheadedness, syncope, dizziness

Question 42

Orthostatic hypotension

Answer 42

drop >20mmHg from laying to standing`

Question 43

Normotension

Answer 43

SBP: < 90 mmHg

Question 44

Systolic Hypertension

Answer 44

``` Systolic BP > 140 mm Hg with normal diastolic BP. In the acute setting, due to: Increased cardiac output Thyrotoxicosis Generalized response to stress Anemia Pain, anxiety, or both ```

Question 45

Diastolic Hypertension

Answer 45

``` Diastolic BP > 90 mm Hg. Isolated diastolic hypertension may be associated with: Intrinsic renal disease Endocrine disorders Renovascular hypertension Neurologic disorders ```

Question 46

Murmur

Answer 46

Timing, Location, Pitch, Intensity, Pattern, Resp. phase, Radiation