Cardiac Exam Flashcards
Pericardium
Tough, double walled, fibrous sac encasing, lubricating and protecting heart
Ventricles
Large, thick-walled chamber that pump blood to lungs and throughout body.
Atria
Small, thin-walled structures acting primarily as reservoirs for blood returning to the heart from veins throughout the body.
Semilunar valves
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).
Atrioventrcular valves
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).
Apex and base of heart
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.
Precordium
Area of chest/thorax that overlies heart.
Preload vs afterload
Preload: Initial stretching of cardiac myocytes from returning blood prior to contraction.
Afterload: Amount of resistance myocardium must overcome to eject blood.
Systole vs diastole
Systole: Ventricular contraction.
Diastole: Ventricles relax (while atria contract).
S1
Produced by closure of tricuspid and mitral valves at start of systole.
S2
Produced by closure of pulmonic and aortic valves marking start of diastole.
S3
Sound occasionally heard as ventricular filling is nearly complete. (Think KEN-TUCK-y)
S4
Sound occasionally heard when atria contract forcefully to get blood resorvoir to ventricles. (Think ten-NES-SEE)
Murmur vs thrill
Murmur: Caused by abnormal turbulent flow of blood when valve is stenotic or damaged.
Thrill: Palpable murmur associated with congenital or valvular abnormalities.
Bruit
Unexpected audible swishing sound or murmur over artery or vascular organ.
Point of Maximal Impulse (PMI) and other possible origins
Generally represents beat of LV during systole generated by apex. However, can be generated by hypertrophied RV, dilated aorta/pulmonary artery, other pathologies.
Lift vs heave
Lift: Sustained palpable movements of localized areas of precordium.
Heave: More pronounced lift.
Rub vs click vs snap vs ejection sound
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).
Important surface landmarks in cardiac exam and what’s best heard there
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.
Fatigue
Worse with exertion, unable to keep up with peers.
Diaphoresis
Sympathetic response to stress; excessive sweating
Syncope
Temporary loss of consciousness; many etiologies
Orthopnea
SOB that begins with lying down corrected by sitting or standing
Claudication
Pain, burning, fatigue in legs occurs with walking; better with rest
