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PD Block 2 > Cardiac Exam > Flashcards

Cardiac Exam Flashcards

1
Q

Pericardium

A

Location: fibrous sac that holds the heart; contains the heart, roots of great vessels, and pericardial fluid
Function: protects, lubricates, and fixes heart in place

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2
Q

Right Ventricle

A

Ventricles receive blood from atria and strongly pump it out during systole. Muscular. Oomph of heart.
Location: Right bottom of heart
Function: Receives blood from RA, pumps to lungs via pulmonary artery

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3
Q

Left Ventricle

A

Location: Left bottom of heart
Function: Receives blood from LA, pumps blood to aorta/body

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4
Q

Right Atrium

A

Atria receive blood from the circulation (body & lungs) and drain into ventricles. Thin walled, reservoirs
Location: Top right of heart
Function: receives deoxygenated blood from the body/vena cavae

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5
Q

Left Atrium

A

Location: Left top of heart
Function: receives oxygenated blood from the pulmonary circulation via pulmonary veins

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6
Q

Aortic Valve

A

Location: Between LV and ascending aorta
Function: forced open in systole, prevents blood from flowing backward from the aorta into the LV (3 leaves)

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7
Q

Pulmonic Valve

A

Location: Between RV and pulmonary artery
Function: forced open in systole, prevents blood from flowing backward from the pulmonary artery into the RV (3 leaves)

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8
Q

The great vessels

A 
Superior Vena Cava
Inferior Vena Cava
Pulmonary Artery
Pulmonary Veins
Aorta
Function: bring blood to and from heart
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9
Q

Apex

A

Location: lower ‘tip’ of the heart; most downward, forward aspect of the heart. Tip of the LV; behind the 5th left intercostal space, midclavicular, just below nipple
muscle fibers in apex are primarily responsible for regulating ventricle contraction and play role in transmitting signals from atrial nodes

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10
Q

Base

A

Location: opposite the apex; most posterior section. LA, and some of the RA, and inferior and superior vena cava and pulmonary veins

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11
Q

Precordium

A

Location: area on the anterior chest overlying the heart and lower thorax
Function: where heart contraction can be palpated and auscultated

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12
Q

Tricuspid Valve

A

Location: 3 leaves, separates RA and LV
Function: Deoxygenated blood from the IVC collects in the RA, tricuspid valve opens on diastole and allows blood to flow in the RV

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13
Q

Mitral Valve

A

Location: 2 leaves, separates the LA from the LV
Function:regulate blood flow from LA to LV

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14
Q

Blood flow through heart during Systole

A

Semilunar valves (aortic and pulmonary) open when ventricles contract; blood flows to pulmonary artery via the RV and to aorta via the LV; ventricular contraction and atrial refilling (occurs about the same time)

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15
Q

Blood flow through the heart during Diastole

A

Atrioventricular valves (tricuspid and mitral) open, blood flows into the ventricles, passively, ventricles fill, atria contract to eject remaining blood

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16
Q

Wigger’s Diagram

A

DRAW

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17
Q

Preload

A

the initial stretching of the cardiac myocytes prior to contraction

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18
Q

Afterload

A

can be thought of as the ‘load’ that the heart must eject blood against closely related to aortic pressure

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19
Q

Systole

A

the part of the cardiac cycle during which the heart contracts, particularly the ventricles, resulting in a forceful flow of blood into both the systemic and pulmonary circulations

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20
Q

Diastole

A

the time between two contractions of the heart when the muscles relax, allowing the chambers to fill with blood; diastole of the atria precedes that of the ventricles; diastole alternatives, usually in a regular rhythm, with systole.

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21
Q

S1

A

Produced by the closure of the mitral and tricuspid valves
Indicates beginning of systole
Loudest over the apex of the heart (use diaphragm)

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22
Q

S2

A

Produced by the closure of the aortic and pulmonic valves
Indicates beginning of diastole
Loudest at pulmonic and aortic valves (use diaphragm)

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23
Q

S3

A

Passive filling of ventricles during diastole

Best heard in left lateral decubitus position

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24
Q

S4

A

Second phase of ventricular filling

Contraction of atria to insure all blood was drained into vesicles

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25
Q

Murmur

A

caused by abnormal turbulent flow when a valve is stenotic or damaged

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26
Q

Bruit

A

an unexpected audible swishing sound or murmur over an artery or vascular organ

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27
Q

Point of maximal impulse (PMI)

A

Usually generated by the apex, but it may be produced by an enlarged or hypertrophied RV, a dilated aorta or pulmonary artery or an LV wall motion abnormality

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28
Q

Thrill

A

palpable murmur

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29
Q

Heave/lift

A

Can be caused by a number of abnormalities. Heave (more pronounced lift)
Lift (RV hypertrophy)

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30
Q

Situs inversus/ dextrocardia

A

the inversion or transposition of the body viscera so that the heart is on the right and the liver is on the left; the chest and abdominal contents become mirror images of the usual

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31
Q

S3 Gallop

A

S3 may be heard if blood volume transferred is abnormally large, as in Mitral regurgitation.
S3: the sound the ventricle makes when it is forced to dilate beyond its normal range due to volume overload in the atria (ex: heart failure). Conditions of high cardiac output (ex: thyrotoxicosis, severe anemia) can also cause an S3 gallop

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32
Q

Rub

A

A sound audible through the stethoscope, resulting from the rubbing of opposed inflamed serous surfaces (pericarditis)

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33
Q

Click

A

classic finding in mitral valve prolapse. Usually heard during mid or late systole, accompanied with a late systolic murmur indicate of mitral regurgitation

34
Q

Snap

A

Commonly associated with aortic stenosis (or MV stenosis).

35
Q

Ejection Sounds

A

The opening of the semilunar valves is usually silent. Abnormal dilation or calcification of the aortic and pulmonic valves can cause an abnormal early systolic ejection sound as they open during systole.

36
Q

Electrical conduction system of the heart & Cardiac cycle

A

See objectives

37
Q

Surface anatomy pertinent to Internal structures of the heart

A

See Picture**Aortic, pulmonic, Erb’s point, tricuspid, and mitral focuses

38
Q

Inspection (CV Exam)

A 
Acute cardiac distress (cyanosis, diaphoresis, pallor, temp., difficulty breathing, anxiety, Levine's sign - clutching fist over chest)
Chronic heart conditions (clubbing, xanthelasma - yellow, waxy deposits on extremities and around eyes do to increased cholesterol, Obesity or coarction - underdeveloped lower extremities)
Apical impulse (not normally seen while supine, may need light)
39
Q

Auscultation (CV Exam)

A
  • Listen to all areas with patient upright, supine and left lateral recumbent.
  • Upright: leaning forward = best to hear S2 and aortic murmurs
  • LL recumbent = best to hear S1, mitral murmurs, and low-pitched diastole filling sounds
  • Bell and Diaphragm
  • 5 locations: Aortic, pulmonic, Erb’s, Tricuspid, and Mitral
40
Q

Palpation (CV Exam)

A

Patient elevated 30 degrees, carotid pulse to detect timing of systole, palpate PMI (apical pulse)
Checking for lifts, heaves, thrills

41
Q

Assessment of cardiac rate and rhythm

A

Rate/Rhythm
Assess during auscultation, compare with peripheral arterial pulse.
S1 and S2 to determine rhythm

42
Q

Percussion (CV Exam)

A

Not greatly helpful in determining borders do to chest distortion
Can attempt by listening to change from resonant to dull

43
Q

Fixed splitting

A

Splitting of sounds A2 and P2 that is wide and there is no variation with respirations. Examples: atrial septal defect and right ventricular failure

44
Q

Paradoxic splitting

A

during respiration there is a delay in the closure of the aortic valve (A2) creating an inconsistent movement of A2 and P2. The sounds are separate during expiration and sound closer together during inspiration. Example: Left bundle branch block.

45
Q

Chest pain

A

Many differential dx’s! Angina pectoris (pressure sensation sub-sternal), Levine’s sign (ischemic pain), When associated with breathing (pleuritic chest pain), In children seldom due to cardiac problem, When it’s a constant all day ache or a sharp jab that lasts 1-2 seconds (generally not related to heart)

46
Q

Fatigue

A

Worse with exertion, unable to keep up with peers, persistent chronic hypoxia, body working hard to compensate

47
Q

Dyspnea

A

Difficult/ labored breathing w/shortness of breath, worse with exertion, better w/ rest or propped up pillow, increases w/ severity of pulmonary and cardiovascular disease

48
Q

Diaphoresis

A

Often with anxiety, sympathetic response to stress, seen in MIs

49
Q

Syncope

A

Fainting, temporary loss of consciousness, brief lack of blood flow to brain, also associated with palpations, exertion, dysrhythmia, sudden neck turn, change in posture, common CV symptom in older patients, seen in hypovolemia, low BP, bradycardia, and valve stenosis

50
Q

Cyanosis

A

Due to hypoxia, nails (peripheral cyanosis occurs first), Periorbital (in kids esp. during eating), also in kids: characteristic of congenital heart defects allowing mix of arterial and venous blood or prevented oxygenated blood

51
Q

Cough

A

Dry, wet, nighttime, worse lying down, maybe associated with vascular disease

52
Q

Orthopnea

A

Shortness of breath that begins or increases with lying down, relieved by sitting or standing. Ask if patient sleeps with pillows propping, associated with heart failure

53
Q

Claudication

A

Pain, burning, fatigue in legs/butt, occurs with walking, better with rest, symptoms of narrowing of artery or blockage, may be able to hear bruit (atherosclerosis is the most common cause of arterial blockage which can cause claudication)

54
Q

Paroxysmal nocturnal dyspnea

A

Sudden onset of shortness of breath after a period of sleep, issues with pulmonary function related to CV disease, congestion, better with sitting up

55
Q

Xanthelasma

A

Yellow, waxy deposits around eyes, occurs with extreme hypercholesterolemia, hyperlipidemia, which are related to CV health risks

56
Q

Additional organ system to examine CV complaint

A

Respiratory and Peripheral Vascular
Musculoskeletal (shoulder joint dysfunction, xiphoidynia), GI system (heartburn, peptic ulcer, cholecystitis), Psychoneurotic (anxiety, drug use, herpes zoster)

57
Q

Hypotension

A

low blood pressure

58
Q

Postural/ orthostatic hypotension

A

abnormal decrease in blood pressure from sitting to standing; decrease >20mmHg systolic or >10 diastolic

59
Q

Hypertension - systolic/diastolic

A

high blood pressure
Stage 1: >140/90 - 159/99
Stage 2: >160/100

60
Q

Normotension

A

Normal blood pressure

61
Q

Murmur - Timing and duration

A

Between S1 and S2, or S2 and S1?

Short or prolonged:

62
Q

Murmur - Pitch

A

High, medium, or low? Bell or diaphragm?

63
Q

Murmur - Intensity

A

Grade 1: faint, intermittent
Grade 2: quiet but easy to hear
Grade 3: moderately loud, no palpable thrill
Grade 4: loud, PALPABLE THRILL
Grade 5: loud, palpable thrill, can hear with stethoscope barely touching chest
Grade 6: very loud, palpable thrill, can hear with stethoscope off chest

64
Q

Murmur - Pattern

A

Crescendo: increased blood velocity
Decrescendo: decreased blood velocity
Square/plateau: constant intensity

65
Q

Murmur - Location

A

Where is it auscultated best?

66
Q

Murmur - Radiation

A

Do you hear it only over the specific valve or elsewhere? Sound generally transmitted in direction of blood flow

67
Q

Murmur - Respiratory phase variations

A

Impacted by inspiration/expiration? Variation of intensity, quality, timing? (If venous issue, variation increase with inspiration and decrease with expiration)

68
Q

Superior Vena Cava

A

Routes deoxygenated blood from the head/neck/upper extremities into the RA

69
Q

Inferior Vena Cava

A

Routes deoxygenated blood from the abdomen/pelvis/lower extremities into the RA

70
Q

Pulmonary Artery

A

Routes deoxygenated blood from the RV to the lungs

71
Q

Pulmonary Veins

A

Routes oxygenated blood from the lungs to the LA

72
Q

Aorta

A

Routes oxygenated blood from the LV to the body; ascending - arch - descending - thoracic - abdominal

73
Q

Heart valves

A 
Try Pulling My Aorta
Tricuspid
Pulmonic
Mitral
Aortic
74
Q

Aortic focus

A

best for hearing the aortic valve, heard over the 2nd right intercostal space at the right intercostal border. S2 is heard well here

75
Q

Pulmonic focus

A

Best for hearing the pulmonic valve, located at the left 2nd intercostal space at the left sternal border. S2 is heard well here

76
Q

Erb’s point

A

located at the 3rd left intercostal space, where S2 is BEST heard

77
Q

Tricuspid focus

A

4th left intercostal space, where tricuspid valve is BEST heard

78
Q

Mitral focus

A

5th left intercostal space in the midclavicular line. This is where the apex is located and where S1 is BEST heard

79
Q

S4 Gallop

A

Ventricle isn’t expanding as it fills, and atrium gives one last ‘kick’ to try and force blood out (‘kick’ = S4)
If the ventricle is stiff and non-compliant (ex: left ventricular hypertrophy secondary to longstanding severe hypertension, MI, or cardiomyopathies) then the pressure wave gradient generated as the atria contract generates an S4 sound. Ex of right sided S4: pulmonary hypertension, pulmonary stenosis

80
Q

PMI

A
  • If anywhere other than apex = abnormal
  • provides estimation for size of heart
  • assess location, diameter, amplitude and duration
  • palpable during systole (should have less duration)
81
Q

Physiologic Splitting

A

During inspiration, slight delay in the closure of the P2 component.

PD Block 2 (6 decks)

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