Cardiac Exam

Question 1

Pericardium

Answer 1

Tough, double walled, fibrous sac encasing, lubricating and protecting heart

Question 2

Ventricles

Answer 2

Large, thick-walled chamber that pump blood to lungs and throughout body.

Question 3

Atria

Answer 3

Small, thin-walled structures acting primarily as reservoirs for blood returning to the heart from veins throughout the body.

Question 4

Semilunar valves

Answer 4

Aortic valve lies between LV and aorta. Pulmonic valve lies between RV and pulmonary artery. Contraction of ventricles opens semilunar valves (systole). Relaxation closes them (diastole).

Question 5

Atrioventrcular valves

Answer 5

Tricuspid valve separates right atrium and ventricle. Mitral (bicuspid) valve separates left atrium and ventricle. Contraction of atria opens atrioventricular valves (diastole). When ventricles contract, these valves close (systole).

Question 6

Apex and base of heart

Answer 6

Apex: Most inferior, anterior aspect at 5th left ICS just medial to midclavicular line.
Base: Most superior, posterior aspect at 2nd right ICS just lateral to sternal border.

Question 7

Precordium

Answer 7

Area of chest/thorax that overlies heart.

Question 8

Preload vs afterload

Answer 8

Preload: Initial stretching of cardiac myocytes from returning blood prior to contraction.
Afterload: Amount of resistance myocardium must overcome to eject blood.

Question 9

Systole vs diastole

Answer 9

Systole: Ventricular contraction.
Diastole: Ventricles relax (while atria contract).

Question 10

S1

Answer 10

Produced by closure of tricuspid and mitral valves at start of systole.

Question 11

S2

Answer 11

Produced by closure of pulmonic and aortic valves marking start of diastole.

Question 12

S3

Answer 12

Sound occasionally heard as ventricular filling is nearly complete. (Think KEN-TUCK-y)

Question 13

S4

Answer 13

Sound occasionally heard when atria contract forcefully to get blood resorvoir to ventricles. (Think ten-NES-SEE)

Question 14

Murmur vs thrill

Answer 14

Murmur: Caused by abnormal turbulent flow of blood when valve is stenotic or damaged.
Thrill: Palpable murmur associated with congenital or valvular abnormalities.

Question 15

Bruit

Answer 15

Unexpected audible swishing sound or murmur over artery or vascular organ.

Question 16

Point of Maximal Impulse (PMI) and other possible origins

Answer 16

Generally represents beat of LV during systole generated by apex. However, can be generated by hypertrophied RV, dilated aorta/pulmonary artery, other pathologies.

Question 17

Lift vs heave

Answer 17

Lift: Sustained palpable movements of localized areas of precordium.
Heave: More pronounced lift.

Question 18

Rub vs click vs snap vs ejection sound

Answer 18

Rub: Grating sound heard during auscultation representing inflamed serous surfaces (eg pericarditis).
Click: Usually heard during mid- to late-systole accompanied by a late systolic murmur indicative of mitral regurgitation (eg mitral valve prolapse).
Snap: Usually heard during early diastole. Corresponds to opening of valves (eg mitral stenosis).
Ejection sound: Usually heard during early systole. Corresponds to opening of valves (eg aortic stenosis).

Question 19

Important surface landmarks in cardiac exam and what’s best heard there

Answer 19

Aortic focus: 2nd right ICS; aortic valve.
Pulmonic focus: 2nd left ICS; pulmonic valve.
Erb’s point: 3rd left ICS; S2.
Tricuspid focus: 4th left ICS; tricuspid valve.
Mitral focus: 5th left ICS at MCL; mitral valve and S1.

Question 20

Fatigue

Answer 20

Worse with exertion, unable to keep up with peers.

Question 21

Diaphoresis

Answer 21

Sympathetic response to stress; excessive sweating

Question 22

Syncope

Answer 22

Temporary loss of consciousness; many etiologies

Question 23

Orthopnea

Answer 23

SOB that begins with lying down corrected by sitting or standing

Question 24

Claudication

Answer 24

Pain, burning, fatigue in legs occurs with walking; better with rest

Question 25

Paroxysmal nocturnal dyspnea

Answer 25

Sudden onset of SOB after short period of sleep

Question 26

Xanthelasma

Answer 26

Yellow waxy deposits around eye; suggests hyperlipidemia